ABRUPTIO PLACENTAE AND ITS COMPLICATIONS AT AYUB TEACHING HOSPITAL ABBOTTABAD

Authors

  • Iram Sarwar
  • Aziz un Nisa Abbasi
  • Ansa Islam

Abstract

Background: Abruptio placentae remains a major cause of perinatal morbidity and mortalityglobally, though of most serious concern in the developing world. As most known causes of abruptioplacentae are either preventable or treatable, an increased frequency of the condition remains a sourceof medical concern. Methods: The present study was undertaken at the Department of Obstetrics andGynaecology, Unit B, of the Ayub Teaching Hospital, Abbottabad, Pakistan, from July 2003 to June2004. Patients of abruptio placentae were selected from all cases of 28 weeks or greater gestation,presenting with ante partum haemorrhage during the study period. Patients underwent a completeobstetrical clinical workup including history, general physical examination, abdominal and pelvicexamination. Relevant investigations such as laboratory tests and imaging were performed. Patientswere managed according to maternal and fetal condition. Any maternal and/or fetal complicationswere noted and recorded. All data were collected on predesigned proformas and analyzed bycomputer. Results: A total of 53 cases of abruptio placentae were recorded out of 1194 cases (4.4%)admitted for delivery during the study period, giving a rate of 44 cases of abruptio placentae per 1000deliveries. Induction of labour was required in 27 (50.9%) cases, while caesarean section wasperformed in 16 (30.2%) cases. Major complications were intra uterine fetal demise (31/53, 58.5%),fetal distress (8/22 live births, 36.4%) and post partum haemorrhage, which occurred in 10 (18.9%)cases. Conclusions: A higher than expected frequency of abruptio placentae exists in our setting andthe consequences of abruptio placentae for neonatal mortality outcome are alarmingly high. Themajority of patients presented with intra uterine death so that any management protocol directed atabruptio placentae or its consequences is of little help in preventing perinatal mortality.Key Words: Abruptio placentae, ante partum haemorrhage, perinatal mortality.

References

Ananth CV, Savitz DA, Bowes Jr WA, Luther ER. Influence

of hypertensive disorders and cigarette smoking on placental

abruption and uterine bleeding during pregnancy. Br J Obstet

Gynaecol 1997; 104:572-578

Gaufberg SV. Abruptio Placentae. [Online webpage] 2001

Mar [cited 2003 Jul 15]; [24 screens]. Available from: URL:

http://www.emedicine.com/emerg/topic12.htm.

Eskes TK. Clotting disorders and placental abruption:

homocysteine - a new risk factor. Eur J Obstet Gynaecol

Reprod Biol 2001; 95(2):206-12.

Obstetrical Haemorrhage (Chap. 32). In: Cunningham FG,

MacDonald PC, Gant NF, Leveno KJ, Gilstrap III LC,

J Ayub Med Coll Abbottabad 2006;18(1)

Hankins GDV, Clark SL, editors. Williams Obstetrics 20th

ed. USA: Appleton & Lange; 1997. p. 746-55.

Toivonen S, Heinonen S, Anttile M, Kosma VM, Saarikoski

S. Reproductive risk factors, Doppler findings, and outcome

of affected births in placental abruption. Am J Perinatol

; 19 (8): 451-60.

Sheiner E, Shohan-Vardi I, Hallak M, Hadar A, GortzakUzan L, Katz M et al. Placental abruption in term

pregnancies: clinical significance and obstetric risk factors. J

Matern Fetal Neonatal Med 2003; 13(1): 45-9.

Sharief M, Manther AA. Abruptio placentae: perinatal

outcome in normotensive and hypertensive patients in Basra,

Iraq. [serial online] 1998; emhj; 4(2):319-23. Available from:

URL:

http://www.emro.who.int/publications/EMHJ/0402/16.htm.

Abu-Heiji A, al Chalabi H, el Iloubani N. Abruptio

placentae: risk factors and perinatal outcome. J Obstet

Gynaecol Res 1998; 24(2): 141-4.

Krohn M, Voight L, McKnight B, Daling JR, Starzyk P,

Benedetti TJ. Correlates of placental abruption. Br J Obstet

Gynaecol 1987; 94(4): 333-40.

Williams MA, Leiberman E, Mittendorf R, Monson RR,

Schoenbaun SC. Risk factors for abruptio placentae. Am J

Epidemiol 1991; 134(9): 965-72.

