Antepartum hemorrhage (APH) refers to bleeding in the genital tract from fetal viability to the end of the 2nd stage of labour. It occurs after 28 weeks of pregnancy but before the start of labor. 1This serious obstetric problem can occur owing to several causes, including vasa previa, placenta previa and placental abruption. APH causes fetal and maternal distress, and it is diagnosed by clinical examination, ultrasound, and other procedures.2-3 The severity of APH varies based on the etiology, blood volume, & prenatal age at bleeding. It is the leading cause of fetal and maternal morbidities, and effective care is crucial to prevent negative consequences.4-5 Antepartum hemorrhage can have different perinatal outcomes. depending on the time, amount, and cause of the bleeding. Early pregnancy bleeding can lead to miscarriage or pregnancy loss, especially if there is a significant placental anomaly.6-7 APH in late pregnancy can lead to premature labor, low birth weight, and other problems.8 Monitoring, inpatient treatment, & emergency procedures (e.g., blood transfusion, corticosteroid medication, or cesarean birth) can prevent problems.9 APH can lead to low birth weight, which is a major consequence. APH from placenta previa or placental abruption might limit blood flow and fetal development. The associated lower fetal oxygenation and nourishment caused by this may hinder normal growth, leading to LBW.10 Studies on the prevalence show that LBW is more frequently seen in APH-complicated pregnancies, with intensity of bleeding correlated with severity of growth restriction. Low birth weight babies are more likely to experience issues such as respiratory distress, feeding difficulties, and delayed development.11 Antepartum hemorrhage can increase the chance of stillbirth and newborn mortality, especially with severe or protracted bleeding.12 Placental abruption, which occurs when the placenta separates from the uterine wall prematurely, raises the risk of fetal oxygenation issues. More severe cases may lead to intrauterine fetal death (stillbirth).15 Preterm infants with complicated APH are more likely to experience respiratory failure, infection, and intraventricular hemorrhage, increasing the risk of newborn death.13 According to a study by Dahri B et al., antepartum hemorrhage was associated with 53.79% low birth weight, 42.42% stillbirth, and 17.42% neonatal mortality.14 Early medical intervention,  to enhance fetal lung development or accelerating delivery, is crucial for minimizing mortality. However, complications may arise, including stillbirth and neonatal death. Therefore the current study was conducted to evaluate the perinatal outcomes in Women presenting with antepartum hemorrhage.

The present descriptive study was conducted at DHQ Hospital Landikotal from March 2023 to March 2024 after taking approval from the ethical committee of the hospital. The sample size was calculated using the WHO calculator by taking the 95% confidence level, a 7% margin of error, and an expected neonatal death frequency of 17.42%.14 The required sample size determined was 98. Pregnant women of different age groups (ranged 18-40 years) who had antepartum hemorrhage a gestational age of more than 28 weeks on the basis of last menstrual period , and any parity were included in this study while individuals with history of hypertension coagulation disorders and congenital anomalies identified on ultrasonography were excluded from the study. Demographic data, including gestational age, parity, age, body mass index, and residence status, were obtained. Individuals with hemoglobin levels < 8 g/dL received a blood transfusion, as per hospital procedure. Participants were checked every four hours for fetal heart sounds, blood pressure, pulse and temperature up to delivery. Perinatal outcomes including neonatal death, low birth weight and stillbirth were evaluated. The study defined stillbirth as fetal loss after the 28th week of gestation verified by ultrasound and neonatal death as no signs of life detected during the mother's hospital stay and low birth weight as below 2,500 grams at delivery. The participants were followed up till delivery and results were recorded on a designed proforma .For data analysis SPSS version 23 was used. Frequencies and percentages were found out for categorical variables like neonatal death, stillbirth, residential status and low birth weight. Quantitative variables such as gestational age, parity, age and BMI were presented as mean ± standard deviation. We stratified perinatal outcomes based on age, gestational age, and parity. After stratification, the chi-square or Fisher's exact test was used, with p-values < 0.05 indicating statistical significance.

