study of abruption placentae

To determine the frequency of abruptio placentae and to find out associated risk factors and out come. Cross-sectional study. The Department of Gynaecology and Obstetrics Unit II, Jinnah Postgraduate MedicalCentre [JPMC], Karachi over one year period from July 2004 to June 2005. This study includes those patients who were brought to JPMC, Karachi with abruptio placentae after 28 weeks of pregnancy. Local causes of bleeding per vagina, placentae previa and ruptured uterus were excluded from the study both clinically and with the help of ultrasound. Total number of deliveries during one year from July 2004 to June 2005 was 4497. Total number of patients with placental abruptio were 102, making an incidence of 1:44 deliveries [2.26%]. Eight cases were booked while rest of the patients were nonbooked. Hypertension, preeclampsia [37.2%], anaemia 34.3% and grand multiparty were most common associated risk factors. Maternal age had no significant relation to occurrence of abruptio placentae. Most of the patients presented with bleeding per vaginum [93%] followed by onset of labour pains [80%]. Maternal morbidity was high. Most common complication was anaemia 34.4% followed by post partum infection [> 14%] Perinatal mortality was significantly high [62.5%]. There was only one maternal death due to irreversible shock. Incidence of abruption placenta is high [2.26%]. Resultant maternal morbidity and perinatal mortality is significant. This calls for early detection, regular visits, and special surveillance. There should be timely referral to tertiary care centre

Placenta percreta: a rare catastrophe

To document the clinical presentation, risk factors, management and management of placenta percreta. Case series. A 5 year study from January 2001 to December 2005 in Gynaecology and Obstetrics department, Unit II, Jinnah Postgraduate Medical Centre, Karachi. This study included patients of placenta percreta who were either diagnosed on ultrasound during antenatal period or accidentally found at exploratory laparotomy or caesarean section. A total of 11 cases of placenta percreta were managed during the study period. The frequency of the lesion was 1: 2058 deliveries. In 7 patients placenta had invaded and perforated the uterine wall, in 3 patients it had invaded the urinary bladder as well and in one patient there was broad ligament invasion. Most common risk factors were previous caesarean section [CS] in 91 percent cases and placenta previa [91 percent] followed by curettage [9 percent]. Hysterectomy was performed in all patients. Partial cystectomy and bladder repair was done in those cases where urinary bladder was invaded. Urinary bladder injury occurred in two [27.27 percent] patients. Two patients died, one due to irreversible shock and other due to acute renal failure. Placenta percreta is a rare catastrophe associated with high maternal morbidity and mortality. Early diagnosis and surgery following adequate resuscitation should be accomplished with multidisciplinary team