Decision-to-delivery interval in suspected placental abruption – association with pregnancy outcome

Abstract

Objective: To determine the association between decision to delivery interval (DDI) and short-term perinatal outcome in cases of suspected placental abruption delivered by cesarean section (CS).Study design: A retrospective cohort study of all cases of placental abruption delivered by CS (2010–2012) in a single university affiliated tertiary center. Composite adverse neonatal and maternal outcome were assessed.Results: The rate of placental abruption was 0.5% (140/27 677 deliveries) and 65/140 (46%) were delivered by CS. Indications for CS were non-reassuring fetal heart rate (NRFHR) in 32/65 (49.3%), maternal bleeding 20/65 (30.7%) and other indications in 13/65 (20%). Obstetrical and labor characteristics were similar unrelated to the indication for CS. Gestational age at delivery was higher in the group operated due to NRFHR (36 ± 4.3, 34 ± 3.7 and 32 ± 4.1 weeks, respectively, p = 0.03). DDI was shortest when CS was due to NRFHR followed by CS due to maternal bleeding or other indications (23 ± 19, 30 ± 16, 50 ± 40 min, respectively, p = 0.001). The umbilical artery PH was lower in those who operated due to NRFHR (7.17 ± 0.17, 7.23 ± 0.06 and 7.30 ± 0.09, respectively, p = 0.002). The overall rate of neonatal and maternal composite outcome was 66% and 40%, respectively with no significant difference in relation to indication for CS.Conclusion: In cases of suspected placental abruption, fetal short-term morbidity is probably related to the indication for CS and not only to DDI.