A total of 98 pregnant women with APH were enrolled in this study out of 68(69.3%) were belonged to rural areas and 30(30.6%) were from urban areas. The mean age of the study population was 30.20 ± 4.55 years and the mean gestational age was 31.34 ± 3.79 years. The average parity was 1.52 ± 1.11 and the mean BMI was 26.83± 3.33 kg/m2 as presented in table 1. Perinatal outcomes of the study population were evaluated. Low birth weight was the most common perinatal outcome (40.8%), followed by stillbirth (22.4%) and neonatal mortality (10.20%) respectively as presented in table 2. Low birth weight and it association with various demographic features revealed that low birth was strongly associated with gestational age and parity (P value < 0.05) as presented in table 3.  There were 17 (20.7%) stillbirths for gestational ages ≤35 weeks and none for gestational ages >35 weeks. The difference was statistically significant (p-value =0.012). There were 8 cases (12.1%) of stillbirth among those under 30 years old, compared to 7 cases (21.8%) among those over 30 years old. This difference was statistically significant (p value = 0.133). In terms of parity, 11 (14.2%) individuals with parity between zero and two had stillbirth, whereas 4 (19.0%) individuals with parity >2 experienced stillbirth. (p= 0.214) as shown in table 4.In the case of neonatal mortality, individuals under 30 years had 8 cases (12.1%), while those above 30 had 2 cases (6.2%). The p-value was 0.418, suggesting no significant correlation. 10(12.05%)neonates died at a gestational age of ≤35 weeks. All 15 subjects with gestational ages more than 35 weeks survived, with no neonatal deaths reported. This difference was statistically significant (p value =0.05). There was no significant correlation between parity and newborn mortality, with 7 (9.33%) of patients having parity between 0 or 2 and 3 (14.2%) with parity >2 as presented in table 5.

APH is defined as, the bleeding from or into the genital tract that occurs between fetal viability and the second stage of labor. In North America, the threshold of viability is twenty weeks. In the UK, it is twenty-four weeks, while in India, it is twenty-eight.15 It is the major cause of   maternal morbidity and death. It is the leading cause of mortality in around 30% of women.16 APH is one of the most was worried obstetric presentations. It affects around 2-5% of pregnancies worldwide.  In the Pakistani population It cause complications in 7.3% of deliveries.17 A study found that placental abruption and placenta previa are connected to negative pregnancy outcomes. Antepartum hemorrhage from unknown etiology is the leading cause of APH. In 50% of cases, it contributes to APH.18 Due to advanced medical facilities in developed countries there is a dramatic drop in perinatal mortality from APH. Modern medical facilities have led to a dramatic drop in perinatal mortality from APH in industrialized countries. According to one study, the total perinatal death rate was 47%.19   Perinatal death rates for placenta previa and abruption are 29.6% and 64.7%, respectively. Women with toxemia had an 80% perinatal mortality rate.19 A research found a 42% perinatal death rate in instances of APH, with 40 percent for placenta previa & 47.3% for placental abruption.20 An additional study showed that the frequency of placental abruption was 51.9%, placenta previa 45.8%, and unidentified hemorrhage 2.3% in APH.21 In placental abruption, 66.7% of newborns had a low birth weight, compared to 33.3% in placenta previa. Perinatal death rates for placental abruption were 20.6%, while placenta previa was just 5%. APH patients had 65.6% C-section deliveries and 34.4% vaginal deliveries.21 The present study was carried out to explore the perinatal outcomes in women presenting with antepartum. A total of 98 pregnant women with APH were enrolled in this study. Low birth weight was the most common perinatal outcome (40.8%), followed by stillbirth (22.4%) and neonatal mortality (10.20%). Our study findings are similar to the study conducted by Imtiaz et al in 2025. In their study, 38.9% of the subjects had low birth weight, 20.4% had stillbirths, and 14.2% died during neonatal period.22 The results of present study are also comparable with research conducted by Anis et al in which the most common perinatal outcome was low birth weight, followed by stillbirth and neonatal mortality.23 This study showed that individuals with APH are more likely to have adverse neonatal outcomes, such as stillbirths, low birth weight, and mortality. However our study findings are not parallel with the study conducted by Patel M et al in which the most prevalent of perinatal outcome was stillbirth and there was rare cases of neonatal death.24   Our study revealed that demographic characteristics, such as age, parity and   gestational age were found to significantly affect adverse pregnancy outcomes, such as stillbirth, underweight at birth, and infant mortality. Low birth was strongly associated with gestational age and parity. This study demonstrated that stillbirths was associated with gestational ages, parity and age. But there was no significant correlation between parity and neonatal death. These findings are similar to the previous study.22 This study did not observe a connection between neonatal death and parity, contrasting to Mushtaq et al.'s findings that higher parity was associated with higher incidence of perinatal complications.25 This study's findings on  still birth low birth weight,  & neonatal mortality rates are consistent with worldwide patterns. However, healthcare access and urban-rural health inequities must be addressed to improve outcomes. The study emphasizes the need for early diagnosis, intervention, and strict prenatal care requirements, especially in remote regions without healthcare services. However, the study had limitations. The data collected from a single center may not be fully representative of all populations. Although the research sample is adequate, it may not reflect all perinatal outcome variability between people and places. Variables such as socioeconomic status, maternity-related comorbidities, and healthcare access were not systematically investigated to explain potential outcome variation. More multi-center trials with larger sample sizes and extensive assessments of maternity-related variables would provide a better understanding of APH and its effects.

