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BACKGROUND INFORMATION.
Abruptio placenta (AP) is complete or partial premature separation of normally sited placenta from the uterine wall before delivery .Abruptio placenta is still a major public health issue worldwide and it has been associated with poor maternal and fetal outcome. It occurs in around 0.8 -1.0% of all pregnancies worldwide [Kyrklund-Blomberg N et al, 2001].
Etiology of AP has not been well defined. Risk factors which have been found associated with AP include maternal age, parity, smoking, Hypertension, past history of AP, Abdominal trauma, Polyhydromnios and chorioamnionitis [Nath C et al, 2007].
Aim of the study: To determine the prevalence, risk factors and the fetal maternal outcome of abruptio placentae at KCMC hospital.
Material & methods. A Matched case control study was conducted at KCMC-Medical Birth Registry. The study was conducted from September 2011 to April 2012, utilized Birth Registry data which were collected from July 2000 to December 2010.There were 105 cases and 105 controls included in the study. Cases were the patients with abruption placentae ≥ 28 weeks of gestation and controls were patients without abruption placentae, ≥ 28 weeks of gestation. Controls were selected randomly and matched with cases by age and parity. Outcome variables were Social demographic characteristics, risk factors for Abruptio placentae and fetal-maternal outcome (morbidities &mortalities).
Data analysis. Data analysis was computer based. Computer software SPSS version 17.00 was used. Data entry sheet was developed in SPSS. Mean +SD, range was calculated for continuous variables like age, parity, gravidity and gestational age. The chi-square test and Fischer’s exact test was used to find an association between categorical variables. Statistical tests were performed using two-sided tests at the 0.05 level of significance. For all regression models, the results were expressed as effect (or odds ratios for binary outcomes), corresponding two-sided 95% confidence intervals and associated p-values. P-values was reported to three decimal places with values less than 0.001 reported as <0.001.
Results: Total number of deliveries during the study period was 33,997.Patients identified with Abruptio placentae were 105, giving a prevalence of 0.31%.There were 3 maternal deaths due to Abruptio placentae. Perinatal mortality was high 66/105(63%). The major risk factor for abruptio placentae was previous caesarean scar compare to those who deliver vaginally (OR 4.1, 95% CI 1.9 to 8.6).In this study we found that ,other risk factors like pre eclampsia/eclampsia, PPROM/PROM etc. were not associated with Abruptio placentae .
Conclusion: Abruptio placentae is associated with high morbidity and mortality both for the mother and the baby. The risk factor for Abruptio placentae (AP) was previous caesarean section. Majority of the risk factors for AP like pre eclampsia/eclampsia, Trauma, Multiple pregnancy, alcohol use during pregnancy, PROM, Diabetes, High parity and multigravida were not associated with AP at our hospital |
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