An Uncommon Cause of Antepartum Haemorrhage: A Case Study

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John Osaigbovoh Imaralu
Atinuke Olukemi Olaleye
Adeola Ajose
Kolawole Aramide

Abstract

Aim: To highlight the potential for benign lesions of the cervix uteri to present in bizarre unexpected ways during late pregnancy and the need for cautious evaluation to ensure optimal treatment is given, especially when life-altering decisions need to be made.

Presentation of Case: We present here a literature review and a case of 25 year old primigravida with twin gestation and antepartum hemorrhage (APH) initially thought to be due to cervical cancer but which turned out to be caused by chronic cervicitis.

Discussion: Obstetric hemorrhage remains the commonest cause of maternal mortality and morbidity in Nigeria. The occurrence of APH portends grave risks to the fetus and mother. A high risk of prematurity exists when bleeding occurs before term; a further risk of caesarean hysterectomy exists when a diagnosis of cervical cancer is suspected in women with APH. Infective cervical lesions such as cervicitis have been reported as causes of antepartum hemorrhage, but they are not significant enough to determine or affect obstetric outcome. Chronic cervicitis presenting as heavy antepartum hemorrhage leading to preterm delivery is a rare occurrence.

Conclusion: Infective lesions of the cervix are important benign causes of antepartum hemorrhage; the ability of chronic cervicitis to mimic exophytic cervical cancer is a consequence of physiologic changes in pregnancy which should be considered during patient evaluation. Cautious patient assessment should be done to ensure optimal care is given without undue risk to the fetus or mother.

Keywords:
Antepartum hemorrhage, caesarean section, cervicitis, hysterectomy, misdiagnosis

Article Details

How to Cite
Imaralu, J., Olaleye, A., Ajose, A., & Aramide, K. (2019). An Uncommon Cause of Antepartum Haemorrhage: A Case Study. Asian Journal of Pregnancy and Childbirth, 2(2), 1-6. Retrieved from http://journalajpcb.com/index.php/AJPCB/article/view/30098
Section
Original Research Article

References

Takai IU, Sayyadi BM, Galadanci HS. Antepartum hemorrhage: A retrospective analysis from a northern nigerian teaching hospital. Int J App Basic Med Res 2017;7: 112-6.

Giordano R, Cacciatore A, Cignini P, Vigna R, Romano M. Antepartum Hemorrhage. J. Prenat. Med. 2010; 4 (1): 12-16.

Trop I, Levine D. Hemorrhage during pregnancy: Sonography and MR imaging. AJR Am J Roentgenol. 2001; 176: 607-615.

Magann EF, Cummings JE, Niederhauser A, Rodriguez-Thompson D, McCormack R, Chauhan SP. Antepartum bleeding of unknown origin in the second half of pregnancy: a review. Obstet Gynecol Surv. 2005; 60: 741-745.

Sood AK., Sorosky JI. Invasive cervical cancer complicating pregnancy. Obstet Gynecol Clin North Am. 1998;25:343-52.

Anorlu RI, Orakwue CO, Oyeneyin L, Abudu OO. (2004).Late presentation of patients with cervical cancer to a tertiary hospital in Lagos: what is responsible? Eur J Gynaecol Oncol. 2004;25(6):729-32

Ijaiya MA, Aboyeji PA, Buhari MO. Cancer of the cervix in Ilorin, Nigeria West Afr J Med. 2004; 23(4):319-22.

Rosalba Giordano, Alessandra Cacciatore, Pietro Cignini, Roberto Vigna, Mattea Romano, Antepartum haemorrhage J Prenat Med. 2010; 4(1): 12–16.

Ananth CV, Wilcox AJ. Placental abruption and perinatal mortality in the United States. Am J Epidemiol. 2001;153(4):332-7.

McDonald SD, Faught W, Gruslin A. Cervical Cancer During Pregnancy. J Obstet Gynaecol Can. 2002;24(6):491-8.

Apgar BS, Zoschnick LB. Triage of the abnormal Papanicolaou smear in pregnancy. Prim Care. 1998; 25:483-503.

Jones WB, Shingleton HM, Russell A, Fremgen AM, Clive RE, Winchester DP, et al. Cervical carcinoma and pregnancy: A national patterns of care study of the American College of Surgeons. Cancer. 1996;77: 1479-88.

Okunlola MA, Arowojolu AO, Adekunle OA, Owonikoko KM. Carcinoma of the cervix co-existing with multiple pregnancy: A case report. Afr J Med Med Sci. 2004; 33(2):177-8.

Amant F, Van Calsteren K, Vergote I, Ottevanger N. Gynecologic oncology in pregnancy. Crit Rev Oncol Hematol. 2008; 67:187–95.

Antonelli NM, Dotters DJ, Katz VI, Kuller JA Cancer in pregnancy: a review of the literature. Obstet Gynecol Surv. 1996; 5( I): 125-34.

Michael CW, Esfahani FM. Pregnancy-related changes: A retrospective review of 278 cervical smears. Diagn Cytopathol. 1997; 17(2):99-107.

Ugboaja JO, Oguejiofor CB, Oranu EO, Igwegbe AO. Factors associated with the use of traditional birth attendants in Nigeria: A secondary analysis of 2013 Nigeria national demography and health survey. Niger J Gen Pract. 2018; 16:45-52.

Oladipo A, Mathew J. Cervicitis decidualis: A rare cause of antepartum hemorrhage.J Low Genit Tract Dis. 2005; 9(1):52-4.

Pattinson RE. Pelvimetry for fetal cephalic presentations at term. Cochrane Database of Systematic Reviews. 2001; (3):2001.

O’Donovan P, Gupta JK, Savage J, Thornton JG, Lilford RJ. Is routine antenatal booking vaginal examination necessary for reasons other than cervical cytology if ultrasound examination is planned? BJOG. 1988;95:556–9.