The present study concluded that antepartum hemorrhage is a major risk factor for perinatal adverse outcomes such as still birth, low birth weight & neonatal death. So early diagnosis, prompt intervention, and enhanced prenatal care are critical in areas with limited healthcare access

1. Battula, S. P., Mohammed, N. H., & Datta, S. (2021). Antepartum haemorrhage. Obstetrics, Gynaecology & Reproductive Medicine, 31(4), 117-123.
2. Im, D. H., Kim, Y. N., Cho, E. H., Kim, D. H., Byun, J. M., & Jeong, D. H. (2023). Risk factors and pregnancy outcomes of Antepartum hemorrhage in women with placenta Previa. Reproductive Sciences, 30(9), 2728-2735.
3. Dinho, A. E., Mårtensson, L. B., Georgsson, M., Laisser, R., & Knutsson, S. (2024). Tanzanian midwives’ clinical practices and experiences in caring for women with antepartum hemorrhage: A critical incident technique study. BMC Pregnancy and Childbirth, 24(1).
4. Okunade, K. S., Oyedeji, O. A., Olowoselu, O. F., Adejimi, A., Ademuyiwa, I., Olumodeji, A. M., Adelabu, H., Ugwu, A., Adenekan, M., & Oluwole, A. A. (2024). Incidence and Antepartum risk factors of severe postpartum haemorrhage in anaemic pregnant women in Lagos, Nigeria: A secondary cohort analysis. Cureus.
5. Ayele, T. B., & Moyehodie, Y. A. (2023). Prevalence of preterm birth and associated factors among mothers who gave birth in public hospitals of east Gojjam zone, Ethiopia. BMC Pregnancy and Childbirth, 23(1).
6. Agarwal, S., Ranjan, M., Sachan, S., & Kumar, L. (2023). Antepartum hemorrhage and its maternal and perinatal outcome: An experience at a hospital in North India. Journal of Family Medicine and Primary Care, 12(12), 3204-3208.
7. Matar, M., Yared, G., Massaad, C., & Ghazal, K. (2025). Vaginal bleeding during pregnancy: A retrospective cohort study assessing maternal and perinatal outcomes. Journal of International Medical Research, 53(2).
8. Oguejiofor, C., Okafor, C., Eleje, G., Ikechebelu, J., Okafor, C., Ugboaja, J., Ogabido, C., Njoku, T., Umeononihu, O., Okpala, B., Nwankwo, M., Ezeigwe, C., Enechukwu, C., & Eke, A. (2023). A five-year review of feto-maternal outcome of Antepartum haemorrhage in a tertiary center in Nigeria. International Journal of Innovative Research in Medical Science, 8(03), 96-101.
9. Danieli-Gruber, S., Shalev-Rosenthal, Y., Matot, R., Brzezinski-Sinai, N., Zeevi, G., Pardo, A., Orbach, S., & Hadar, E. (2023). Risks of urgent cesarean delivery preceding the planned schedule: A retrospective cohort study. PLOS ONE, 18(8), e0289655.
10. Abraha, T. A., Gebremariam, G. K., Asfaha, B. T., Weldegebreal, T. K., & Aregawi, D. H. (2025). Adverse birth outcome and associated factors among mothers with antepartum hemorrhage in public hospitals Tigray, northern Ethiopia, 2020. BMC Pregnancy and Childbirth, 25(1).
11. Kebede, E., & Kekulawala, M. (2021). Risk factors for stillbirth and early neonatal death: A case-control study in tertiary hospitals in Addis Ababa, Ethiopia. BMC Pregnancy and Childbirth, 21(1).
12. Jovanovic, I., Ivanovic, K., Kostic, S., Tadic, J., Dugalic, S., Petronijevic, M., Gojnic, M., Petronijevic, M., & VrzicPetronijevic, S. (2023). Intrauterine fetal death in term pregnancy—A single tertiary clinic study. Life, 13(12), 2320.
13. Agarwal, R., & Agrawal, R. (2024). Exploring risk factors and perinatal outcomes of preterm birth in a tertiary care hospital: A comprehensive analysis. Cureus.
14. Dahri, B., Taj, I., Taj, A., Nadeem, T., & Nisa, K. (2022). Perinatal outcome in patients of Antepartum haemorrhage. Pakistan Journal of Medical and Health Sciences, 16(12), 742-744

