Fetal Heart Sounds Research Articles

The burden of and factors associated with misclassification of intrapartum stillbirth: Evidence from a large scale multicentric observational study.

Global estimates suggest 2.6million stillbirths and 2.5million neonatal deaths occur annually worldwide. The majority of these deaths occur in low resource settings where analysis of health metrics and outcomes measurements may be challenging. We examined the misclassification of documented intrapartum stillbirth and factors associated with misclassification. A prospective observational study was performed in 12 public hospitals in Nepal. Data were extracted from the medical records of all births that occurred during the 6-month period of the study. For the study purpose, we classified birth outcome based on the presence of fetal heart sound (FHS) at admission and use of neonatal resuscitation. The health worker-documented intrapartum stillbirths were considered potentially misclassified when there were FHS present at admission and no resuscitation initiated after birth. The association between potentially misclassified intrapartum stillbirth and complications during labor, birthweight and gestational age was assessed using Pearson's chi-square test, bivariate and multivariate logistic regression. A total of 39 562 mother-infant dyads were enrolled in the study, all of whom had FHS at admission. Among the 391 intrapartum stillbirths recorded during the study, 180 (46.0%) of them had FHS at admission with no resuscitation initiated after birth and were considered potentially misclassified intrapartum stillbirths. Among these potentially misclassified intrapartum stillbirths, 170 (43.5%) had FHS present 15minutes before birth and 10 had no FHS 15minutes before birth Among the potentially misclassified intrapartum stillbirths, 23.3% had complications during labor, 93.3% had birthweight less than 2500 g and 90.0% were born preterm. The risk of intrapartum misclassification was nearly four times higher among low birthweight babies (adjusted odds ratio [aOR] 3.5, 95% confidence interval [CI] 1.8 to 7.0, P<0.001) and five times higher among preterm babies (aOR 5.3, 95% CI 3.0 to 9.3, P<0.001). We estimate that 46% of intrapartum stillbirths were potentially misclassified intrapartum stillbirths. Improving quality of both FHS monitoring and neonatal resuscitation as well as measurement of the care will reduce the risk of potentially misclassified intrapartum stillbirth and consequently intrapartum stillbirth.

Clinical analysis and classification of placental abruption

Objective To investigate the diagnosis, treatment, and maternal and fetal outcomes of placental abruption. Materials and methods We recruited 585 cases of placental abruption from the Women and Children’s Hospital Affiliated to Xiamen University between January 2012 and December 2017. Cases were categorized into four groups (class 0–III) according to the clinical guidelines published by the Obstetrics and Gynecology Branch of the Chinese Medical Association. We then compared clinical data and auxiliary examinations across the four groups. Results The differences were statistically significant (p < .01) among the four groups of placental abruption with regard to the incidence of an abnormal ultrasound finding. Positive ultrasound signs were evident in 6.4% of the patients categorized as class 0 and 100.0% of patients categorized as class III. Monitoring showed that fetal heart rate (FHR) was abnormal in class II patients with placental abruption; patients in class III showed no fetal heart sounds. Cesarean section was carried out for 26.6%, 75.1%, 65.2%, and 47.1% of patients in classes 0, I, II, and III, respectively. The rate of cesarean section for classes I and II was the highest, while the lowest rate occurred for class 0. Postpartum hemorrhage occurred in 2.5%, 9.3%, 15.2%, and 29.4% of patients across the four groups, DIC occurred in 0.0%, 1.3%, 2.3%, and 23.5% of cases, and perinatal death occurred in 1.0%, 1.3%, 7.6%, and 100.0% of cases, respectively. The highest incidence of postpartum hemorrhage was in class III (29.4%) and the lowest was in class 0 (2.5%). The highest incidence of DIC was in class III (23.5%) and the lowest was in class 0 (0.0%). The highest incidence of neonatal asphyxia was in class II (34.1%) and the lowest was in class 0 (10.1%). Regarding perinatal death, the highest incidence was in class III (100.0%) and the lowest was in class 0 (1.0%). These data showed significance differences when compared across the four groups of patients (p < .01). Conclusions We recommend that the diagnosis of placental abruption should consider risk factors, clinical features, FHR monitoring, and dynamic ultrasound monitoring. Early diagnosis and treatment can improve maternal and infant prognosis.

AcCorps: A low-cost 3D printed stethoscope for fetal phonocardiography.

