ORIGINAL ARTICLE
Year : 2023 | Volume
: 28 | Issue : 1 | Page : 39--42
Maternal and perinatal outcomes of abruptio placenta at the Lagos University Teaching Hospital: A five-year retrospective review
Ayodeji A Oluwole1, Aloy O Ugwu2, Opeyemi R Akinajo2,
1 Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria; Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
2 Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
Correspondence Address:
Aloy O Ugwu
Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, P.M.B. 12003, Surulere, Lagos
Nigeria
Abstract
Background: Abruptio placentae is a form of antepartum hemorrhage that occurs when there is a partial or complete separation of the placenta before the delivery of the fetus. In addition to vaginal bleeding, it is often associated with abdominal pain, uterine tenderness, fetal heart irregularity, and hypertonic uterine contraction. It is a significant cause of maternal and perinatal morbidity and mortality. It is therefore important to review this obstetrics emergency with a view to creating more awareness on its complications. Objectives: The study was aimed to determine the prevalence as well as the perinatal and maternal outcomes of abruption placentae at the Lagos University Teaching Hospital (LUTH), Nigeria. Materials and Methods: This was a retrospective review of records of pregnant women managed in the labor and postnatal wards of LUTH, Idi-Araba, Nigeria, over a 5-year period from January 2015 to December 2019. Relevant data retrieved were entered and analyzed using the IBM Statistical Package for Social Sciences (SPSS Statistics), version 23. Results: A total of 80 pregnancies were complicated with abruptio placentae giving a prevalence of 0.96% of all admissions during the study period. Several maternal complications recorded included acute renal failure (6.25%), disseminated intravascular coagulation (2.08%), postpartum anemia (37.5%), and postpartum hemorrhage (54.7%). Forty six percent (46%) of the neonates had no complication, 11.3% had early neonatal death, 20% had fresh stillbirth, and 22.5% had birth asphyxia. Conclusion: Abruptio placentae contributed a sizeable proportion to maternal morbidity and perinatal morbidity and mortality in the study population.
How to cite this article:
Oluwole AA, Ugwu AO, Akinajo OR. Maternal and perinatal outcomes of abruptio placenta at the Lagos University Teaching Hospital: A five-year retrospective review.Int J Med Health Dev 2023;28:39-42
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How to cite this URL:
Oluwole AA, Ugwu AO, Akinajo OR. Maternal and perinatal outcomes of abruptio placenta at the Lagos University Teaching Hospital: A five-year retrospective review. Int J Med Health Dev [serial online] 2023 [cited 2023 Mar 30 ];28:39-42
Available from: https://www.ijmhdev.com/text.asp?2023/28/1/39/363254 |
Full Text
Introduction
Placental abruption is the premature separation of a normally situated placenta from the uterine wall after the age of fetal viability but before the delivery of the fetus, resulting in hemorrhage mostly from the decidual–placental interface. Placental abruption accounts for about one-third of all antepartum hemorrhages, also complicates close to 0.5%–1% of all pregnancies, and is a cause of fetal death in about one of every 420–830 deliveries and has also been implicated in 10% of preterm births.[1] It is an acute obstetric emergency and remains a significant source of perinatal morbidity and mortality.[1],[2] The perinatal mortality rate has been estimated to be 20-fold higher when compared with normal pregnancies (12% versus 0.6%, respectively).[3] Most perinatal mortality (up to 77%) occurs prior to delivery, while early neonatal deaths are primarily associated with problems of prematurity.[4],[5],[6]
Some identifiable risk factors for abruptio placentae can be both modifiable and nonmodifiable; these risk factors include hypertensive disorders of pregnancy, multiple pregnancy, polyhydramnios, previous history of abruptio placentae, multiparity, extremes of maternal age, preterm rupture of membrane, external cephalic version, cigarette smoking, cocaine use, congenital uterine anomalies, uterine fibroids, blunt abdominal trauma, male infant sex, intrauterine growth restriction, previous placental ischemic disease, asthma, and chorioamnionitis.[7],[8]
Clinical features of abruptio placentae ranges from vaginal bleeding that may be revealed or concealed or both, different degrees of abdominal pain and/or back pain, uterine contractions/tenderness, and irregular fetal heart rate, fetal distress, or even fetal demise.[1],[2],[3] Ultrasound scan plays a role in the diagnosis of placental abruption; however, its role depends on the size and location of bleeding and time interval between abruption and the time of ultrasound scan.[7] So many laboratory makers have been evaluated for the diagnosis of abruptio placentae. The changes in the serum level of these makers may be detected during the prenatal period as evidence of placental ischemic disease that may precede the occurrence of abruption; they include increased alpha fetoprotein, or human chorionic gonadotropin, cancer antigen 125 (CA-125), decreased pregnancy-associated plasma protein A, or unconjugated estriol.[9],[10] Fibrinogen level has also been used, which correlates with degrees of hemorrhage.[11] Kleihauer–Betke test, which is positive in little proportions of abruption, is also useful in the determination of the degree of feto-placental hemorrhage.[11]
The management of abruptio placentae will depend on the clinical status at presentation, the presence of comorbidities, gestational age, and fetal status. In cases of maternal and fetal compromise where fetal viability has been confirmed, early delivery is preferred, and this is usually by caesarean section unless labor is already established and advanced. However, if intrauterine fetal death has occurred, then vaginal delivery is the preferred method provided the maternal condition permits this.[7]
This study aimed to determine the incidence of abruptio placentae and feto-maternal outcomes at the Lagos University Teaching Hospital (LUTH).
