Sarwar Iram, Abbasi Aziz un Nisa, Islam Ansa
Department of Obstetrics and Gynaecology, Unit B, Ayub Teaching Hospital, Abbottabad, Pakistan.
J Ayub Med Coll Abbottabad. 2006 Jan-Mar;18(1):27-31.
Abruptio placentae remains a major cause of perinatal morbidity and mortality globally, though of most serious concern in the developing world. As most known causes of abruptio placentae are either preventable or treatable, an increased frequency of the condition remains a source of medical concern.
The present study was undertaken at the Department of Obstetrics and Gynaecology, Unit B, of the Ayub Teaching Hospital, Abbottabad, Pakistan, from July 2003 to June 2004. Patients of abruptio placentae were selected from all cases of 28 weeks or greater gestation, presenting with ante partum haemorrhage during the study period. Patients underwent a complete obstetrical clinical workup including history, general physical examination, abdominal and pelvic examination. Relevant investigations such as laboratory tests and imaging were performed. Patients were managed according to maternal and fetal condition. Any maternal and/or fetal complications were noted and recorded. All data were collected on predesigned proformas and analyzed by computer.
A total of 53 cases of abruptio placentae were recorded out of 1194 cases (4.4%) admitted for delivery during the study period, giving a rate of 44 cases of abruptio placentae per 1000 deliveries. Induction of labour was required in 27 (50.9%) cases, while caesarean section was performed in 16 (30.2%) cases. Major complications were intra uterine fetal demise (31/53, 58.5%), fetal distress (8/22 live births, 36.4%) and post partum haemorrhage, which occurred in 10 (18.9%) cases.
A higher than expected frequency of abruptio placentae exists in our setting and the consequences of abruptio placentae for neonatal mortality outcome are alarmingly high. The majority of patients presented with intra uterine death so that any management protocol directed at abruptio placentae or its consequences is of little help in preventing perinatal mortality.
胎盘早剥仍是全球围产期发病和死亡的主要原因，不过在发展中国家最为令人担忧。由于胎盘早剥的大多数已知病因是可预防或可治疗的，该病症发病率的上升仍是医学关注的一个问题。
本研究于2003年7月至2004年6月在巴基斯坦阿伯塔巴德阿尤布教学医院B区妇产科进行。胎盘早剥患者选自研究期间所有妊娠周数达到或超过28周且出现产前出血的病例。患者接受了全面的产科临床检查，包括病史、全身体格检查、腹部和盆腔检查。进行了实验室检查和影像学等相关检查。根据母婴情况对患者进行处理。记录任何母婴并发症。所有数据均收集在预先设计的表格上并通过计算机进行分析。
在研究期间收治分娩的1194例病例中，共记录了53例胎盘早剥病例（4.4%），即每1000例分娩中有44例胎盘早剥。27例（50.9%）病例需要引产，16例（30.2%）病例进行了剖宫产。主要并发症为宫内胎儿死亡（31/53，58.5%）、胎儿窘迫（8/22例活产，36.4%）和产后出血，产后出血发生在10例（18.9%）病例中。
在我们的研究环境中，胎盘早剥的发生率高于预期，且胎盘早剥对新生儿死亡率的影响高得惊人。大多数患者出现宫内死亡，因此任何针对胎盘早剥及其后果的处理方案在预防围产期死亡方面帮助不大。