The analysis of fetal heart rate provides valuable information regarding the fetus wellbeing. Fetal phonocardiography is a low-cost and passive method allowing the acquisition of fetal heart rate by recording acoustic vibrations on the mother's abdomen. However, most of available stethoscopes are not optimized for a robust acquisition of fetal heart sound. In this publication, we investigated a new design of low-cost and 3D printed stethoscope. This device was optimized to provide an acoustic amplification especially in the low-frequency band which corresponds to the fetal heart sounds. This device was tested i) in silico, ii) on a test bench and iii) on 5 pregnant volunteers.

A Heart Rate Calculation Method Based on Dynamic Rectangular Window Interception

Aiming at the detection of instantaneous heart rate of heart sounds, a dynamic rectangle window interception calculation method was designed and a heart sound acquisition system was developed. The system can be used to monitor the state of heart at home for adults and foetuses. The algorithm can be used for analysis of adult heart sounds, fetal heart sounds acquired by the acquisition system and ultrasound Doppler heart sound. The algorithm firstly performs a normalization processing on the sound signal and then filters the filter, captures the data in a rectangular frame dynamically, locates the heart sound signal, calculates the instantaneous heart rate, and finally obtains the heart rate with high accuracy. Study shows that the heart rate algorithm has the characteristics of high recognition accuracy and fast calculation speed, which can realize the convenient and rapid home heart rate monitoring for adults and fetuses.

Women's Attitudes Toward Self-Monitoring of Their Pregnancy Using Noninvasive Electronic Devices: Cross-Sectional Multicenter Study.

BackgroundPregnancy can be distressing, particularly if expectant mothers are worried about the well-being of their fetus. Consequently, the desire for reassurance and frequent fetal monitoring is often pronounced. Smart wearable devices and telemedicine are promising tools that could assist women in self-monitoring their pregnancy at home, hence disburdening emergency departments (EDs). They present the possibility to clarify the need for urgent care remotely and offer tighter pregnancy monitoring. However, patients’ acceptance of such new technologies for fetal monitoring has not yet been explored extensively.ObjectiveThis survey aimed to elucidate the attitudes of women toward self-monitoring of their pregnancy using noninvasive electronic devices. The technical details of the proposed devices were not specified.MethodsA cross-sectional multicenter study was conducted at the departments of obstetrics of the University Hospitals of Heidelberg and Leipzig, Germany. All patients seen in the obstetrics clinic who were above 18 years were offered participation. We designed a survey questionnaire including validated instruments covering population characteristics, issues in current and past pregnancies, as well as attitudes toward self-monitoring of pregnancy with smart devices.ResultsA total of 509 pregnant women with no previous experience in telemedicine participated. Only a small minority of 5.9% (29/493) regarded self-monitoring with wearable devices as an alternative to consulting their physicians. Along these lines, only 7.7% (38/496) strongly believed they would visit the ED less often if such devices were readily available. However, if the procedure were combined with a Web-based telemetric physician consult, 13.5% (66/487) would be highly motivated to use the devices. Furthermore, significantly more women regarded it as an alternative prior to seeing a doctor when they perceived a decline in fetal movements (P<.001). Interestingly, women with university degrees had a higher propensity to engage in pregnancy self-monitoring compared with women without one (37% vs 23%; P=.001). Of the participants, 77.9% (381/489) would like smart wearable devices to measure fetal heart sounds, and 62.6% (306/489) wished to use the devices on their own. Feedback from a doctor or midwife was also very important in their choice of such devices (61.8%, 301/487 wished feedback). The intended frequency of use differed vastly among women, ranging from 13.8% (65/471) who would like to use such a device several times per day to 31.6% (149/471) who favored once per week at most.ConclusionsOur results point to a skeptical attitude toward pregnancy self-monitoring among pregnant women. Nevertheless, many women are open to using devices for pregnancy monitoring in parallel to consulting their physician. The intention to use such devices several times daily or weekly, expressed by more than half of the participants, highlights the potential of such technologies.

