Maternal and perinatal outcome in abruptio placenta – Study at teaching hospital

Background: Obstetric emergencies faced in India are much different from those faced by the western world. Out of them, Abruption leading to hemorrhagic shock is a major obstetric emergency, which requires adequate management to avoid catastrophic events including maternal death. Aim: To assess the various modalities of treatment for abruption and its outcome, to assess maternal and perinatal outcome in patients with abruption, to determine the association and influence of various maternal factors on the outcome of pregnancy. Materials and methods: The study was conducted at GMH, Nayapool which serves as a tertiary referral Center having approximately 18000-24000 deliveries per annum. The study was conducted during June, 2006 to July-2007. During this period there were 18950 deliveries. Out of this 296 cases were selected. Results: Out of 18,000 deliveries, 1.64% (n-296) of the patients were complicated by abruption. The mean maternal age was 22-25 years with maximum incidence in both extremes of age. (20-25 years-64.80%, 31-35 years-28.37%). Multiparous women (83.10%) were more affected compared to primigravida (16.89%). A staggering 89.86% or women had no antenatal care and 91.21% of patients belonged to low socio-economic status. 41.21% of women were in 28-32wks of gestation and 35.81% were in 32- 36 weeks. Bleeding per vaginum was the presenting complaint in 89% of patients. 66.22% of patients came with IUD. Maternal complications were frequent. There were 6 maternal deaths, 4 due to hypovolemic shock, 1 due to DIC, 1 due to status Eclampticus. Duration of time between onset of bleeding and seeking medical advice was significant. 2 patients developed PPH. The average induction-delivery interval was 5.2hrs, 82.43% of patients had vaginal delivery and Cesarean section was done in 17.56% of patients. 62.5% of patients received blood transfusion and 55.74% of patients were given FFP's Maternal mortality rate was 2.36% Perinatal Mortality was 61%. Out of these 66.21% of the patients came with IUD, 7.43% had early neonatal deaths, 7.42% had stillbirths. Conclusion: The possibility of abruptio placentae should be considered by the clinician when managing pregnant women with any of those characteristics. Abruptio placentae should be managed in centers where there is advanced maternal and neonatal facilities.