Severe abruption: Maternal and Perinatal Outcomes

Introduction: Abruption is a common cause of Antepartum Hemorrhage and complicates 0.4-1% pregnancies overall. Severe abruption is defined as evidence of maternal shock or coagulation defects, uterine tetany and intrauterine death of fetus according to the Page classification. Methods: All pregnant women with severe abruption, grade 3 of Page classification were included. Complete evaluation was done with presenting complaints, obstetric history, past history, associated obstetric co-morbidites, obstetrical examination and relevant investigations were done. Maternal and perinatal outcomes were observed and analysed. Results: Among 8600 pregnant women admitted, the incidence of abruption was 1.8% (n=158), with 23 cases being classified as severe. Half of the patients (52%) had abruption at early preterm gestation (<34 weeks). Most common associated risk factor was presence of pre-eclampsia in 65% patients. More than half (56.5%) had vaginal delivery. Major maternal complications observed included PPH in all patients, DIC in 22% patients and AKI in 30.4% patients. Perinatal mortality was 78.2% and 26% required NICU admission. Conclusion: Abruption is one of the major causes of maternal and fetal morbidity and mortality. Early identification and timely termination leads to reduction in maternal complications, but still has a poor perinatal outcome. The aim should be early termination of pregnancy.