[Abruptio placentae. Diagnosis, management and maternal-fetal prognosis: a retrospective study of 100 cases]

Abstract

Objectives: To update knowledge on placental abruption because there are few recent series published although the perinatal care has progressed.

Patients and methods: A retrospective observational study has been conducted on 100 consecutive cases of abruptio placentae, occurring from January 2008 to June 2011, in the two maternity units of the University Hospital of Strasbourg (France).

Results: One hundred and five births among which five twin pregnancies were included. Clinical context was evident in 91% of cases, but the classic clinical triad was present in only 4% of cases. Clots were found at immediate placenta examination in 77% of cases. Pathological diagnosis was directly in accordance with clinical diagnosis in half the cases. Mean date of childbirth was 33 weeks of amenorrhea and 6 days. Sixty-seven patients gave birth prematurely. Among them, 50 patients delivered before 34 weeks. Sixty caesareans were performed in emergency before labor, including 47 with general anesthesia. Twelve patients had post-partum haemorrhage and ten coagulation disorders. There was no maternal death. Perinatal mortality was 19% with 13 fetal deaths in utero (12.4%), four children born in an apparent death state with resuscitation failure (3.8%) and three neonatal deaths (2.8%).

Discussion and conclusion: Placental abruption is a serious and unpredictable situation. Joint medical care of obstetricians and intensivists is often required. Perinatal mortality mainly occurs in utero.

Keywords: Abruptio placentae; Hématome rétroplacentaire; Hémorragie du post-partum; Hémorragies du troisième trimestre; Maternal morbidity; Morbidité maternelle; Mortalité périnatale; Perinatal mortality; Post-partum haemorrhage; Pre-eclampsia; Premature rupture of membranes; Pré-éclampsie; Rupture prématurée des membranes; Third trimester bleeding.