Abstract
Aim and Objectives: The aim of present study was to study maternal and perinatal outcome in cases of abruptio placenta and initiate early intervention to bring down maternal morbidity and to prevent maternal and perinatal mortality.
Methods: A prospective observational study was done on 110 cases of abruptio placenta presenting to the labour ward and delivered. Maternal outcome such as mode of delivery, maternal complications and Operative interference were studied. Perinatal outcome in the form of birth weight, APGAR score at 1 and 5 minute, NICU admissions and perinatal deaths were studied.
Results: Incidence of abruptio placentae was 0.97%.Majority (59.1%) of cases with abruptio placenta was multipara and 39.1% were primigravida with commonest age group being 21-25 years. The associated conditions were preeclampsia (54.5), anaemia (13.6%), trauma (11.8%), polyhydramnios (5.5) and twins (1.8) and unknown (12.7%). LSCS was performed in 62% patients. 38% had a normal vaginal delivery whereas 5.5 % had a forceps delivery. Maternal complications were DIC (24.5%), PPH (14.5%), shock (10%) and ARF (5.4%). Operative Interference was done in 13.7% cases. No maternal mortality was noted. Maximum (74.6 %) were live births and 28(25.5 %) were stillbirths. The perinatal mortality was 29.1%.
Conclusions: Early intervention is the key to reduce maternal and perinatal morbidity and mortality. Availability of adequately trained staff, ICU and NICU facilities, well equipped operation theatres, blood and blood products, infrastructure is of utmost importance for active management of a patient with abruptio. Therefore tertiary care centres are an ideal setup to manage such patients.
Keywords: Abruptio placentae, Morbidity, Mortality, APGAR score, Primigravida, Polyhydramnios.
References
- Konje JC, Taylor DJ. Bleeding in later pregnancy. In: James DK, Steer PJ, Weiner CP, Gonik B editors. High risk pregnancy 3rd ed. Philadelphia: Pennsylvania; 2006. 1266-71.
- Green top guideline No. 63. Antepartum haemorrhage. Royal College of Obstetricians and Gynecologists 2011; 1-28
- Pitaphrom A, Sukcharoen N. Pregnancy outcomes in placental abruption.J Med Oncolassoc Thai. 2006; 1572-8.
- Ananth CV, Berkowitz GS, Savitz DA, Lapinski RH. Placental abruption and adverse perinatal outcomes. JAMA 1999; 282:1646–1651.
- Sumangala Devi, BinduVijayKumar, Madhuri Joshi. Feto Maternal Outcomes in Abruptio Placenta. IJSR 2016;5(11):669-672
- Vigid De Gracia P, Montufar RC, Smith A. Pregnancy and severe chronic hypertension: maternal outcome. Hypertension pregnancy 2004; 23(3):285-93.
- Noorani KJ, Noorani M. Prevalence of acute renal failure in patients developing abruptio placentae as a consequence of PIH. Pakistan J ObstetGynecol 1995; 8(1):15-16.
- Sadia Z Khan AZ, Naheed F. Fetal outcome varies with different grades of placental abruption. Ann Kind Edward Med Coll 2003; 9 (1):40-2.
- Ananth CV, Oyelese Y, Yeo L, Pradhan A, Vintzileos AM. Placental abruption in the United States, 1979 through 2001: Temporal trends & potential determinants. AJOG 2005;192:191-8.
- Saftlas A, Olsen D, Atrash H. National trends in the incidence of abruptio placenta,1979-1987. ObstetGynecol 1991; 78:1081-1086.
- Rasmussen S, Irgens LM, Bergsjo P and Dalaker K. The occurrence of placental abruption in Norway 1967-1991. Acta Obstet Gynecol Scand 1996; 75:222-228.
- Coleman J, Srofenyo EK, Ofori EK, Brakohiapa EK, Antwi WK. Maternal and fetal prognosis in abruptio placentae at Korle-Bu Teaching Hospital, Ghana. Af J Reproduct Health. 2014; 18(4):115-22.
- Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol. Oct 2006; 108(4):1005-16
- Hurd WW, Miodovnik M., Hertzberg V, Lavin JP. Selection and management of abruptio placentae: a prospective study. Obstet Gynecol 1983; 61:467-473.
- Sheiner E, Shoham-Vardi I, Hallak M, Hadar A, Gortzak-Uzan L, Katz M. Placental abruption in term pregnancies: clinical significance and obstetric risk factors. J MaternFetal Neonatal Med 2003; 13(1):45-9.
- Nath CA, Ananth CV, Smulian JC, Shen-Schwarz S, Kaminsky L. New Jersey-Placental Abruption Study Investigators. Histologic evidence of inflammation and risk of placental abruption. Am J ObstetGynecol 2007; 197:319 e1-6.
- Tikkanen M, Nuutila M, Hiilesmaa V, Paavonen J, Ylikorkala O. Clinical presentation and risk factors of placental abruption. Acta Obstet Gynecol Scand 2006; 85:700-5.
- Singh AG , et al. Maternal and fetal outcome in abruptio placentae at NSCB Medical College Hospital Jabalpur, India, EJBPS, 2015;2(3): 1446-1452
- Suseela TL, Jyothi SJ, Rabbani P ,Jhonsi Chb. Evaluation of risk factors for prenatal and maternal outcome in abruption of placenta. EJPMR , 2016, 3(8), 541-545123
- Iram Sarwar, Aziz un Nisa Abbasi, Ansa Islam, Abruptio placentae and its complications at Ayub teaching hospital Abbottabad, JAyub Med Coll Abbottabad 2006;18(1).
- Vijayasree M. A clinical study of maternal and fetal outcome in abruptio placenta - couvelaire uterus a preventable obstetric catastrophe. Sri Lanka Journal of Obstetrics and Gynaecology, 2015:38-41.
- Dars S, Sultana F, Akhter N, Abruptio Placentae: Risk Factors and Maternal Outcomes at a Tertiary Care Hospital, JLUMHS 2013;12(3):198-202.
- Jabeen M, FouziaGul F. Abruptio Placentae: Risk Factors and Perinatal Outcome. JPMI. 1995; 18(4):669-76.
- Mukherjee S, Bawa AK, Sharma S, Nandanwar YS, Gadam M. Retrospective study of risk factors and maternal and fetal outcome in patients with abruptio placentae, J Nat SciBiol Med. 2014; 5(2): 425–428.
- Choudhary V, Somani SR, Somani S. Evaluation of risk factors and obstetric and perinatal outcome in abruptio placenta. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 2015; 14(5), Ver. VII:36-39.
- Patel A. Fetomaternal outcome in cases of abruptio placenta. International Journal Of Advances In Case Reports, 2016;3(1):56-58.
Corresponding Author
Dr Meenal Sarmalkar
Additional Associate Professor, Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra India- 400022