15.Gandhi SK, Vamja AP, Chauhan KP. Antepartum hemorrhage and its fetomaternal outcome:  a retrospective study.  Int  J  Reprod Contracept Obstet Gynecol. 2020;9(11):4562-4567.

16. Long SY, Yang Q, Chi R, Luo L, Xiong X, Chen ZQ. Maternal and neonatal outcomes resulting from antepartum hemorrhage in women with placenta previa and its associated risk factors: A single-center retrospective study. Ther Clin Risk Manag. 2021:31-38.
17. Islam F,  Afzal  SH,  Haider  R,  Karim  F,  Yesmin  SF.  Comparative Study of  Fetomaternal Outcome in Abruptio Placenta and Placenta Previa. Asian J Med Health. 2024;22(6):19-29.
18. Hailu H,  Fisseha  G,  Goba  G,  Teka  H,  Ahmed  S,  Yemane  A.  Incidence,  associated  factors  and  outcomes  of  antepartum hemorrhage  at  Ayder  Comprehensive  Specialized  Hospital  and Mekelle  General  Hospital,  Mekelle,  Tigray,  Ethiopia.Ethiop  J Reprod  Health.  2023;15(3):12-12

19.Agarwal S, Ranjan M, Sachan S, Kumar L. Antepartum hemorrhage and its maternal and perinatal outcome: An experience at a hospital in  North  India.  J Family Med Prim Care.  2023; 12(12):3204-3208

20.Dutta I, Roy P, Dasgupta S, Khan M, Saha P. Obstetrics referrals: maternal  and  perinatal  outcome  in  medical  college  hospital  in  eastern  India.  Indian  J  Obstet  Gynecol  Res.  2020;7(1):91-99. https://doi.org/10.18231/j.ijogr.2020.019

21. Anjankar PS,  Ramteke  S.  Maternal  and  perinatal  outcome  in antepartum haemorrhage patients attending tertiary care hospital in central  India:  a  prospective  observational  study.  Int  J  Reprod Contracept Obstet Gynecol. 2022;11(11):2997-3004
22. Imtiaz, R., Idrees, K., Samee, J., & Qureshi, H. A. (2025). Perinatal outcome in Patients Presented with Antepartum Hemorrhage. Indus Journal of Bioscience Research, 3(5), 924-928.
23. Anis, A., Hassan, S., Tariq, M., Naz, M., Mahsud, S., & Nadeem, I. (2024). Perinatal Outcomes in Women Presenting with Antepartum Hemorrhage. Journal of The Society of Obstetricians and Gynaecologists of Pakistan, 14(4), 431-434.

24.Patel M, Nakum K, Lunagariya M, Patel J. Maternal and perinatal outcome in antepartum hemorrhage: At Sir T hospital.The Southeast Asian J Case Report Rev. 2016; 5(5):2414-9

25. Mushtaq, R., Abbas, A., & Ahmed, W. (2019). Perinatal outcomes in pregnant patients presenting with antepartum hemorrhage: Our experiences at a teaching hospital in central Punjab. The Professional Medical Journal, 26(10), 1645-1650