Abstract
BackgroundAbruptio placentae remains a major cause of maternal and perinatal morbidity and mortality in developing countries. Little is known about the burden of abruptio placentae in Tanzania. This study aimed to determine frequency, risk factors for abruptio placentae and subsequent feto-maternal outcomes in women with abruptio placentae.MethodsWe designed a retrospective cohort study using maternally-linked data from Kilimanjaro Christian Medical Centre (KCMC) medical birth registry. Data on all women who delivered live infants and stillbirths at 28 or more weeks of gestation at KCMC hospital from July 2000 to December 2010 (n = 39,993) were analysed. Multivariate logistic models were used to calculate odds ratios (OR) and 95 % confidence intervals (CIs) for risk factors, and feto-maternal outcomes associated with abruptio placentae.ResultsThe frequency of abruptio placentae was 0.3 % (112/39,993). Risk factors for abruptio placentae were chronic hypertension (OR 4.1; 95 % CI 1.3–12.8), preeclampsia/eclampsia (OR 2.1; 95 % CI 1.1–4.1), previous caesarean delivery (OR 1.3; 95 % CI 1.2–4.2), previous abruptio placentae (OR 2.3; 95 % CI 1.8–3.4), fewer antenatal care visits (OR 1.3; 95 % 1.1–2.4) and high parity (OR 1.4; 95 % CI 1.2–8.6). Maternal complications associated with abruptio placentae were antepartum haemorrhage (OR 11.5; 95 % CI 6.3–21.2), postpartum haemorrhage (OR 17.9; 95 % 8.8–36.4),), caesarean delivery (OR 5.6; 95 % CI 3.6–8.8), need for blood transfusions (OR 9.6; 95 % CI 6.5–14.1), altered liver function (OR 5.3; 95 % CI 1.3–21.6) and maternal death (OR 1.6; 95 % CI 1.5–1.8). In addition, women with abruptio placentae had prolonged duration of hospital stay (more than 4 days) and were more likely to have been referred during labour. Adverse fetal outcomes associated with abruptio placentae include low birth weight (OR 5.9; 95 % CI 3.9–8.7), perinatal death (OR 17.6; 95 % CI 11.3–27.3) and low Apgar score (below 7) at 1 and 5 min.ConclusionsFrequency of abruptio placentae is comparable with local and international studies. Chronic hypertension, preeclampsia, prior caesarean section delivery, prior abruptio placentae, poor attendance to antenatal care and high parity were independently associated with abruptio placentae. Abruptio placentae was associated with adverse maternal and foetal outcomes. Clinicians should identify risk factors for abruptio placentae during prenatal care when managing pregnant women to prevent adverse maternal and foetal outcomes.
Highlights
Abruptio placentae remains a major cause of maternal and perinatal morbidity and mortality in developing countries
The objective of this study was to determine the frequency, risk factors for abruptio placentae and feto-maternal outcomes associated with abruptio placentae in Tanzania
Our study confirmed that chronic hypertension, preeclampsia/eclampsia, previous caesarean delivery or abruptio placentae and high parity are independent risk factors for abruptio placentae
Summary
Abruptio placentae remains a major cause of maternal and perinatal morbidity and mortality in developing countries. Abruptio placentae is defined as placental detachment before and during delivery [1] It occurs in about 0.38–1 % of singleton births, and the incidence increases among twin pregnancies, ranging from 1 to 2 % [2, 3]. It is a major obstetric complication associated with an increased risk of foetal and maternal morbidity and mortality globally, especially in developing countries [1, 4,5,6]. Abruptio placentae has been associated with adverse foetal outcomes including low birth weight, preterm birth, intrauterine growth restriction, birth asphyxia, fetal distress, low apgar score, transfer to neonatal intensive care unit, stillbirth [1, 10,11,12], congenital anomalies and perinatal death ranging from 4.4 to 67.3 % [1, 9, 13]
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