Simulator of Foetal Phonocardiographic Recordings and Foetal Heart Rate Calculator

Nowadays, the classic diagnostic method to monitor general foetus well-being using the foetal heart rate conditions, ultrasonic cardiotography, is called into question. A valuable alternative is foetal phonocardiography, a passive and low-cost recording of foetal heart sounds. This paper presents a software which generates synthetic foetal phonocardiographic recordings simulating different recording conditions (by modifying noise level). From a real foetal phonocardiographic recording this software calculates the foetal heart rate. The software was developed using information picked from the literature especially for identifying the waveforms and characteristics of foetal and maternal heart sounds, and the different noises involved in real phonocardiographic recordings. Considering the possibility to simulate different recording situations and physiological or pathological foetal conditions just by modifying some parameters, this simulator software can be useful for testing different foetal-heart-rate extraction algorithms, like the authors’ one. In this paper are presented the different postulates used for developing this software.

Birth risks according to maternal height and weight - an analysis of the German Perinatal Survey.

Objective To investigate the variability in the prevalences of selected birth risks in women of different heights and weights. Methods Data from the German Perinatal Survey of 1998-2000 were analyzed: 503,468 cases contributed to our analysis of the prevalences of selected birth risks specified according to maternal weight groups, 502,562 cases contributed to our analysis according to maternal height groups and 43,928 cases contributed to our analysis of birth risks in women with a body mass index (BMI) of 21-23 kg/m2 but different heights and weights. Data analysis was performed using SPSS version 22. Results Some birth risks varied substantially by maternal height in women with a "normal" BMI of 21-23 kg/m2: the prevalence of post-term birth increased from 8.7% in women with a height of 150 cm to 13.5% in 185 cm tall women, the prevalence of preterm birth decreased from 5.9% (150 cm tall women) to 3.1% (185 cm tall women), a pathologic cardiotocography (CTG) or poor fetal heart sounds on auscultation occurred in 19.4% of the 150 cm tall women but only in 9.2% of 185 cm tall women and cephalopelvic disproportion decreased from 12.3% (150 cm tall women) to 1.2% (185 cm tall women). Analyses of women in different body height and weight groups (without restriction of BMI) likewise showed differences in the prevalences of some birth risks. Conclusion Birth risks may vary by height and weight in women with the same, "normal" BMI. BMI should not be the only way by which the impact of maternal height and weight is assessed with regard to perinatal outcomes such as birth risks.

Validation of beat by beat fetal heart signals acquired from four-channel fetal phonocardiogram with fetal electrocardiogram in healthy late pregnancy

Fetal heart rate monitoring is an essential obstetric procedure, however, false-positive results cause unnecessary obstetric interventions and healthcare cost. In this study, we propose a low cost and non-invasive fetal phonocardiography based signal system to measure the fetal heart sounds and fetal heart rate. Phonocardiogram (PCG) signals contain acoustic information reflecting the contraction and relaxation of the heart. We have developed a four-channel recording device with four separated piezoelectric sensors harnessed by a cloth sheet to record abdominal phonogram signals. A multi-lag covariance matrix based eigenvalue decomposition technique was used to extract fetal and maternal heart sounds as well as maternal breathing movement. In order to validate the fetal heart sounds extracted by PCG signal processing, 10 minutes’ simultaneous recordings of fetal Electrocardiogram (fECG) and abdominal phonogram from 15 pregnant women (27 ± 5-year-old) with fetal gestation ages between 33 and 40 weeks were obtained and processed. Highly significant (p < 0.01) correlation (r = 0.96; N = 270) was found between beat to beat fetal heart rate (FHRECG) from fECG and the same (FHRPCG) from fetal PCG signals. Bland–Altman plot of FHRECG and FHRPCG shows good agreement (<5% difference). We conclude that the proposed beat to beat fetal heart rate measurement system would be useful for monitoring fetal neurological wellbeing as a better alternative to traditional cardiotocogram based antenatal fetal heart rate monitoring.

Labour & delivery monitoring patterns in facility births across five districts of India: A cross-sectional observational study.

Background & objectives:India has recorded a marked increase in facility births due to government's conditional cash benefit scheme initiated in 2005. However, concerns have been raised regarding the need for improvement in the quality of care at facilities. Here we report the monitoring patterns during labour and delivery documented by direct observation in reference to the government's evidence-based guidelines on skilled birth attendance in five districts of India.Methods:A cross-sectional study design with multistage sampling was used for observation of labour and delivery processes of low-risk women with singleton pregnancy in five districts of the country. Trained research staff recorded the findings on pre-tested case record sheets.Results:A total of 1479 women were observed during active first stage of labour and delivery in 55 facilities. The overall frequency of monitoring of temperature, pulse and blood pressure was low at all facilities. The frequency of monitoring uterine contractions and foetal heart sounds was less than the expected norm, while the frequency of vaginal examinations was high at all levels of facilities. Partograph plotting was done in only 15.8 per cent deliveries, and labour was augmented in about half of the cases.Interpretation & conclusions:The findings of our study point towards a need for improvement in monitoring of maternal and foetal parameters during labour and delivery in facility births and to improve adherence to government guidelines for skilled birth attendance.

