| Summary: | A dissertation submitted in partial fulfilment of FCOG (SA) degree. University of Witwatersrand
October 2017. === Placental abruption is one of the causes of obstetric haemorrhage that is associated with adverse maternal and neonatal outcomes. Knowledge of the risk factors and complications of placental abruption is important to reduce the maternal and perinatal morbidity and mortality associated with this condition.
Objectives
1. To determine the frequency of abruptio placentae at Chris Hani Baragwanath Academic Hospital.
2. To assess maternal risk factors common in the patients admitted with placental abruption.
3. To determine the number of patients that had operative deliveries.
4. To assess maternal morbidity associated with placental abruption.
5. To assess perinatal outcomes of births in women with abruptio placentae.
Methods
This was a descriptive prospective study of morbidity in women with placental abruption. The study was carried out in the department of Obstetrics and Gynaecology at Chris Hani Baragwanath Hospital (CHBAH). Patients with placental abruption who gave informed consent to participate in the study were interviewed using a structured questionnaire. The study was conducted at Chris Hani Baragwanath Hospital. The study was carried out over a 6 month period and 60 subjects were recruited. All the women with the diagnoses of placental abruption and singleton pregnancies were included in the study.
Results
Of the 13734 delivered women 60 patients (0.4%) had placental abruption. Out of the 60 patients 53 (83%) were booked. The age group was between 18 – 42 years with the mean age of 28.2±6.8years. The mean gestational age on admission was 31.8±4.7.
Forty six (71.6%) patients had parity of one and more. The risk factors that were identified in the study were previous history of placental abruption which occurred in 4 patients (6.7%),previous caesarean section in 7 (11.7%).The commonest medical disorder observed was hypertensive disease, pre-eclampsia was found in 24 patients(40%), gestational hypertension was found in 5 patients (8.3%) and chronic hypertension in 4(6.7%).
The maternal complications that were identified were PPH in 15(44%) patients that had stillbirths compared to 1(3.8%) in the group that had live births, DIC was observed in 8 (23.5%),haemorrhagic shock occurred in 2 (5.9%) of the patients, acute kidney injury in 20(58.8%) in the group that had stillbirths compared to 3(11.5%) in the group that had live births, Couvelaire uterus in 9(26.4%) in the group that had still births, hysterectomy was performed in 2 (5.8%) and ICU admission was required for 5 (14.7%) of the patients.
The neonatal out comes that were observed were stillbirths in 34 patients, birth asphyxia in 5(19.2%) and ICU admission was required in 11(42.3%). There were no maternal deaths.
Conclusion
In conclusion placental abruption is still a dangerous complication for both the mother and baby. In this study the patients that had stillbirths had worse outcomes compared to those that had live births. Therefore the conditions that are associated with this condition should be identified. Early recognition of this condition as well as proper referral of the patient can ensure better outcomes. === LG2018
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