An audit of patients with abruptio placentae in the Pretoria Academic Complex

Abstract

BACKGROUND: Obstetric hemorrhage is the third most common cause of maternal death in South Africa. Abruptio placentae (AP) contributed to 12.9% of deaths caused by haemorrhage between 2017 and 2018. OBJECTIVE: To investigate the risk factors, management and outcomes of pregnancies affected by AP. METHODS: We conducted a prospective descriptive study in a one-year period at the Pretoria Academic Complex (PAC). All patients who presented with AP were recruited for the study. The demographics, risk factors, management, complications and outcomes were reported using descriptive statistics. RESULTS: One hundred women with AP presented during the study period, representing an incidence of 1% of pregnancies at PAC. Sixtyone percent of the women had caesarean delivery while 37% had vaginal delivery. A minority of women presented with known risk factors of AP in this setting. Two comparison groups were defined based on the degree of placental separation from the decidua, i.e. >50% and <50%. A woody hard abdomen occurred more frequently in patients with >50% AP (43% v. 57%; p=0.002). More women had postpartum haemorrhage in the >50% group (67% v. 33%; p=0.001). Fifty-eight (58%) live babies and 44 (44%) stillborn babies were delivered. CONCLUSION: The known risk factors of AP were largely absent in women with AP in this setting. The typical clinical findings of AP were late signs associated with severe placental separation. Early resuscitation and delivery of the fetus can positively influence perinatal and maternal morbidity and mortality.