Title: Abruptio placenta: A Retrospective Study on Aetiological Factors and Maternal Outcomes

Authors: Thanku Thomas Koshy, Rachel Alexander

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i2.37

Abstract

Background: Abruptio placenta denotes separation of a normally implanted placenta after 20 weeks of gestation. This is a uniquely dangerous condition to both the mother and the foetus because of its potentially serious pathologic sequelae. The maternal complications include haemorrhagic shock, coagulopathy renal failure and even death. The fetal morbidity and mortality are due to prematurity and hypoxia. This study examines the risk factors and maternal complications of the abruptio placenta.

Methods: This is a retrospective study of Abruptio Placenta cases carried at tertiary care centrein Kerala. In our study we examined 99 women whose delivery was complicated by abruption of placenta.  We also included 99 mothers at term as control who came in labour without abruptio placenta. A detailed obstetrics history was obtained and maternal high risk factors were noted.

Results: Incidence of Abruptio placenta is 0.32%. It is most common in the women of age group 21-24 years. Low income group had the highest incidence of abruptio placenta. 39.39 % of cases were associated with severe pre-eclampsia. Previous obstetric history was found to have a bearing on the incidence of abruption. Increased incidence of abruption was found in women with a history of first trimester abortion by instrumental evacuation. Regarding the grade of abruption, maximum cases were belonged to Page’s grade 3, and the least number of cases was seen in grade 3.

Conclusions: Abruptio placenta is related with poor maternal outcome. Hence early diagnosis and prompt resuscitative measures would prevent maternal mortality and morbidity.

Keywords: Abruptio Placenta, Maternal Outcome, Page’s Grading, Risk Factors.

References

  1. Ananth CV, Getahun D, Peltier MR, Smulian JC. Placental abruption in term and preterm gestations: evidence for heterogeneity in clinical pathways. Obstet Gynecol. 2006;107(4):785–92
  2. Macheku GS, Philemon RN, Oneko O, Mlay PS, Masenga G, Obure J, et al. Frequency, risk factors and feto-maternal outcomes of abruptio placentae in Northern Tanzania: a registry-based retrospective cohort study. BMC Pregnancy and Childbirth. 2015;15(1):242.
  3. 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. Journal of Natural Science, Biology, and Medicine. 2014;5(2):425-8.
  4. Chamberlain G, Steer P. Abnormal Antenatal Care in Turnbull’s Obstetrics. 2001; 3rd ed. London: Harcourt Publishers Limited; 220-5.
  5. Carr SR. High risk pregnancy: management options. JAMA. 1995;273(3):259–60.
  6. Wills V, Abraham J,Rajeev A. Abruptio Placenta: An Analysis of Risk Factors and Perinatal Outcome. Academic Medical Journal of India, 2015 Mar 29;3(1):18-24.
  7. Jakobsson M, Gissler M, Paavonen J, Tapper AM. The incidence of preterm deliveries decreases in Finland. BJOG. 2008;115(1):38–43.
  8. Karegard M, Gennser G: Incidence and recurrence rate of abruption placentae in Sweden. ObstetGynaecol. 67:523,1986.
  9. Ananth CV, Savitz DA, Luther ER et al. Maternal cigarette smoking as a risk factor for placental abruption. Am. J. Epidemiol. 144: 881, 1996 a.
  10. Pritchard J, Mason R, Corley M. Genesis of severe placental abruption. Am. J. ObstetGynaecol. 108:22,1970.
  11. NaeyeRl, Harkin WL et al. Abruptio placenta Snd perinatal death - A prospective study. Am. J. ObstetGynaecol. 128:740,1977.
  12. Salafia CM, Lopez JA, Sherer et al. Histologic evidence of old intra uterine bleeding more frequent in prematurity. Am. J. Obstet. Gynaecol. 173:1065,1995.
  13. Rasmussen S, Irgens LM, et al. Perinatal mortality and case fatality after placental abruption in Norway. 1967-1991.
  14. Kramer MS, Usher RH et al. Etiological determinants of abruptio placentae. Obstet. Gynaec. 89:221,1997.
  15. Hibbard BM, Jeffcoate TN. Abruptio placentae. ObstetGynaecol. 27: 155,1966.
  16. Ananth C.V., Savit DA, Williams MA. Placental abruption and its association with hypertension and prolonged rupture of membranes. ObstetGynaecol 88:309,1996.
  17. Major CA, Veciana M et al. PPROM and Abruptio placentae - Is there an association between these pregnancy complications ? Am. J. ObstetGynaecol. 33:22,1993.
  18. Ananth CV, Wilcox AJ et al. Effect of maternal age and parity on the risk of uteroplacental bleeding disorder in pregnancy. Obstet. Gynaecol. 88:511,1996.

Corresponding Author

Thanku Thomas Koshy

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