MATERNAL AND PERINATAL OUTCOMES IN PREGNANCY ASSOCIATED WITH ABRUPTIO PLACENTA

Background: Placental Abruption is an important cause of antepartum haemorrhage. It is defined as the separation of the placenta either partially or totally from its implantation site before delivery. APH is a major cause of maternal and perinatal morbidity and mortality. Therefore the study was planned to study the maternal and perinatal outcomes in patients of abruption placenta. Methods: The present study was conducted in the department of obstetrics and gynaecology, SMGS, Hospital, Govt. Medical College Jammu over a period of 1 year. It was a prospective study and all case of Abruptio placenta ≥ 28 weeks of gestational age were included. Results: It was observed that maximum cases of Abruptio Placenta i.e 67.65% were multigravida. 41.47% of cases of Abruptio Placenta had hypertension. 4.41 % had Polyhydramnios. 61.76% The maternal complication in patients with APH are malpresentation, premature labor, postpartum hemorrhage, sepsis, shock and retained placenta. Patients with APH have higher rates of caesarean section, Peripartum hysterectomies, massive haemorrhage and even death. This massive haemorrhage in turn can lead to major blood loss, hypovolemic shock, renal failure, liver failure and adult respiratory distress . Pulmonary oedema, DIC, postpartum anaemia and Sheehan’s syndrome are other major maternal morbidities. Various fetal complications are premature baby, low birth weight, intrauterine death, congenital malformation and birth asphyxia. Placental abruption is the strongest known trigger of spontaneous preterm labour and PROM both leading to excessively high rates of preterm birth .


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The maternal complication in patients with APH are malpresentation, premature labor, postpartum hemorrhage, sepsis, shock and retained placenta. Patients with APH have higher rates of caesarean section, Peripartum hysterectomies, massive haemorrhage and even death. This massive haemorrhage in turn can lead to major blood loss, hypovolemic shock, renal failure, liver failure and adult respiratory distress. Pulmonary oedema, DIC, postpartum anaemia and Sheehan's syndrome are other major maternal morbidities. Various fetal complications are premature baby, low birth weight, intrauterine death, congenital malformation and birth asphyxia. Placental abruption is the strongest known trigger of spontaneous preterm labour and PROM both leading to excessively high rates of preterm birth.
APH is a major cause of maternal and perinatal morbidity and mortality which could be prevented by early registration, regular antenatal care, early detection of high risk cases, early referral to higher centre. 4 Therefore the study was planned to study the maternal and perinatal outcomes in patients of abruption placenta.

Aims & Objectives:-
To evaluate maternal and perinatal outcome in pregnancies with Abruptio placenta.

Material & Methods:-
The present study was conducted in the department of obstetrics and gynaecology, SMGS, Hospital, Govt. Medical College Jammu over a period of 1 year.
A prospective study was undertaken.
Inclusion Criteria:-All case of Abruptio placenta ≥ 28 weeks of gestational age.
Exclusion Criteria:-1. All Cases of APH < 28 weeks. 2. The cases of antepartum haemorrhage with the clinical finding and ultrasound report of placenta previa were excluded.
68 patients satisfied above inclusion criteria. There were 2 twin pregnancies in the study group.
The patients were evaluated with detailed history taking and general, systemic and obstetrical examination.
In per speculum examination confirmation of bleeding through Os were noted as to excluded any bleeding from local injury/lesion or trauma.
Management of the patient was done according to standard guidelines, maternal status at the time of admission & foetal status as immediate delivery, induction, caesarean section, conservative or expectant management.
Maternal and perinatal outcome were noted. Mode of delivery and birth weight of foetus were noted. Patient and neonates were followed till discharge from hospital. Observation were tabulated & analysed.

Results & Observations:-
The total number of deliveries in one our hospital were 18567 during the study period 364 patients admitted with antepartum Heamorrhage So the incidence of APH in our hospital was 1.96%. Out of 364 patients, 68 were that of Abruptio Placenta, who fulfilled the inclusion criteria.
It was observed that maximum cases of Abruptio Placenta i.e 45.59 % were in 20-25yrs of age group. Most of cases of Abruptio Placenta (67.65%) were multigravida and 11.77% were grand multipara. (Table 1)     The most common fetal complication in Abruptio Placenta was prematurity (35.71%). IUD was seen in 20% of cases and neonatal mortality was 28.57%. Jaundice was observed in 7.14% whereas 31.42% had no foetal complications.
Majority of neonates 58.58% had APGAR score of above 7, while 24.28% had APGAR score of less than 3 and 17.14% presented with APGAR score between 4 and 7. 44.28% had birth weight between 2.5-3.9 Kg whereas 52.85% had low birth weight ( < 2.5kg ) mainly due to prematurity ). Only 37.14% presented with foetal distress, where as 57.14% had NICU admission the main reason for NICU Admission was preterm delivery. {Table 6)

Discussion:-
The present study was conducted in SMGS Hospital, GMC Jammu to determine the maternal and perinatal outcome in patients with Abruptio Placenta during one year period .
In our study, 32.35% cases of Abruptio Placenta were primigravida and 67.65% were multigravide, which is consistent with the findings of Signal S.et al. 5 who found 63.01% of patients in his study to be multigravide and 26.94% primigravidea. Siddiqui SA et al. also found that majority of patient of Abruptio Placenta were multigravida. 6 So being a problem of multiparty, reduction of family size and issue of contraception are highly applicable to reduced the incidence associated with morbidity & morality.

Conculsion:-
Abruptio placent is associated with significant maternal and perinatal morbidity and mortality. Good regular antenatal care and availability of emergency medical services remains the backbone for the good maternal and perinatal outcome.