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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.
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References
- Ouédraogo I, Sawadogo YA, Kain DP, Zamane H, Sib SR, Kiemtore S, et al. Placental Abruption in the Obstetrics and Gynecology Service of Regional Hospital Center of Ouahigouya: Epidemiological, Clinical Ant and Therapeutic Aspects about 89 Cases Collected from 1st January 2013 to 31stDecember 2015. Open Journal of Obstetrics and Gynecology. 2017;07(01):86–94.
- Fadl SA, Linnau KF, Dighe MK. Placental abruption and hemorrhage—review of imaging appearance. Emergency Radiology [Internet]. 2018 Aug 29 [cited 2018 Nov 14]; Available from:http://link.springer.com/10.1007/s10140018-1638-3
- Abasi I, Jeremiah I, Ekine A. Risk Factors and Pregnancy Outcome of Placental Abruption at the Niger Delta University Teaching Hospital, Okolobiri, South-South Nigeria. B J MedMedicalResearch.2015Jan10;5(8):1000–6.
- Shen TT, DeFranco EA, Stamilio DM, Chang JJ, Muglia LJ. A population-based study of race-specific risk for placental abruption. BMC Pregnancy Childbirth. 2008 Sep 12;8:43.
- Cresswell JA, Ronsmans C, Calvert C, Filippi V. Prevalence of placenta praevia by world region: a systemic review and meta-analysis. Trop Med Int Health 2013; 18(6): 712 – 24.
- Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health. 2014 Jun;2(6):e323–33.
- Tebeu PM, Nnomo JA, Kenmeni C, Obama MA, Fosso GK, Fomulu JN, et al. The Pattern of Abruption Placenta in Cameroon. Med J Obstet Gynecol 2013 Nov; 1(3): 1015.
- Nandonde K, Matovelo D, Massinde A, Rumanyika R. Predictors of foeto-maternal outcome of patients with abruptio placenta at Bugando Medical Centre, Tanzania. Tanzania Journal of Health Research. 2016;18(1):10.
- Nkwabong E. Nkwabong’s Prognostic Classification of Placenta Abruption. Ann Med Health Sci Res 2017 Sept;7:74-75.
- Tikkanen M. Placental abruption: epidemiology, risk factors and consequences: Placental abruption, epidemiology.Acta Obstetricia et Gynecologica Scandinavica.2011Feb;90(2):140–9.
- Egbe TO, Omeichu A, Halle-Ekane GE, Tchente CN, Egbe E-N, Oury J-F. Prevalence and outcome of teenage hospital births at the Buea Health District, South West Region, Cameroon. Reprod Health. 2015 Dec;12(1):118.
- Macheku GS, Philemon RN, Oneko O, Mlay PS, Masenga G, Obure J, et al. Frequency, risk factors and feto-maternal outcomes of abruptio placentae in Northern Tanzania: a registry based retrospective cohort study. BMC Pregnancy and Childbirth [Internet]. 2015 Dec [cited2018 Nov 14];15(1)
- Akadri AA, Ogunsowo KM, Odelola OI. Abruptio Placenta: A retrospective analysis in a tertiary hospital, Sagamu, Nigeria. Tropical Journal of Obstetrics and Gynaecology.2018;35(2):7.
- Lindqvist PG, Happach C. Risk and risk estimation of placental abruption. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2006 Jun;126(2):160–4.
- Ghaheh HS, Feizi A, Mousavi M, Sohrabi D, Mesghari L, Hosseini Z. Risk factors of placental abruption. Journal of Research in Medical Sciences. 2013;5.
- Coleman J, Srofenyo EK, Ofori EK, Brakohiapa EK, Antwi K. Maternal and Fetal Prognosis in Abruptio Placentae at Korle-Bu Teaching Hospital, Ghana. :8.
- Li Y, Tian Y, Liu N, Chen Y, Wu F. Analysis of 62 placental abruption cases: Risk factors and clinical outcomes. Taiwanese Journal of Obstetrics and Gynecology. 2019Mar;58(2):223–6.
- Boisramé T, Sananès N, Fritz G, Boudier E, Aissi G, Favre R, et al. Placental abruption: risk factors, management and maternal–fetal prognosis. Cohort study over 10 years. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2014 Aug;179:100–4.
