engleski

Placental abruption as obstetric emergency in Zagreb clinical hospital 1998-2000

Introduction: Placental abruption is defined as complete or partial segregation of a normally implanted placenta before the third stage of labor. It is known as one of the most serious obstetric complications, with high perinatal mortality and possible maternal mortality. Material and Methods: In the Department of Gynecology and Obstetrics, Clinical Hospital of Zagreb, during the period of 3 years (1998-2000) 14710 delivered women were observed. In 45 cases the diagnoses of placental abruption was made. The following data were obtained from patients medical charts: age, parity, hospital/outpatient, smoking habit, previous placental abruption, preeclampsia/hypertension, ultrasound diagnose, vaginal bleeding as symptom, CTG, mode of delivery, perinatal outcome, hemorrhagic shock as complication, and transfusion as therapy. 8 medical charts could not be found. All the data were analyzed by SPSS 10 statistical program. Results: From the total number of 14710 deliveries, 45 (0, 3%) were complicated with placental abruption. 20 women (54, 1%) were from the age group 31-40. 32 (86, 5%) were multiparae. 29 (78, 4%) were patients from our clinic and 8 (21, 6%) were "transport in utero" from other hospitals. 14 (37, 8%) were smokers. 1 (2, 7%) had placental abruption diagnosed in previous delivery. 6 (16, 2%) were diagnosed with preclampsia or hypertension before pregnancy. In 10 (27, 0%) retroplacental hemorrhage was diagnosed by ultrasound before delivery. Vaginal bleeding with or without abdominal pain was the main symptom in 24 (64, 8%) cases. In 24 (64, 8%) cases cardiotocography showed evidence of fetal distress (prepathologic or pathologic CTG). 13 (35, 1%) pregnancies were terminated with vaginal delivery and in 24 (64, 9%) cases Cesarean Section was preformed. Perinatal outcome was: mors in utero in 4 (10, 8%) cases, neonatal death in 3 (8.1%) cases and live newborns in 30 (81, 1%) cases, respectively. Hemorrhagic shock occurred as maternal complication in 5 (13, 5%) cases and all of them received blood transfusion or plasma as therapy. None of the pregnant women died. Conclusion: Placental abruption complicated 0, 3% pregnancies in our clinic (literature data 0, 4-1%). It caused hemorrhagic shock in 13, 5% cases, but the maternal mortality was 0% in our clinic, though the literature data showed up to 1%. Perinatal death as complication of this condition was 18, 9%, what was very close to literature data (15-21%). These numbers place placental abruption into very serious emergency conditions in obstetrics.

placental abruption

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