Clinical study on obstetric variables affecting perinatal mortality in placental abruption

Jung, Hee Jung; Jeong, Eun Ha; Lee, Kyung; Jung, Hee Ra; Kim, Myoung Hwan; Ko, Ji Kyung; Cho, Yong Kyoon; Choi, Hoon; Kim, Bok Rin

Abstract

OBJECTIVE
To evaluate obstetric variables in the placental abruption that affect on perinatal mortality.
METHODS
We reviewed clinical data of all singleton deliveries complicated with placental abruption between January 2000 and December 2007, in Department of Ob. & Gyn., Sanggye Paik Hospital.
RESULTS
Placental abruption complicated 54 cases (0.55%) of all deliveries (n=9,903) from January 2000 to December 2007. The peak age was 26-30 years (42.1%). The most common symptom was vaginal bleeding (57.4%) and intrauterine fetal death had already occurred in 9.3%. Perinatal mortality rate was 13.0% and there was no maternal death. 38.9% of placental abruption occurred between 33 to 36weeks of gestational age. 38.9% of placental abruption was diagnosed before delivery with ultrasonography and 9.3% was chronic placental abruption. 33.3% of placental abruption was associated with preeclampsia, and then associated with PPROM (24.1%), uterine myoma (3.7%), chronic hypertension (1.9%) and smoking (1.9%). When the hypertensive disorders were associated, fetal distress rate was higher than normotensive pregnancy (63.2% vs 20.0%, P-value: 0.005). Mean gestational age (days) (194+/-32.8 vs 248.12+/-28.0, P-value<0.001) and the severity of placental abruption (P-value: 0.005) affect perinatal mortality in placental abruption. The most common complication of placental abruption was DIC (16 cases, 29.6%), followed by Couvelaire uterus (4 cases, 7.4%) and uterine rupture (1 case, 1.9%).
CONCLUSION
Obstetric variables that affect perinatal mortality were gestational age at the diagnosis and the severity of placental abruption.