Abstract:

Background: An Abruptio placenta (AP) is one of the most serious obstetric complication and life-threatening for both the fetus and mother worldwide. The situation is worse in resource-poor settings including Tanzania; it contributes significantly high maternal and perinatal morbidity and mortality.

Objectives: To determine the fetal-maternal outcomes of abruption placenta and its predictors of adverse outcomes at Bugando Medical Centre.

Methodology: This was a descriptive cross sectional hospital-based study conducted for six months starting October 2012 until April 2013. We recruited 95 women who presented with clinical features of AP. Social demographical, clinical presentations, laboratory investigations and fetal parameters were collected and recorded on pre-tested questionnaires and analyzed by computer using STATA 11 and P-values of less than 0.05 were significant.

Results: A total of 3797deliveries were conducted during a 7 months period with cases of AP giving incidence of 2.5%. Majority women with AP 46.3% were under 25yrs of age, and incidence of AP higher in Anemic women 89 (93.7%) and multi-parous 76 (80%). C-section was the commonest mode of delivery 49(51.6%) with low perinatal death (p=0.001) and reduced hospital stay. There were three maternal deaths due to pulmonary embolism, coagulopathy and irreversible shock. Statistically, maternal death was strongly predicted by DIC (p=0.04). Prolonged hospital stay was predicted by maternal shock (p=0.05), mode of delivery (p<0.001) and ICU admission (p=0.015). The striking fetal adverse outcomes were prematurity 78(82.1%) followed by fetal distress 65(68.4%), and in utero-death 30(31.6%). Sixty four babies born alive but 22 died within 1st week of life due to prematurity and birth asphyxia. Perinatal death 52(54.8%) was predicted by low birth weight (prematurity) (p<0.001), SVD mode of delivery (p=0.001), birth asphyxia (p<0.001), retro placental clot >700ml (p<0.001).

Conclusion and Recommendation: The incidence in our setting is significantly higher with poor maternal and fetal outcomes. The predictors of maternal adverse outcomes due to AP were found to be DIC, anemia, PPH, ICU admission and maternal shock while predictors for perinatal death due to AP was found to be low birth weight, birth asphyxia, maternal anemia, low Apgar score, retro placental clot volume above 700ml an SVD mode of delivery.
Predictors of adverse fetal maternal outcomes should closely be monitored with prompt delivery as well as having adequate maternal-neonatal intensive care facilities so as to improve chance of survival and reduce hospital stay. Further research is required to determine the reasons of excess males in pregnancies complicated by placental abruption and long-term follow-up study would be useful in future studies.