ABSTRACT
Background: Abruptio placenta or accidental haemorrhage is one of the obstetrical emergencies and is truly accidental with few warning signs. Present study is planned to study the maternal and fetal outcome in patients of abruption placenta in a tertiary care referral hospital in a rural set up which is helpful to plan management strategies and to decrease mortality and morbidity.Methods: A prospective observational study was conducted at Department of Obstetrics and Gynaecology at tertiary care centre during September 2015 to August 2019. A total of 270 cases of abruptio placenta coming to the labor ward and delivered were included in the study. The information collected regarding maternal and fetal parameters were recorded in a master chart in Microsoft Excel 2010 and analyzed using the statistical package for the social sciences software (SPSS) version 20.0.Results: In the present study there were a total of 29887 deliveries with 270 cases of abruptio placenta, incidence being 0.9%. Bleeding per vagina is the most common presentation (85.6%) followed by pain abdomen (70.7%). Common risk factors for accidental hemorrhage were: Pre-eclampsia (39.6%) and anaemia (32.2%). Rate of cesarean section was 40.7% (n-110) while rate of forceps delivery was 4.8% (n-13). Associated maternal complications include: post-partum hemorrhage (18.9%), DIC (10%), acute renal failure (4.1%) and puerperal sepsis (1.9%) while maternal mortality rate was 1.9%. Low birth weight (<2.5kg) was observed in 74.8% cases while still birth and neonatal mortality rate was 35.2% and 12.6% respectively.Conclusions: Abruptio placenta or accidental hemorrhage is major risk factor for maternal and perinatal morbidity and mortality, thus efforts should be taken to reduce risk factor for abruptio placenta. Strengthening of antenatal care, anticipation and evaluation of associated high-risk factor and prompt management of complication can improve maternal and perinatal outcome in these cases. Abruptio placenta should be managed in centers where there is advanced maternal and neonatal health care facilities are available.
ABSTRACT
Background: Stillbirth constitutes about 60% of the perinatal deaths. And this is an event which has always challenged the obstetricians for decades. Various maternal, foetal and placental factors may result to stillbirths. Yet, in spite of the modern facilities available and advances made in the medical field, many times no contributing factors can be attributed to the exact cause of stillbirth and refusal of autopsy examination seals the chapter, with the cause of stillbirth remaining unexplored. Objective: The objective of the current study was to explore the maternal, foetal and placental conditions associated with stillbirth and to ascertain the common causes of stillbirth. Methods: A hospital-based prospective study was conducted in the Department of Obstetrics and Gynaecology, Regional Institute of Medical College, Imphal, Manipur in the year 2003. At the time of admission, after obtaining informed verbal consent, a detailed history was taken followed by thorough physical examination and routine investigations were dome for all the admitted patients in the antenatal ward. After delivery, all the women who had stillbirth were approached again to undergo special investigations like blood sugar estimation, VDRL test, urine examination for culture and sensitivity, ELISA for HIV and TORCH antibodies, Widal test, liver function tests and kidney function test. Based on the above findings, the stillbirths were analysed as macerated stillbirths and fresh stillbirths. Results: Only 43 women out of all the 100 women who had stillbirths could be investigated for TORCH antibodies. Out of these 43 women, 4 (9.3%) women were positive for Ig M toxoplasma antibody, 3 (7.0%) women were positive for Ig M Rubella antibody, 10 (23.3%) women were positive for Ig M CMV and 9 (20.9%) women were positive for Ig M HSV I & II indicating present infection. Ig G antibody alone was positive in 25 (58.1%) women for toxoplasmosis, 29 (67.4%) women for Rubella, 31 (72.1%) women for CMV and 20 (67.4%) women for HSV I & II indicating past infection (Table 1). Forty-eight women underwent VDRL testing and 08 (20%) women were found to be positive. Only 20 women gave consent for their placenta to undergo histopathological examination. Among these the commonest histological finding was syncytial knots (70%). Maternal anaemia (78%) was by far the commonest medical condition associated in women who either had macerated or fresh stillbirth. And accidental haemorrhage with or without placenta previa and prolonged/obstructed labour were the common conditions associated with stillbirth. The most probable causes of stillbirth assigned for all the 100 stillbirths, made after careful clinical consideration were intra-partum asphyxia (59%), foetal asphyxia (19%), unexplained intra-uterine deaths (15%) and congenital malformations (7%). Conclusion: Proper antenatal care for screening high risk factors and management thereof and educating the women to overcome the fear for hospital delivery are the needs of the hour. Also, a constant supervision by the senior staffs and their availability for consultation while conducting deliveries in the medical institutions may prevent a sizeable number of stillbirths. Vaginal delivery of difficult and breech delivery may be avoided as far as possible. Instead, Caesarean section should be opted.