Universal Journal of Public Health 5(6): 312-314, 2017 http://www.hrpub.org DOI: 10.13189/ujph.2017.050604 A Case Report on Life Threatening Hemorrhage in Preterm Pregnancy with Placenta Praevia and Management Challenges in a Low Neonatal Resourced Regional Hospital 187 km away from a Tertiary Center Ayesha Akhter 1,* , Bruno Giorgio 1 , Adebayo Adeyemi 1 , Md Rafiqul Islam 1,2,3,4 1 Goulburn Valley Health, Australia 2 Department of Rural Health, the University of Melbourne, Australia 3 School of Health and Social Development, Deakin University, Australia 4 Rumbalara Aboriginal Cooperative Limited, Australia Copyright©2017 by authors, all rights reserved. Authors agree that this article remains permanently open access under the terms of the Creative Commons Attribution License 4.0 International License Abstract Placenta praevia is one of the obstetric emergencies, which can cause life threatening hemorrhage. Time interval to access support for these patients from emergency retrieval team are often challenging. Also, dilemmas may appear on taking decision for in-utero versus ex-utero transfer of neonates to tertiary hospital. In this case study, the patient presented with a life threatening antepartum hemorrhage (APH) in a low neonatal resourced regional hospital at 29 weeks of gestation. She was extremely needle phobic that delayed the resuscitation process. The overall situation and the patient’s clinical condition were inappropriate for road transfer. Moreover, considering the weather condition on the day, air ambulance was grounded. Eventually, in-utero transfer of the neonate to tertiary hospital was impossible. As a result, she was delivered by an uncomplicated caesarean section and an initial resuscitation of the newborn was provided by the pediatric team of the hospital. Emergency neonatal retrieval team was able to arrive 3 hours after the birth for transferring the premature neonate to a tertiary center. Keywords Life Threatening APH, Low Neonatal Resourced Hospital, Transfer Difficulties, Decision Dilemmas 1. Introduction Antepartum hemorrhage (APH) is defined as bleeding from or into the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the newborn [1]. APH associated with maternal or fetal compromise is an obstetric emergency. A low lying placenta occurs in 5% of pregnancies at 16-18 weeks gestation but is evident in only 0.5% pregnancies at term [2]. Placenta praevia accounts for 30% of antepartum hemorrhages and is a leading cause of perinatal and maternal mortality worldwide [3]. Khan KS et al (2006) reported that APH causes up to 50% of the estimated 500,000 maternal deaths that occur globally in each year [4]. Management should include maternal resuscitation and delivery of the fetus to control the bleeding [2]. Placenta praevia comprises a major role in causing preterm deliveries. Preterm babies are vulnerable to severe complications including neonatal death. It is, therefore, essential to provide timely adequate support to prevent short term and long term complications of preterm newborns. Preterm babies born in low neonatal resourced facilities need to transfer to well-equipped tertiary centers which can be sometimes challenging thus warranted an onsite management. Therefore, it is critical to offer continuing adequate training and skills for the staff of these low resourced, regional and remote hospitals that provide initial supports to such preterm newborns. We report a case of placenta praevia here with several aspects of management challenges in a regional Australian hospital. We obtained written informed consent from the patient to disseminate and publish the case anonymously. 2. The Case In this case report, the patient was 22 years of old, non-indigenous, Australian born pregnant woman with one prior normal vaginal delivery. On admission, her BMI was 27. The morphology ultrasound at 19 weeks revealed anterior low-lying placenta two centimeters from the internal os. She presented approximately at 11 am in a low neonatal