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OBSTETRICS| Volume 34, ISSUE 11, P1043-1052, November 2012

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Indications for, Timing of, and Modes of Delivery in a National Cohort of Women Admitted With Antepartum Hemorrhage at 22+0 to 28+6 Weeks’ Gestation

DOI:https://doi.org/10.1016/S1701-2163(16)35434-2
Indications for, Timing of, and Modes of Delivery in a National Cohort of Women Admitted With Antepartum Hemorrhage at 22+0 to 28+6 Weeks’ Gestation
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      Abstract

      Objective

      Antepartum hemorrhage is associated with preterm birthand operative delivery. Since the Canadian Perinatal Networkrecords obstetric interventions for women admitted to tertiarycare hospitals with antepartum hemorrhage, our objective was todescribe the delivery characteristics of this cohort.

      Methods

      Trained abstractors collected data by chart review fromwomen admitted with antepartum hemorrhage between 22+0 and28+6 weeks’ gestation. We included all women with completefollow-up postpartum and used descriptive statistics to report theindications for, timing of, and modes of delivery.

      Results

      The study cohort included 806 women from 13 tertiaryperinatal centres in six provinces. The most common causes ofbleeding were placental abruption (n = 256) and placenta previa(n = 171). The median gestational age at delivery was 30 weeks,and 497 (61.7%) births occurred at less than 34 weeks. Over onehalf of the women began labour spontaneously, and 238 (29.5%)were delivered prior to the onset of labour. Overall, 370 (45.9%)women delivered vaginally, including 98 who had induction oflabour. Of the 436 Caesarean sections (54.1%), 345 (79.1%)were emergencies. The most common indications for Caesareansection were placenta previa, abnormal fetal presentation, andplacental abruption or vaginal bleeding.

      Conclusion

      This inpatient cohort of women with antepartumhemorrhage had high rates of spontaneous labour, preterm birth,and emergency Caesarean section. These results can be used ascurrent Canadian benchmark rates of preterm delivery, inductionof labour, and Caesarean section in women admitted to tertiarycare centres with antepartum hemorrhage between 22+0 and 28+6weeks’ gestation, and can aid in the counselling of similar women.

      Résumé

      Objectif

      L’hémorragie antepartum est associée à l’accouchementpréterme et opératoire. Puisque le Réseau périnatal canadienconsigne les interventions obstétricales menées chez lesfemmes admises dans les hôpitaux de soins tertiaires en raisond’une hémorragie antepartum, notre objectif était de décrire lescaractéristiques de l’accouchement au sein de cette cohorte.

      Méthodes

      Des résumeurs formés ont recueilli des données aumoyen de l’analyse des dossiers des femmes hospitalisées enraison d’une hémorragie antepartum entre 22+0 et 28+6 semainesde gestation. Nous avons inclus toutes les femmes comptant unsuivi postpartum exhaustif et nous avons fait appel à la statistiquedescriptive pour signaler les paramètres suivants en ce qui a traità l’accouchement : indications, chronologie et modes utilisés.

      Résultats

      La cohorte d’étude comptait 806 femmes en provenancede 13 centres périnataux tertiaires dans six provinces. Lescauses les plus courantes de l’hémorragie étaient le décollementplacentaire (n = 256) et le placenta prævia (n = 171). L’âgegestationnel médian au moment de l’accouchement était de30 semaines et 497 accouchements (61,7 %) ont eu lieu à moinsde 34 semaines. Plus de la moitié des femmes ont connu untravail spontané et 238 femmes (29,5 %) ont accouché avantle début du travail. En tout, 370 femmes (45,9 %) ont connu unaccouchement vaginal, dont 98 qui ont subi un déclenchementdu travail. Parmi les 436 césariennes menées (54,1 %), 345 (79,1 %) étaient des urgences. Les indications les plus courantesde césarienne étaient le placenta prævia, la présentation foetaleanormale et le décollement placentaire ou le saignement vaginal.

      Conclusions

      Cette cohorte de femmes hospitalisées en raisond’une hémorragie antepartum présentait des taux élevés detravail spontané, d’accouchement préterme et de césarienned’urgence. Ces résultats peuvent être utilisés à titre de taux deréférence canadiens actuels en ce qui a trait à l’accouchementpréterme, au déclenchement du travail et à la césarienne chezles femmes admises en centre de soins tertiaires, entre 22+0et 28+6 semaines de gestation, en raison d’une hémorragieantepartum, ainsi que contribuer au counseling des femmes setrouvant dans des situations semblables.

      Key Words

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      Article info

      Publication history

      Accepted: June 21, 2012
      Received: February 16, 2012

      Footnotes

      This paper was presented at the ACOG Districts VIII & IX 2011 Annual District Meeting in Los Cabos, Baja California Sur, Mexico, October 30th, 2011.

      Competing Interests: None declared.

      Identification

      DOI: https://doi.org/10.1016/S1701-2163(16)35434-2

      Copyright

      © 2012 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

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