Clinical Analysis Of Risk Factors And Complications Of Placental Abruption

Objective:This study was undertaken in order to investigate the incidence, risk factors, complications, the importance of ultrasound examination, obstetrical managements, meanwhile evaluate the maternal and fetal outcomes of placental abruption (PA).Data and methods:This was a retrospective analysis was carried out of 76 pregnant women who were demonstrated PA after delivery or during cesarean section by clinical and pathological study between January 2006 and June 2010 at Qilu hospital of Shandong Univetsity.Use spss13.0 to carry on statistics analysis.All measurement material uses x±s to indicate and compare the two different groups use two-sample mean t test; the significance of different rates between the two groups useχ2 test, there are significant differences between the two groups if p<0.05.Results:The total delivery number is 10366 from January 2006 to June 2010,Among which 76 cases sufferd from PA.The incidence of PA was 0.73%(76/10366).The maternal age between 18 and 43,the mean age 27.32±2.98,45 cases appeared at the gestational age 26-36 weeks ,31 cases appeared at 37-41 weeks, the incidences between 26-32 weeks,32-36 week,≥36 weeks are 6.58%,38.16%,55.26%,respectively.Delivery weeks:26-41 weeks,362/7 weeks on average.Mild PA (include typeⅠandⅡ) the separate part≤1/3, among which the typeⅠ25 cases (32.89%),typeⅡ21 cases(27.63%),46 cases totally; severe PA(include typeⅢ) the separate part> 1/3,30 cases(39.47%)totally. There were 6 patients (7.89%) who attended more than 10 times of antenatal monitoring suffered PA,13 patients(17.11%) attended 5 to 9 times,57 patients(75.00%) attended less than 5 times. Parity: the number of primipara is 49 (64.47%), multipara 27 cases(35.53%), among which 1case suffered PA 2 times continuously. The single birth 74 cases(97.37%),2 cases of twins (2.63%).The etiologies of PA:the patients accompanied by hypertensive disorders in pregnancy were 30 cases(39.47%), premature rupture of the membranes(PROM) 15 cases(19.74%),gestational diabetes mellitus (GDM) 6 cases (7.89%), polyhydramnios 5 cases(6.58%), too short of the umbilical cord 4 cases(5.26%)include 2 cases with relatively short umbilical cord( cord around neck 3 circles),trauma 3 cases (3.95%), induced by oxytocin and misoprostol used in odinopoeia 3 cases (3.95%), thrombocytopenia 2 cases (2.63%), pregnancy with hysteromyoma 2 cases (2.63%), in twins one fetal detained after the first fetus was born 2 cases (2.63%), placenta previa with PA 1 case (1.32%),unclear reason 3 cases (3.95%). The symptom and sign of PA:vaginal bleeding 50 cases (65.79%), blooded amniotic fluid 34 cases (44.74%), abdominal pain 62 cases (81.58%), fetal distress 53 cases (69.74%), uterine hypertonicity and tenderness 25 cases(32.89%), shock caused by blood loss 22 cases (28.95%), when they saw the doctor 11 fetuses were dead in uteri, PA diagnosed by ultrasound examination, non-symptom 2 cases (2.63%), diagnosed PA after placental examination. Diagnose result:prenatal diagnosis of PA in accordance with diagnosis after delivery were 65 cases (85.53%), among which typeⅠ16 cases (24.62%), typeⅡ19 cases (29.23%), typeⅢ30 cases (46.15%); diagnose after delivery 11 cases(14.47%), among which 5 cases were found PA during cesarean section.6 cases were found PA after vaginal delivery placentas were examined. Among the 76 PA cases ultrasound examination found that 63 cases (82.89%) were abnormal include thick placenta 29 cases (38.16%), hematoma retroplacent 22 cases(28.95%), marginal placenta hematoma 7 cases (9.21%), hematoma between members and uterine wall 5 cases (6.58%), and normal cases 13(17.11%). Clinical managements: 51 cases (78.46%) of the 65 women(85.53%) who were diagnosed PA before deliver gave birth by cesarean section, among which 7 cases were dealed with hysterotomy delivery when found dead fetus in uterus,10 neonates suffered heavy asphyxiation,2 neonates slight asphyxiation,3 cases (3.95%) subtotal hysterectomy were taken during cesarean section,14 cases(21.54%) with vaginal delivery,8 cases dealed with instrumental delivery; Among the 11 PA women (14.47%)who were diagnosed after delivery 5(45.45%) cases were dealed with cesarean section,6 cases(54.54%) with vaginal delivery. The influence of PA to mother and baby:postpartum hemorrhage (PPH) 35 cases (46.05%), disseminated intravascular coagulation(DIC) 10 cases (13.16%), acute renal failure(ARF) 3 cases (3.95%),during operating 13 cases(17.11%) of Couvelaire uterus were found,the separate part>50%, bleeding-out 800-1500ml, after oxytocin injection, uterus massage, warm saline foment, most of the uteri resumed contractively, only 3 (3.95%) of them were dealed with subtotal ectomy of uterus because of DIC. Perinatal death 22 cases(22/78), stillborn fetuses 11 cases (14.10%), 7 cases(8.97%) were dead when attending the hospital,4 cases(5.13%)were dead after attending hospital, stillbirth 4 cases (5.13%), neonate death 7 cases(8.97%), preterm birth 9 cases (11.54%). The maternal death was none. Conclusion:PA is the serious complication during the second and third pregnancy, it accours acutely, progress quickly, most seriously it can threaten the life of mother and baby if it isn't treated in time. According to the symptoms and signs of PA associate with the results of ultrasound examination, make the right decisions to cure in time will improve the perinatal outcomes of mother and baby. In order to reduce the incidence of mother and perinatal fetus morbidity, we should pay attention to antenatal education activities, encourage the pregnant women to attend antenatal monitoring on schedule to discover and prevent pathological pregnancy in time.