Materials and Methods
Study design and setting
This was a retrospective cross-sectional review of women managed in the labor and postnatal wards of the LUTH, Idi-Araba, Nigeria, over a 5-year period. LUTH is the teaching hospital of the College of Medicine, University of Lagos. It has about 800-bed spaces and serves as a referral center for other government-owned and private hospitals in the state and its environs. It is located on the mainland of Lagos, which has a population of over 20 million inhabitants.
Ethical considerations
Ethical approval was obtained from the Health Research Ethics Committee (HREC) of LUTH. Approval number was ADM/DCST/HREC/APP/8127. Ethical principles according to Helsinki’s declaration were observed throughout the study duration.
Study population and eligibility criteria
The antenatal and neonatal case notes of all deliveries complicated with abruptio placentae between January 1, 2015, and December 31, 2019, were retrieved from the Medical Records Department. Those who had antepartum hemorrhage without a certain diagnosis were excluded from the study.
Data collection and analysis
A study pro forma was used to collect relevant data such as patients’ sociodemographic data, parity, gestational age (calculated from the last menstrual period and/or early ultrasound scan), maternal outcome, and perinatal outcome. Data were entered and analyzed using the IBM Statistical Package for Social Sciences (SPSS Statistics), version 23, IBM Corp., Armonk, NY, USA. Categorical variables were summarized and presented as frequency distribution tables, whereas continuous variables were presented as mean and standard deviation.
The criteria for the diagnosis of abruptio placentae were vaginal bleeding from the premature separation of a normally situated placenta from the uterine wall after the age of fetal viability but before the delivery of the fetus.
Maternal outcome measures
The maternal outcome measures were acute renal failure, disseminated intravascular coagulation, postpartum anemia, postpartum hemorrhage, and maternal death.
Perinatal outcome measures
The perinatal outcome measures were early neonatal death, fresh stillbirth, birth asphyxia, and perinatal deaths.
Results
During the 5-year study period, a total of 8305 women were admitted into LUTH labor and postnatal wards for various obstetric indications. Of these, 87 women presented with the abruptio placenta out of which 80 women had all their data retrieved (91.9%) and were used for the analysis of maternal and perinatal outcomes giving the prevalence of abruptio placenta of 0.96%.
[Table 1] shows the socio-demographic characteristics of the study participants; the mean maternal age at presentation was 31.22 ± 0.52 years. Forty percent were multiparous, 35% were nulliparous, whereas 25% were primiparous; 57.5% were unbooked; and 42.5% had antenatal care in our facility. Most of the women presented in the third trimester; the mean gestational age at presentation was 35.5 ± 0.42 weeks.{Table 1}
[Table 2] and [Table 3] show maternal complications and perinatal outcomes in women with abruptio placentae, respectively. Vaginal bleeding occurred in 26.3%; 21% had abdominal pain; 12.5% had hard and woody uterus with tenderness; and 2.5% were asymptomatic. Maternal outcomes of interest were acute renal failure, which occurred in 6.25% (three) of patients, disseminated intravascular coagulopathy 2.08% (1) and 37.5% (18), maternal mortality 2.08% (1).{Table 2} {Table 3}
The peak gestational age at presentation was noticed to be more in the third trimester as seen in the scatter chart above [Figure 1]. Mean gestational age was 35.5 ± 0.42 weeks.{Figure 1}
Discussion
Abruptio placentae contributes a significant proportion to causes of the third trimester bleeding; it is a major contributor to maternal and perinatal morbidity and mortality especially in low- and middle-income countries with a paucity of health-care facilities.
This study reviewed the maternal and perinatal outcomes of pregnancies complicated with abruptio placentae over a 5-year period. A total of 80 pregnancies were complicated with abruptio placentae, giving a prevalence of 0.96% during the study period. This figure is slightly lower than the prevalence of 1.03% reported by Akadri et al. in Sagamu, South West, Nigeria.[7]
A majority of the women were unbooked; this is also similar to studies done in other parts of the country who also reported a higher incidence of abruptio placentae in the unbooked pregnant women.[7],[12]
About 61.2% of the cases were delivered by caesarean section, whereas 38.8% had spontaneous vaginal delivery. This finding of our study is also similar to studies done in other tertiary health-care facilities in the country, which reported a similar trend of more operative deliveries in women with abruptio placentae.[7],[13]
Placental abruption carries potential consequences to both mother and fetus. In this study, it was 537.5 per 1000 live births, which is comparable to 580 per 1000 in Enugu, 523 per 1000 in Uganda, and 119.2 per 1000 in the United States.[14],[15],[16]
However, there is a high incidence of morbidity in the mothers; there was a high incidence of postpartum hemorrhage (54.2%) and maternal anemia both antenatally and postnatally with 37.6% receiving transfusion. The diagnosis of abruption is a clinical one, and the condition should be suspected in women who present with vaginal bleeding or abdominal pain or both.
Postpartum hemorrhage was the commonest maternal complication encountered in our study (54.7%). This is higher than studies done in Abuja and Kano, which reported 37.8% and 24.3%, respectively.[12],[17]
Conclusion
Abruptio placentae is still a major obstetric concern in our environment and is still contributing a sizeable proportion to maternal and fetal morbidity and mortality as seen in our study. There may be a need for creating more awareness on the dangers of this obstetrics catastrophe with the aim of early detection by encouraging registration in hospitals and the management of complications to reduce the attendant sequelae.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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