Anaesthetic Management of Traumatic Brain Injury in Pregnancy for Emergency Craniotomy

Management of head injury requiring emergency craniotomy in a parturient is indeed challenging. Unexpectedly mild head injury can threaten the life of mother or fetus. A multidisciplinary approach to management which is individualized according to severity of injury and gestational age is appropriate. Neuroanaesthetic approach should strive to provide balance between therapy for mother and risks for fetus. Evidence based recommendations from randomized controlled trials to manage such cases is limited. We report a case of 27 year old woman in late 2nd trimester with extradural and subdural hematoma requiring urgent decompressive craniotomy. Post-operatively, she was managed for two days in the intensive care unit with regular monitoring of Fetal Heart Sound (FHS). Pregnancy continued till term with good outcome of mother and child.

Renal Cell Carcinoma in Pregnancy: Radical Nephrectomy and the Use of Dexmedetomidine

Renal cell carcinoma is sinister cancer, uncommon during pregnancy. A 26-week period of gestation, primigravida pregnant women presented with painless hematuria and left flank fullness. She was found to have left-sided renal cell carcinoma, with no metastasis or vascular invasion. All her preoperative investigations were within normal limits, except for mild anemia. An obstetric evaluation was unremarkable, with normal fetal heart sounds. Perioperative care of pregnant patients for oncosurgery poses great challenges, affecting both the mother and the fetus. Preoperative tocolytic therapy was started to prevent preterm labor, and an obstetrician was kept standby during surgery. A combined general anesthesia with rapid sequence induction and cricoid pressure along with preinduction epidural catheter was administered, followed by the insertion of invasive monitoring lines. Dexmedetomidine use is also highlighted, as it has several beneficial effects and has been safely used in pregnant patients. The tumor was successfully removed, and the patient was transferred to the high-dependency-care unit after extubation. We hereby describe the perioperative anesthetic challenges in this unique case report.

A Low-cost Device for Fetal Heart Rate Measurement

The long-term monitoring of the fetal heart rate (fHR) is important to control the fetal well-being. One of the promising methods for fetal monitoring is fetal phonocardiography which is based on recording fetal heart sounds. This paper presents a compact low-cost device for multi lead fHR measurement. The introduced device allows to monitor fHR non-invasively and with no side effects for the mother or fetus. Moreover, we developed LabVIEW application for the signal processing and analysis.

A Noise Suppression Technique for Fetal Phonocardiogram Monitoring Using Adaptive Neuro-Fuzzy Interference System

Fetal phonocardiography (fPCG) is a passive diagnostic method for monitoring of fetal well-being. In contrast with other fetal heart rate (FHR) monitoring methods, fPCG promises an advantage of long-term and low-cost monitoring. Due to this fact, it is even more important to obtain perfectly clear signal without unwanted noise. Low energy of fetal heart sounds in combination with higher energy of mother heart sounds, acoustic noises produced by fetal movements, uterine contractions and other ambient noises makes fPCG extraction more challenging. This paper presents a technique for noise suppression of fPCG based on artificial intelligence method, namely adaptive neuro-fuzzy interference system.

A Comparative Study on Fetal Heart Rates Estimated from Fetal Phonography and Cardiotocography.

The aim of this study is to investigate that fetal heart rates (fHR) extracted from fetal phonocardiography (fPCG) could convey similar information of fHR from cardiotocography (CTG). Four-channel fPCG sensors made of low cost (<$1) ceramic piezo vibration sensor within 3D-printed casings were used to collect abdominal phonogram signals from 20 pregnant mothers (>34 weeks of gestation). A novel multi-lag covariance matrix-based eigenvalue decomposition technique was used to separate maternal breathing, fetal heart sounds (fHS) and maternal heart sounds (mHS) from abdominal phonogram signals. Prior to the fHR estimation, the fPCG signals were denoised using a multi-resolution wavelet-based filter. The proposed source separation technique was first tested in separating sources from synthetically mixed signals and then on raw abdominal phonogram signals. fHR signals extracted from fPCG signals were validated using simultaneous recorded CTG-based fHR recordings.The experimental results have shown that the fHR derived from the acquired fPCG can be used to detect periods of acceleration and deceleration, which are critical indication of the fetus' well-being. Moreover, a comparative analysis demonstrated that fHRs from CTG and fPCG signals were in good agreement (Bland Altman plot has mean = −0.21 BPM and ±2 SD = ±3) with statistical significance (p < 0.001 and Spearman correlation coefficient ρ = 0.95). The study findings show that fHR estimated from fPCG could be a reliable substitute for fHR from the CTG, opening up the possibility of a low cost monitoring tool for fetal well-being.

