Frequency, maternal and fetal outcome of abruptio placenta in a rural medical college hospital, Mirpurkhas Sindh

To determine the frequency, maternal and fetal outcome of abruptio placentae in a rural medical college hospital, Mirpurkhas Sindh, Pakistan. This is an observational prospective study conducted at obstetric and gynaecology department of Muhammad Medical College Hospital during one year from 1st June 2007 to 31st May 2008. All patients with diagnosis of abruptio placenta and gestational age of >24 weeks were included in the study. Data were collected on questionnaire after informed consent and results were analyzed by calculating percentages. Total number of women delivered in ward during study period was 2132. Abruptio placentae was seen in 84[3.9%] patients. Majority of women n=43 [51.1%] were in the age group of 25-30 years. Incidence was higher in multi-parous, being 73 [86.9%]. A total of 59 [70%] women were anemic. Pregnancy induced hypertension was seen in six [7%], diabetes in five [6%] and multiple pregnancy in four [5%]. No risk factor was present in 10[12%] women. As regards mode of delivery, 62 [74%] women delivered spontaneously vaginally and 21 [25%] underwent caesarean section. One patient died undelivered cause being severely anemic, shock and disseminated intravascular coagulation [DIC]. Major maternal complication seen was hypovolumic shock in 21[25%], followed by postpartum hemorrhage in 11 [13%], altered coagulation profile in six [7%] and renal failure in two [2.3%] of patients. 52 [62%] women delivered alive babies while 32 [38%] were stillborn. Out of 52 alive born, two died within first week of birth due to prematurity. Overall perinatal mortality was 40.4%. Abruptio placenta is associated with high rate of maternal and fetal morbidity and mortality and to reduce this, the risk factors associated with abruptio placenta must be evaluated before and during pregnancy

Perinatal mortality in Azadi teaching hospital, Dohuk city, Iraq

Still birth and perinatal mortality has always been a major problematic issue in clinical practice. They are devastating experience for the parents specially the mother. Few local studies have addressed these problems. Estimation of the perinatal mortality rate and studying the major local etiological and predisposing factors in order to highlight the preventive strategies and form a base for future plans. A descriptive study was carried out for all perinatal deaths from 1st January to 31st December 2004 at Azadi teaching hospital in Dohuk city, Kurdistan region, Iraq. During the study period, the number of total births recorded was 10879. There were 427 perinatal deaths giving a perinatal mortality rate of 39.2 per 1000 births. The ratio of fresh stillbirths to macerated cases was 2/1 [126 and 60] respectively. The direct leading causes behind fresh stillbirths were placental abruption [25.4%], pre-eclampsia [16.7%], and congenital anomalies [14.3%]. The main causes of maceration were pre-eclampsia [33.3%], diabetes mellitus [21.6%] and congenital anomalies [20%]. Prematurity [46.9%], birth asphyxia [19.9%] and congenital anomalies [12.4%] were strongly associated with early neonatal deaths [241 cases]. A significantly higher risk of perinatal death was observed among women under 20 or over 40 years of age, grand-multiparity, low socioeconomic status, and poor antenatal care attendance. The profile of perinatal deaths among the studied group suggests the need for improvement in obstetric care, early referral, and availability of advanced neonatal care services including neonatal screening protocols

Abruptio placentae and its complications at Ayub teaching hospital Abbottabad

Abruptio placentae remains a major cause of perinatal morbidity and mortality globally, though of most serious concern in the developing world. As most known causes of abruptio placentae are either preventable or treatable, an increased frequency of the condition remains a source of medical concern. The present study was undertaken at the Department of Obstetrics and Gynaecology, Unit B, of the Ayub Teaching Hospital, Abbottabad, Pakistan, from July 2003 to June 2004. 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 complete obstetrical clinical workup including history, general physical examination, abdominal and pelvic examination. Relevant investigations such as laboratory tests and imaging were performed. Patients were managed according to maternal and fetal condition. Any maternal and/or fetal complications were noted and recorded. All data were collected on predesigned proformas and analyzed by computer. 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 1000 deliveries. Induction of labour was required in 27 [50.9%] cases, while caesarean section was performed 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. A higher than expected frequency of abruptio placentae exists in our setting and the consequences of abruptio placentae for neonatal mortality outcome are alarmingly high. The majority of patients presented with intra uterine death so that any management protocol directed at abruptio placentae or its consequences is of little help in preventing perinatal mortality

Evaluación del Desprendimiento Prematuro de Placenta en la Altura / Evaluation of Abruptio Placentae in high altitude

De 4467 partos ocurridos en el lapso de 15 años en el Hospital II IPSS de la Oroya (3750 mts. sobre el nivel del mar),fueron seleccionados para el presente estudio, 75 casos con diagnóstico de desprendimiento prematuro de placenta normo inserta, con una incidencia de 1.6 por ciento.En esta patología la incidencia se se elevó 3.3 veces en gestantes mayores de 35 años, dos veces cuando tenían más de 4 hijos y 4.3 veces cuando el feto se encontraba en presentación transvera. Sangrado oculto o exterior leve con gran desprendimiento placentario fue hallado en 45.33 por ciento de los casos. En 82.7 por ciento de los caso se practicó cesárea de emergencia, y de ellas, en 70.97 por ciento se utilizó anestesia general. La incidencia de neonatos con apgar menor de 4 por DPP llegó al 18.02 por ciento (63.64 por ciento de los casos). 14.40 por ciento de los recién nacidos de bajo peso en estos 15 años, corresponden a DPP, así como 12.50 por ciento de los neonatos con menos de 35 semanas; siendo DPP la principal causa de muerte neonatal temprana intrahospitalaria. En 50.67 por ciento del total de casos de DPP, lo valores de hemoglobina materna fueron menores de 10 gr por ciento lo que correspomde a anemia aguda severa y hasta pre shock en nuestro medio. El comportamiento de la DPP en altura es más aparatosa que a nivel del mar. Su incidencia y morbimortalidad es superior a la reportada por la literatura y su etiología se deberá a que la hipoxia condiciona fragilidad capilar a nivel velloso, y al mayor volumen y viscosidad sanguínea que aumenta la resistencia vascular del lecho placentario. También influyen patrones culturales aún no desterrados que preconizan la versión externa para "acomodar" una mala presentación fetal.

Dezesseis casos de descolamento prematuro da placenta normalmente inserida / 16 cases of abruptio placentae with normal insertion

No trabalho ora apresentado os AA constataram que a via abdominal predominou na conduta adotada na M.C.D. no ano de 1982. Houve 16 casos em apreço num total de 4.958 partos, sem que se registrasse nenhum êxito letal no que se refere às parturientes, e a mortalidade perinatal foi assaz inferior à assinalada em compêndios e trabalhos publicados