الفهرس 
Placental abruptionOnly 14 pages are availabe for public view
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Abstract
Placental abruption is the most common cause of antepartum hemorrhage and is defined as premature separation of normally implanted placenta. The detached portion of placenta is unable to exchange gases and nutrients. When the remaining fetoplacental unit is unable to compensate for this loss of function, the fetus is compromised. The incidence appears to be increasing probably due to increase in prevalence of the risk factors for the disorder. Placental abruption is due to rupture of uterine spiral artery. Bleeding into deciduas leads to separation of placenta. Hematoma formation further separates the placenta from the uterine wall causing compromise of the blood supply to the fetus. It is a serious obstetric condition that increases maternal and neonatal morbidity and mortality. Maternal and fetal survival depends on early diagnosis and intervention. This study aims to show our experience and tools in the evaluation of abruptio placenta, with identification of the incidence and outcome in Tanta university hospitals for a period of 12 months from August 2017 to the end of July 2018. The first phase of the study dealt with collection of the data retrieved from all records focusing on cases of antepartum hemorrhage and abruptio placenta, as all the data were recorded by administrate obligations of Tanta university hospital The cases of abruptio placenta were diagnosed by clinical examination recorded into the files (antepartum hemorrhage associated with abdominal pain, rigid abdomen and deterioration of general condition of the patients) and with radiological diagnosis (retroplacental hematoma). ➢ Our results showed the following: The incidence of placental abruption was 1.13 % from total deliveries i.e. 1 every 88.5 case (132 from 11689 cases). A. Maternal data: o Age ranged from 20 to 45 years with a mean and SD of 30.25 ± 5.89. BMI ranged from 19 to 45 kg/m2with a mean and SD of 26.5 ± 5.04. Gestational age ranged from 28 to 41 w with a mean and SD of 33.3 ± 3.45. Gravidity ranged from 1 to 5 with median 2. Parity ranged from 0 to 4 with median 1. Number of previous CS ranged from 0 to 3 with median 1. o 13 cases (9.8%) were shocked; 11 cases (8.3%) prepartum and 2 cases (2%) intraoperative. There was significant decrease in HR, significant increase in MAP and significant increase in urine output postpartum compared to admission. o We noticed that there was insignificant difference between prepartum and postpartum data except in Hb; there was significant decrease in postpartum. o As regards clinical findings: 9 cases (6.8%) were asymptomatic, 123 cases (93.2%) with abdominal pain and 101 cases (76.5%) with vaginal bleeding. Hematoma was found in 34 cases (25.8%) by US. o 24 cases (18.2%) had a previous history of abruptio placenta, 31 cases (23.5%) with DM and 36 cases (27.3%) with hypertension Vaginal delivery was in 31 cases (23.5%) and CS was in 101 cases (76.5%). o All cases had hematoma intraoperative. Couvelaire uterus was found in 3 cases (3%). Artery Ligation was done in 4 cases (4%) and hysterectomy was done in 3 cases (3%). Severe bleeding was found in 13 cases (12.9%), moderate bleeding in 23 cases (2.3%), mild in 95 cases (94.1%), no bleeding in 3 cases (3%) (discovered accidentally intraoperative). o Intraoperative complications: ▪ Massive bleeding was found in 13 cases (12.9%), atony in 4 cases (4%), Couvelaire uterus in 3 cases (3%) and DIC in 2 cases (2%). ▪ As regards blood transfusion, 11 cases (8.3%) prepartum, 13 cases (9.9%) intrapartum and 17 cases (12.9%) postpartum. Hospital stay ranged from 2 to 9 days with median 2. ICU admission was needed in 32 cases (24.2%). ▪ As regards complications: postpartum hemorrhage was in 17 cases (12.9%), renal failure was in 8 cases (6%), sepsis was in 31 cases (23.5%), DIC was in 4 cases (4%) and death was in 6 cases (4.5%). B. Fetal data: o Gestational age by LMP ranged from 28 to 41 w with a mean and SD of 33.3 ± 3.45, but gestational age by US ranged from 27 to 40 w with a mean and SD of 33.61 ± 3.47. o As regards fetal position, 89 cases were cephalic, and 43 cases were breech. As regards amount of amniotic fluid, 79 cases were normal, 38 cases were polyhydramnios, and 15 cases were oligohydramnios. o Weight at delivery ranged from 1100 to 4000 gm with a mean and SD of 2325.8 ± 584.2, but weight by US ranged from 1200 to 4200 gm with a mean and SD of 2280 ± 539.1..