Fetal Heart Sounds Detection Using Wavelet Transform and Fractal Dimension.

Phonocardiography is a non-invasive technique for the detection of fetal heart sounds (fHSs). In this study, analysis of fetal phonocardiograph (fPCG) signals, in order to achieve fetal heartbeat segmentation, is proposed. The proposed approach (namely WT–FD) is a wavelet transform (WT)-based method that combines fractal dimension (FD) analysis in the WT domain for the extraction of fHSs from the underlying noise. Its adoption in this field stems from its successful use in the fields of lung and bowel sounds de-noising analysis. The efficiency of the WT–FD method in fHS extraction has been evaluated with 19 simulated fHS signals, created for the present study, with additive noise up to (3 dB), along with the simulated fPCGs database available at PhysioBank. Results have shown promising performance in the identification of the correct location and morphology of the fHSs, reaching an overall accuracy of 89% justifying the efficacy of the method. The WT–FD approach effectively extracts the fHS signals from the noisy background, paving the way for testing it in real fHSs and clearly contributing to better evaluation of the fetal heart functionality.

Detecting fetal heart sounds by means of Fractal Dimension analysis in the Wavelet domain.

Phonocardiography is a low-cost technique for the detection of fetal heart sounds (FHS) that can extend clinical auscultation in mobile and home care setups. The work presented here examines the transferability of a Wavelet Transform (WT)-based method that combines also Fractal Dimension (FD) analysis, previously proposed as WT-FD for the cases of lung and bowel sound analysis [4], to the extraction of FHSs. The WT-FD method has been evaluated with 12 simulated FHS signals and has shown promising results in terms of accuracy and performance (89%) in identifying the location of heartbeat, even in cases of signals with additive noise up to (6dB). This robustness paves the way for WT-FD testing in real FHSs, recorded under clinical setting, clearly contributing to better evaluation of the fetal heart functionality.

Improving Adherence to Essential Birth Practices Using the WHO Safe Childbirth Checklist With Peer Coaching: Experience From 60 Public Health Facilities in Uttar Pradesh, India.

Adherence to evidence-based essential birth practices is critical for improving health outcomes for mothers and newborns. The WHO Safe Childbirth Checklist (SCC) incorporates these practices, which occur during 4 critical pause points: on admission, before pushing (or cesarean delivery), soon after birth, and before discharge. A peer-coaching strategy to support consistent use of the SCC may be an effective approach to increase birth attendants' adherence to these practices. We assessed data from 60 public health facilities in Uttar Pradesh, India, that received an 8-month staggered coaching intervention from December 2014 to September 2016 as part of the BetterBirth Trial, which is studying effectiveness of an SCC-centered intervention on maternal and neonatal harm. Nurse coaches recorded birth attendants' adherence to 39 essential birth practices. Practice adherence was calculated for each intervention month. After 2 months of coaching, a subsample of 15 facilities was selected for independent observation when the coach was not present. We compared adherence to the 18 practices recorded by both coaches and independent observers. Coaches observed birth attendants' behavior during 5,971 deliveries. By the final month of the intervention, 35 of 39 essential birth practices had achieved >90% adherence in the presence of a coach, compared with only 7 of 39 practices during the first month. Key behaviors with the greatest improvement included explanation of danger signs, temperature measurement, assessment of fetal heart sounds, initiation of skin-to-skin contact, and breastfeeding. Without a coach present, birth attendants' average adherence to practices and checklist use was 24 percentage points lower than when a coach was present (range: -1% to 62%). Implementation of the WHO Safe Childbirth Checklist with coaching improved uptake of and adherence to essential birth practices. Coordination and communication among facility staff, as well as behaviors with an immediate, tangible benefit, showed the greatest improvement. Difficult-to-perform behaviors and those with delayed or theoretical benefits were less likely to be sustained without a coach present. Coaching may be an important component in implementing the Safe Childbirth Checklist at scale.Note: At the time of publication of this article, the results of evaluation of the impact of the BetterBirth intervention were pending publication in another journal. After the impact findings have been published, we will update this article on the effect of the intervention on birth practices with a reference to the impact findings.

