Placenta Abruptio: A Dreaded Obstetrical Entity in the South West Region of Cameroon. A retrospective Study

Gregory Halle-Ekane, Catherine Binye, Andre Simo Wambo, Rogers Ajeh, Felix Elong Adolphe, Clifford Lo-oh, Robinson Mbu

Abstract


ABSTRACT
Background. Placental abruption (PA) is one of the leading causes of perinatal morbidity and mortality especially in the low and middle income countries. However, there is a paucity of data on the causes and complications of PA in the South West region, Cameroon. Objectives. To determine the causes and obstetric complications of PA in the Buea and Limbe Regional Hospitals. Methods. A hospital-based retrospective cohort study was carried out at aforementioned Hospitals. Data was collected from case notes of pregnant women from January 1, 2009 to December 31, 2018. Medical records of cases were matched for age and parity with controls in the ratio of 1:2. The Chi square and Fischer’s exact test were used to compare categorical variables and modeled into multivariate analysis. A p-value < 0.05 was considered statistically significant. Results: The prevalence of PA was 0.22%. The causes of placental abruption were : abdominal trauma (ORa 3.1; p<0.001), chronic hypertension (ORa 2.4; p=0.03), and premature rupture of membranes (ORa 2.4;p<0.001). Maternal complications independently associated with PA were : PPH (ORa 1.4;p<0.001), hypovolemic shock (ORa 3.7;p=0.007), need for blood transfusion (ORa 3.4; p=0.001), clinical anemia (ORa 3.9; p<0.001), and acute kidney injury (ORa 2.3;p=0.008). Fetal complications were : fetal distress (ORa 1.7; p=0.03), birth asphyxia (ORa 2.0; p<0.001), stillbirth (ORa1.5; p=0.001), and early neonatal death (ORa 4.3; p<0.001). Conclusion. This study revealed that prevalence of PA was low. However, it was associated with significant maternal-fetal morbidity and mortality, hence need for timely and proper management.
RÉSUMÉ
Introduction. L’hématome retro placentaire (HRP) est l’une des principales causes de morbidité et de mortalité périnatale dans le tiers monde. Ses causes et ses complications n’ont pas été décrites dans la région sud-ouest du Cameroun. Objectif : Déterminer les causes et complications materno-fœtales associées aux HRP dans les hôpitaux régionaux de Buea et de Limbe. Méthodes. Étude de cohorte rétrospective à partir des dossiers hospitaliers des femmes enceintes du 1er janvier 2009 au 31 décembre 2018. Les cas ont été appariés en fonction de l'âge et la parité avec les témoins (rapport de 1: 2). Les tests de Khi carré et exact de Fisher ont été utilisés pour comparer des variables catégorielles et modélisés dans une analyse multivariée. Résultats. La prévalence de l’HRP était de 0,22 %. Les causes d'HRP étaient : traumatisme abdominal (ORa 3.1; p<0.001)), hypertension chronique (ORa 2.4; 95%; p=0.03), et la rupture prématurée des membranes (ORa 2.4; p<0.001). Les conséquences maternelles indépendamment associées à l’HRP étaient : Hémorragie du postpartum (ORa 1.4; p<0.001), le choc hypovolémique (ORa 3.7; p=0.007), la transfusion sanguine (ORa 3.4; p=0.001), l’anémie clinique (ORa 3.9; p<0.001), et l'insuffisance rénale aigu (ORa 2.3; p=0.008). Les complications fœtales étaient : la souffrance fœtale aigue (ORa 1.7; p=0.03), l’asphyxie néonatale (ORa 2.0; p<0.001), le taux de Mort-nés (ORa 1.5; p=0.001) et la mortalité néonatale précoce (ORa 4.3; 95% p<0.001). Conclusion. Cette étude a révélé que la prévalence de l'HRP était faible.  Cependant, il était associé à une morbidité et une mortalité materno-fœtales importantes, d'où la nécessité d'une prise en charge rapide et appropriée.


Keywords


Placental abruption, risk factors, complications, maternal, perinatal, Cameroon

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