Asaf KH. Grand multiparity: still an obstetric risk factor. Pak

J Obstet Gynaecol 1997; 10(1, 2):24-8.

Rai L, Duvvi H, Rao UR, Vaidehi, Nalinii V. Severe abruptio

placentae - still unpreventable. Int J Gynaecol Obstet 1989;

(2): 117-20.

Alexander JM, Cox SM. Clinical course of premature rupture

of membranes. Semin Perinatol 1996; 20(5): 369-74.

Dahmus MA, Sibai BM. Blunt abdominal trauma: are there

any predictive factors for abruption placentae or maternalfetal distress? Am J Obstet Gynecol 1993; 169(4): 1054-9.

Pepperell RJ, Rubinstein E, MacIsaac IA. Motor car

accidents during pregnancy. Med J Aust 1977; 1 (7):203-5.

Shah S, Miller PR, Meredith JW, Chang MC. Elevated

admission white cell count in pregnant trauma patients: an

indicator of on going placental abruption. Am Surg 2002;

(7): 644-7.

Neilson JP. Interventions for treating placental abruption. J

Obstet Gynaecol 2001; 21(5): 443-447.

Hubbard JL, Hosmer SB. USA. Couvelaire Uterus. J Am

Osteopath Assoc 1997; 97(9):536-7.

Rasmussen S, Irgens LM, Bergsjo P, Dalaka K. The

occurrence of placental abruption in Norway 1967- 1991.

Acta Obstet Gynaecol Scand 1996; 75(3): 222-8.

Naeye RL, Harkness WL, Utts J. Abruptio placentae and

perinatal death: a prospective study. Am J Obstet Gynaecol

; 128(7): 740-6.

Ananth CV, Berkowitz GS, Savitz DA, Lapinski RH.

Placental abruption and adverse perinatal outcomes. J Clin

Epidemiol 1999; 52(5): 453-61.

Salma IK, Stephen AW, Carrol P. Pregnancy outcome in

severe placental abruption. Br J Obstet Gynaecol 2003;

:679-63.

Noorani KJ, Norrani M. Prevalence of acute renal failure in

patients developing abruptio placentae as a consequence of

PIH. Pakistan J Obstet Gynaecol 1995; 8(1): 15-6.

Izhar R. Incidence of placental abruption in grand multipara

[dissertation]. Obstetrics and Gynaecology, Hayat Shaheed

Hospital Peshawar; 1997. Naeye RL, Tafari N, Marboe CC.

Perinatal death due to abruptio placentae in an African city.

Acta Obstet Gynaecol Scand 1979; 58(1): 37-40.

Ray JG, Laskin CA. Folic acid and homocysteine metabolic

defects and the risk of placental abruption, pre-eclampsia and

spontaneous pregnancy loss: A systematic review. Placenta

; 20(7):519-29.

Mayhew TM. Changes in fetal capillaries during preplacental

hypoxia: growth, shape remodelling and villous

capillarization in placentae from high-altitude pregnancies.

Placenta 2003; 24(2-3):191-8.

Mayhew TM. Thinning of the intervascular tissue layers of

the human placenta is an adaptive response to passive

diffusion in vivo and may help to predict the origins of fetal

hypoxia. Eur J Obstet Gynecol Reprod Biol 1998; 81(1):101-

Konje JC, Taylor DJ. Bleeding in late pregnancy (Chap. 8).

In: James DK, Steer PJ, Weiner CP, Gonik B, editors. High

Risk Pregnancy Management Options 2nd ed. USA: WB

Saunders; 1999. p. 111-28.

Kyrklund-Blomberg NB, Gennser G, Cnattingius S. Placental

abruption and perinatal death. Paediatr Perinat Epidemiol

; 15(3):290-7.

Abdella TN, Sibai BM, Hays JM Jr, Anderson GD.

Relationship of hypertensive disease to abruption placentae.

Obstet Gynaecol 1984; 63(3):365-70.

Naidu J, Moodley M, Adhikari R, Ramsaroop N, Morar O,

Dunmoye S. Clinico-pathological study of causes of perinatal

mortality in a developing country. J Obstet Gynaecol 2001;

(5): 443-447.

Mukherjee NK, Mitra NK. The effect of malnutrition on

placenta. Indian J Pathol Microbiol 1990; 33(4):314-22.

Downloads

Most read articles by the same author(s)

<< < 1 2