A RETROSPECTIVE STUDY OF MATERNAL AND FETAL OUTCOMES IN PLACENTAL ABRUPTION

Introduction:Placental abruption (PA) is a critical obstetrical emergency characterized by the premature separation of a normally implanted placenta, leading to maternal and fetal complications. It is unpredictable, with a sudden onset, often associated with risk factors like advanced maternal age, multiparity, pre-eclampsia, and history of high-risk pregnancy (HRP). Clinically, PA presents with abdominal pain, vaginal bleeding, uterine tenderness, and fetal distress.Patho physiologically, PA occurs when maternal vessels tear away from the placenta, causing a hematoma that disrupts maternal-fetal circulation, leading to hemodynamic instability, coagulation abnormalities, and potential fetal demise. The severity of PA varies, classified from asymptomatic (Class 0) to severe (Class 3), based on clinical symptoms and the extent of placental separation. Management strategies depend on the severity and gestational age, ranging from conservative management in mild cases to urgent delivery in severe cases.PA is associated with significant maternal and fetal morbidity and mortality, including hemorrhage, fetal demise, and potential recurrence in future pregnancies. Prompt recognition and management are essential to improve outcomes.

Aim:To study the maternal and perinatal outcomes associated with placental abruption

Material and Methods:This retrospective study was conducted on 22 cases of placental abruption in the Department of Obstetrics and Gynecology at MRMC Kalaburagi, covering the period from January 2023 to December 2023. The study exclusively included women diagnosed with placental abruption. Cases involving placenta previa and other extraplacental causes of antepartum hemorrhage were excluded from the analysis.

Results:In the retrospective study of 22 cases of placental abruption, the age distribution of patients varied: 2 were 19 years old, 17 were between 21 and 30 years old, and 3 were over 30 years old. Among the women, 45% were primigravida, and 54% were multigravida. Delivery methods were split, with 40.9% undergoing a lower segment caesarean section (LSCS) and 59% delivering vaginally 7 patients required induction. Blood transfusion was necessary for 16 cases, which accounts for 72% of the sample. Couvelaire uterus was observed in 3 cases (13.6%). The study reported one maternal mortality, representing 4.5% of the cases.

Conclusion:This study highlights significant maternal and perinatal outcomes associated with placental abruption. The majority of the women were within the 21-30-year age group, with a notable percentage being multigravida. A substantial portion of deliveries required lower segment cesarean section, and many patients underwent blood transfusions, reflecting the severity of the condition. Couvelaire uterus was observed in a notable subset of cases, and maternal mortality was relatively low but significant. These findings underscore the critical need for vigilant management and monitoring of placental abruption cases to improve both maternal and fetal outcomes.

References: 1. Maternal, labor, delivery, and perinatal outcomes associated with placental abruption: a systematic review. Downes KL, Grantz KL, Shenassa ED. Am J Perinatol. 201734:935–957. 2. Pregnancy outcome in severe placental abruption. Kayani SI, Walkinshaw SA, Preston C.  BJOG. 2003110:679–683.