A Look on Rising Burden of Abruption Placentae in PUMHS Teaching Hospital

Abstract

Objective: To determine frequency, risk factor and associated adverse feto-maternal outcome of Abruptio Placentae (AP). Methods: This was a prospective, cross sectional, observational work performed in the Gyne and Ohs department, from Jan 2017 to Dec 2017. We include 113 women with singleton fetus and clinical diagnosis of abruption placentae after 24 weeks. Patient diagnosed with polyhydramnios, multiple gestation and bleeding owing to other causes like placenta previa, vasa previa. local causes like cervical pathology were excluded. Data collected were recorded on predesigned profornm and statistically analyzed. Results: From 4922 deliveries, 113 cases of abruption placenta were identified, giving a frequency of 2.29%. Among risk factors observed, 83% patient were unhooked, 36% in age between 20-30 years, 56% were 2"d, 3"1, or 4th gravida, 43.9% were between 30-35 weeks gestation. 54.39% belong to poor class families. Hypertension was main risk factor observed in 82.46% of cases, 45.6% of the patient presented with pre-eclampsia, among these 37.7% show severe pathology. 91% patient were anemic. Majority of patient (78%) delivered vaginally and rest abdominally. Major complications were preterm labour (67.5%), followed by post-partum hemorrhage (15.8%), maternal shock (6.1%), disseminated intravascular coagulation ( DIC ) (1.8%), acute renal failure in 2.6%, pulmonary edema (1.8%). We had to perform obstetrical hysterectomy in 4.4% cases to save their life, 3 mothers could not be saved (one was due to PPH and rest 2 were because of severe pre-eclampsia with pulmonary edema and DIC). Perinatal mortality seen in 45.6%, 61% of newborns hadAPGAR score equal or less than 7, and 70% weighed equal or less than 2.5%. Conclusion: Hypertension, anemia, and poor socioeconomic status seems to be main risk factor in this study. With delayed approach to tertiary care center, life of both mother and fetus is in jeopardy. Hemorrhage, blood transfusion, prematurity of fetus, emergency caesarean section, and hysterectomy are the main factors for feto maternal morbidity.