Title: Peripartum Management of Placenta Previa and Abruption Placenta in Rural Perspectives: A Real Test of Obstetrician’s Clinical and Surgical Skills
Authors: Dr Vijayata Sangwan, Dr Mukesh Sangwan, Dr Sunita Siwach, Dr Pinky Lakra, Dr Shivani Khandelwal, Dr Rajiv Mahendru
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.41
Abstract
Introduction: Antepartum haemorrhage (APH) complicates 3-5% of all pregnancies. Abruption placenta and placenta previa contributes 60-70% of total causes of APH. It also predisposes a patient further for PPH and makes her condition more critical.
Aim & Objectives: to present our experience on peripartum management and handling of complications in patients of abruption placenta and placenta previa.
Material & methods: this is a retrospective study in the department of obstetrics & gynecology in a rural medical college during its first three years of establishment. The data was collected from the medical records and statistically analyzed for presentation of patients, neonatal outcome and management of peripartum complications focusing on different methods of controlling postpartum haemorrhage in both the conditions.
Results: The incidence of APH, abruption placenta and placenta previa in the present study was 3.65%, 2.54% & 1.11%. Majority of patients in the study group were 25.77±4.88yrs age and multiparous (2.8±1.64). Risk factors for placenta previa were present in 18.77% patients. Neonatal morbidity and mortality were more commonly associated with abruption placenta. The most common complication was postpartum haemorrhage secondary to uterine atony, morbidly adherent placenta and DIC. Other complications include on table cardiac arrest, long ICU stay.
Conclusion: Antepartum haemorrhage itself makes patient condition haemodynamically critical and further post partum haemorrhage narrows the window of survival for the patient. An obstetrician clinical and surgical skills plays a critical role in survival of such patients.
References
1. Antepartum haemorrhage RCOG Greentop Guidelines no. 63, Nov 2011.
2. Glordano R, Cacclatore A, Clgnlnl P, Romano M. Antepartum haemorrhage. J Perinatal Medicine 2010; 4(1):12-6.
3. Mukherjee S, Bawa AK, Sharma S, Nandanwar YS, gadam M. Retrospective study of risk factors and maternal and fetal outcome in patients with abruption placentae. J of Natural Scie, Bio & Med 2014; 5(2): 425-28.
4. Siddiqui SA, Tariq G, Soomro N, Sheikh A, Hasnain FS, Memon KA. Perinatal outcome and a near miss morbidity between placenta previa and abruption placentae. J Coll of Physicians &Surgeons Pakistan. 2011; 21(2): 79-83.
5. Sarwar I, Abbasi AN, Islam A. Abruptio placentae and its complications at Ayub Teaching hospital Abbottabad. J Ayub Med Coll Abbottabad 2006; 18(1).
6. Purohit A, Desai R, Jodha BS, Garg B. Maternal & fetal outcome in third trimesters bleeding. IOSR J of Dental & medical sciences. 2014; 13(5): 13-6.
7. Prevention & treatment of postpartum haemorrhage in low resource settings. FIGO Safe Motherhood & Newborn Health Committee. Int. J. Gynecol&Obstet 2012;117: 108-18.
8. Motwani MN, Sheeth J. Maternal mortality from APH: review of 20 yrs death. ObstGyn India 1990; 39:364-6.
9. Walfish M, Neuman A, Wlody D. Maternal haemorrhage. Br J Anaesth 2009; 103: i47-56.
10. Chan LL, Lo TK, Lau WL, Lau S, Law B, Tsang HH, Leung WC. Use of second line therapies for management of massive primary PPH.(online published 27 June 2013) http://dx.doi.org/10.1016/j.ijgo2013.03.027
11. B-LynchC, CokerA, Laval AH et al. The B Lynch surgical technique for control of massive postpartum haemorrhagean altern-ative to hysterectomy. Five cases reported. Br J Obstet Gynecol1997;104:372-5.
12. WohlmuthC,Gumbs J, Quebral, Ivie J. B Lynch suture a case series. Int. J. Fertil Womens Med. 2005;50:164-73.
13. Joshi VM, Otiv SR, Majumder R, Nikam YA, Shrivastav M. Internal iliac artery ligation for arresting postpartum haemorrhage. BJOG 2007; 114: 356-61.
14. Atin H, Shyamapada P. Uterine and ovarian arteries ligation: a safe technique to control PPH during caesarean section. J ObstetGynecol India 2008; 58(4)319-21.
15. Dutta DK, Dutta I. Management of major degree placenta previa during LSCS operation- a new surgical technique. Asian J Med Sciences 2103;4 (2): 1-7.
16. Mukhopadhyay S, Arulkumaran S. Golden hour in the management of postpartum haemorrhage. Women’s Health. Procee-dings of the world congress on Women’s” Health 2000, Organised by FOGSI and BOGS 2000: B10-5.
17. Chandana D, Partha M, Nilanjana C, Arup Kumar M, KaramkarKakali S. Isthmic cervical apposition suture – an effective method to control postpartum haemorrhage during cesarean section for placenta previa. The J. of Obstet&Gynecol of India 2005; 55(4): 322-24.
18. Rashmi B, Vanita J, Seema C, Jasvinder K, Sarla G. Uterovaginal packing with rolled gauze in postpartum haemorrhage. Med gen Med 2004; 6(1): 50.
19. Tirumuru S, Saba S, Morse H, Muammar B. Intrauterine balloon tamponade in the management of severe postpartum haemorrhage a case series from a busy U.K. district general hospital. Open Journal of Obstetrics & Gynecology 2013;3:131-36.
20. Burchell RC. Physiology of internal iliac artery ligation. J ObstetGyneco Brit Cwlth1968;75:642-51.