References
Ouédraogo I, Sawadogo YA, Kain DP, Zamane H, Sib SR, Kiemtore S, et al. Placental Abruption in the Obstetrics and Gynecology Service of Regional Hospital Center of Ouahigouya: Epidemiological, Clinical Ant and Therapeutic Aspects about 89 Cases Collected from 1st January 2013 to 31stDecember 2015. Open Journal of Obstetrics and Gynecology. 2017;07(01):86–94.
Fadl SA, Linnau KF, Dighe MK. Placental abruption and hemorrhage—review of imaging appearance. Emergency Radiology [Internet]. 2018 Aug 29 [cited 2018 Nov 14]; Available from:http://link.springer.com/10.1007/s10140018-1638-3
Abasi I, Jeremiah I, Ekine A. Risk Factors and Pregnancy Outcome of Placental Abruption at the Niger Delta University Teaching Hospital, Okolobiri, South-South Nigeria. B J MedMedicalResearch.2015Jan10;5(8):1000–6.
Shen TT, DeFranco EA, Stamilio DM, Chang JJ, Muglia LJ. A population-based study of race-specific risk for placental abruption. BMC Pregnancy Childbirth. 2008 Sep 12;8:43.
Cresswell JA, Ronsmans C, Calvert C, Filippi V. Prevalence of placenta praevia by world region: a systemic review and meta-analysis. Trop Med Int Health 2013; 18(6): 712 – 24.
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health. 2014 Jun;2(6):e323–33.
Tebeu PM, Nnomo JA, Kenmeni C, Obama MA, Fosso GK, Fomulu JN, et al. The Pattern of Abruption Placenta in Cameroon. Med J Obstet Gynecol 2013 Nov; 1(3): 1015.
Nandonde K, Matovelo D, Massinde A, Rumanyika R. Predictors of foeto-maternal outcome of patients with abruptio placenta at Bugando Medical Centre, Tanzania. Tanzania Journal of Health Research. 2016;18(1):10.
Nkwabong E. Nkwabong’s Prognostic Classification of Placenta Abruption. Ann Med Health Sci Res 2017 Sept;7:74-75.
Tikkanen M. Placental abruption: epidemiology, risk factors and consequences: Placental abruption, epidemiology.Acta Obstetricia et Gynecologica Scandinavica.2011Feb;90(2):140–9.
Egbe TO, Omeichu A, Halle-Ekane GE, Tchente CN, Egbe E-N, Oury J-F. Prevalence and outcome of teenage hospital births at the Buea Health District, South West Region, Cameroon. Reprod Health. 2015 Dec;12(1):118.
Macheku GS, Philemon RN, Oneko O, Mlay PS, Masenga G, Obure J, et al. Frequency, risk factors and feto-maternal outcomes of abruptio placentae in Northern Tanzania: a registry based retrospective cohort study. BMC Pregnancy and Childbirth [Internet]. 2015 Dec [cited2018 Nov 14];15(1)
Akadri AA, Ogunsowo KM, Odelola OI. Abruptio Placenta: A retrospective analysis in a tertiary hospital, Sagamu, Nigeria. Tropical Journal of Obstetrics and Gynaecology.2018;35(2):7.
Lindqvist PG, Happach C. Risk and risk estimation of placental abruption. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2006 Jun;126(2):160–4.
Ghaheh HS, Feizi A, Mousavi M, Sohrabi D, Mesghari L, Hosseini Z. Risk factors of placental abruption. Journal of Research in Medical Sciences. 2013;5.
Coleman J, Srofenyo EK, Ofori EK, Brakohiapa EK, Antwi K. Maternal and Fetal Prognosis in Abruptio Placentae at Korle-Bu Teaching Hospital, Ghana. :8.
Li Y, Tian Y, Liu N, Chen Y, Wu F. Analysis of 62 placental abruption cases: Risk factors and clinical outcomes. Taiwanese Journal of Obstetrics and Gynecology. 2019Mar;58(2):223–6.
Boisramé T, Sananès N, Fritz G, Boudier E, Aissi G, Favre R, et al. Placental abruption: risk factors, management and maternal–fetal prognosis. Cohort study over 10 years. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2014 Aug;179:100–4.