A Study of Maternal Outcome in Uterine Rupture in Pregnancy at a Tertiary Care Institute

Aim and Objective: The present research was carried out with an objective to determine the incidence, etiology, trend, and management, maternal and fetal outcome of ruptured uterus and to identify the preventive measures. Material and Methods: A prospective observational study was conducted over a period of 2 years from Nov 2012 – Nov 2014 in a tertiary care hospital of Mumbai, India. A total of 40 patients who came with rupture of uterus in pregnancy were studied. These cases were analyzed based on clinical features, etiology and risk factors of rupture uterus, the mode of management and the foetal and maternal outcome. Results: There were 40 cases of uterine rupture out of 32,200 deliveries giving an incidence of 1 in 805 i.e. 0.12%. Most common clinical features were those of classical signs of rupture with ill defined uterine contour, superficially felt foetal parts and absent foetal heart sounds. The commonest cause of rupture was due to separation of previous cesarean scar rupture (72.5%). The lower uterine segment was the commonest site of rupture. Rent repair was the commonest procedure done in the cases of ruptured uterus. Perinatal mortality of 77.5% and maternal mortality of 10% was observed in this study. Conclusion: Skilled attendance with accessible emergency obstetric care and focused antenatal care are key elements for the prevention and management of uterine rupture.

A new tool for foetal phonocardiography simulation.

Among diagnostic techniques for foetal monitoring, phonocardiography is gaining more and more interest for its low cost, passive nature and capability to detect some cardiac diseases. In spite of these characteristics, its use in clinical routine is still limited due to different troubles; for example, signals recorded through maternal abdomen show generally a quite low signal-to-noise ratio, so that detection and analysis of foetal heart sounds result very difficult. In this scenario, the availability of artificial phonocardiographic signals, simulated with conditions resembling different foetal conditions, week of gestation and noise amount, to name someone, can be a very useful tool to train medical staff. In this paper a software for phonocardiography simulation, updated to take account also of the split is presented. The software is completed with a user interface which allow to modify in a simple way simulation parameters. It is worth highlighting that this software can be useful also for testing performances of other analysis software and mathematical tools for recognising of valves components in the heart sounds.

A Clinical Study of Maternal and Fetal Outcome in Abruptio Placenta - Couvelaire Uterus a Preventable Obstetric Catastrophe

Introduction : Hemorrhage is the single most important cause of maternal death worldwide. Obstetrical hemorrhage accounts for almost half of all postpartum deaths in developing countries. Among them Abruptio placenta occurs in around 1% of all pregnancies. Aim of this study was to determine the maternal and fetal outcome in pregnancy complicated by abruption placenta in relation to the risk factors. Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology, Mamata medical college, khammam from January 2010 to December 2014 for a period of five years. All pregnant women who were diagnosed with abruptio placenta after 28 weeks of gestation were included in the study. Patients were identified from the admission and labour room registers. Results: Total number of deliveries during the study period were 4000. Patients identified with abruptio placenta were 100, giving a frequency of 2.5%. Majority women were multigravidae and 56% of all the between 26-30 years of age. The mean gestational age at diagnosis was 34 ± 4.21 weeks. Vaginal bleeding was the most common clinical finding seen in 80% of the women, followed by blood stained amniotic fluid in 16% suggesting concealed abruption placenta. Fetal heart sounds were absent on admission in 65% of the women. Most common cause of abruption 44% was either patients with past history of pre – eclampsia or PIH in the present pregnancy. 9 patients with couvelaire uterus were identified and treated effectively. Among them, two patients died due to postpartum hemorrhage. Parity and gestational age were found to be significant risk factors for abruptio placentae. Conclusion: Abruptio placenta was associated with poor maternal and fetal outcomes. Early diagnosis and significant treatment of pre eclampsia during the antenatal period would prevent abruption and related complications. Sri Lanka Journal of Obstetrics and Gynaecology Vol.37(3) 2015: 38-41