ABRUPTIO PLACENTAE AND ITS COMPLICATIONS AT AYUB TEACHING HOSPITAL ABBOTTABAD
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.
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