The Retrospective Analysis of Abruptio Placenta Cases In a Tertiary Center: Risk Factors and Perinatal Outcomes

Abstract

89 Dinçgez Çakmak et al., Analysis of Abruptio Placenta Cases / doi: 10.14744/hnhj.2018.04900 branes, smoking, and trauma [8–14]. Placental abruption is one of the most important complications of pregnancy. It is associated with increased maternal and fetal mortality and morbidity [6,9]. The most common and severe maternal complications, which can be even life-threatening, are requirement of massive transfusion, hemorrhagic shock, requirement of hysterectomy, acute renal failure, and disseminated intravascular coagulation. Prematurity and related complications, fetal hypoxia, and fetal demise are the most commonly encountered perinatal complications [15]. Early diagnosis of placental abruption is crucial to prevent its catastrophic clinical consequences [1]. Most of the time, placental abruption requires clinical diagnosis. The most common clinical findings are vaginal bleeding, uterine contractions, and pain. Ultrasonographic findings are reported to be present only in 50% of cases; and normal ultrasonographic findings do not allow ecartation of placental abruption [16]. This study aimed to analyze risk factors, laboratory parameters, and pregnancy outcomes of patients who underwent cesarean section with an initial diagnosis of placental abruption that was confirmed during the operation. Materials and Methods This study was conducted in The University of Health Sciences Bursa Yuksek Ihtisas Research and Training Hospital. We included 91 patients whose initial diagnosis of placental abruption was intraoperatively confirmed during cesarean section between January 2016 and April 2018. Patient records were obtained from computer system, and patient files were retrospectively analyzed. Age, gravida, parity, gestational age at delivery, the clinical and sonographic findings at first admission, predisposing factors (hypertension, pre-eclampsia, polyhydramnios, non-vertex presentation, early rupture of membranes, preterm labor, intrauterine growth restriction, smoking, trauma), systolicdiastolic blood pressures, hemoglobin level, platelet count, aspartate (AST) and alanine (ALT) aminotransferase levels at first admission, the gender of fetuses, birth weights, firstand fifth-minute Apgar scores, fetal demise rate, neonatal intensive care unit requirement, and maternal complications (disseminated intravascular coagulation, hypovolemic shock, acute renal failure, hysterectomy requirement, pulmonary edema, transfusion requirement, death) were recorded. Patients who complained of vaginal bleeding, uterine tenderness, and painful uterine contractions together with ultrasonographic findings like subchorionic and retroplacental hematoma, heterogeneity in placental tissue, and increased placental thickness and presence of preplacental and retroplacental collection were initially diagnosed as placental abruption. Definitive diagnosis was made by the macroscopic observation of detached area of placenta, retroplacental bleeding, or coagulum, intraoperatively. The mean arterial blood pressure was calculated by using the following formula: [(2 × diastolic blood pressure) + systolic blood pressure]/3. Chronic hypertension was defined as systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg before 20th gestational week or before pregnancy. Pre-eclampsia was defined as systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg after 20th gestational week accompanied with proteinuria (>300 mg/24 h or +1 by dipstick) or hypertension without proteinuria accompanied with thrombocytopenia, visual symptoms, pulmonary edema, increased serum creatinine levels, and abnormal liver and kidney function tests [17]. The definition of preterm labor was accepted as occurring between 24 and 37 gestational weeks; and that occurring before 34 gestational weeks was accepted as early preterm labor. Rupture of membranes before the onset of labor was classified as early rupture of membranes; and the presence of regular uterine contractions or cervical dilatation before 37 gestational weeks was classified as preterm labor [18]. In the neonatal intensive care unit of our hospital, admission criteria are cardiorespiratory monitorization requirement, severe neonatal jaundice, <32 weeks preterm births, presence of respiratory distress syndrome, neonatal sepsis, and neonatal blood transfusion requirement. The SPSS software (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 20. p=0. Armonk, NY: IBM Corp.) was used to perform statistical analysis, and a p value of ≤0.05 was considered as statistically significant. The Kolmogorov–Smirnov test was used to assess whether the variables followed normal distribution or not. Normally distributed variables were given as mean±standard deviation, and those not normally distributed were given as median. Descriptive statistical analysis was performed. Results were given as numbers and percentages. In our country, ethical committee approval is not required for retrospective studies; this study was conducted in accordance with the Helsinki Declaration and its later amendments or comparable ethical standards. Moreover, it was approved by the head of the department and the institution. 90 Dinçgez Çakmak et al., Analysis of Abruptio Placenta Cases / doi: 10.14744/hnhj.2018.04900