Perinatal and maternal outcome following abruptio placentae

Objective: To characterize the maternal and fetal presentation of abruptio placentae and associated maternal and fetal morbidity and mortality by mode of delivery and fetal status on admission. Study Design: Perinatal data (gestational age >24 weeks) from women with ab ruptio placentae at a tertiary referral center were analyzed. For the purpo se of evaluating fetal morbidity and mortality, group 1 included women with hypertensive disorders of pregnancy (preeclampsia or chronic hypertension) , PROM, cocaine abuse, and >20% abruptio placentae without regard to fetal status on admission (reassuring, nonreassuring, or stillborn). In group 1, either umbilical artery pH<7.0, Apgar < 3(5), or base excess > 12 mmol/L re presented perinatal hypoxia for this evaluation. Group 2 included women wit h stillborn fetuses on admission without regard to etiology or size of abru ptio placentae. Comparisons between groups were made with one-way analysis of variance, Kruskal-Wallis, or chi (2) tests; p<0.05 was considered signif icant. Results: Group 1 was comprised of 342 women; 58.4% of fetuses had abnormal fetal heart rate tracings. Overall, the sensitivity of an abnormal fetal he art rate tracing to predict perinatal hypoxia was 87.2%, specificity was 33 .9%, positive predictive value was 22.2%, and negative predictive value was 92.5%. Of parameters suggestive for perinatal hypoxia, 17.3% of neonates h ad Apgar <3(5), 13.0% had umbilical artery pH <7.0, and 9.9% had base exces s >12 mmol/L. Overall, neonatal survival was 84.7%; 12.0% of fetuses were s tillborn. For those fetuses alive on admission, cesarean delivery was assoc iated with a significant reduction in neonatal mortality: odds ratio of 0.1 0 (95% confidence interval: 0.05-0.20) and p=0.0001. Group 2 was comprised of 61 women. Women presenting with a stillborn infant on admission were mor e likely to require transfusions and suffer the complications (disseminated intravascular coagulopathy, acute renal failure, and acute respiratory dis tress syndrome) than women presenting with a live fetus. Conclusion: Cesarean delivery appeared to reduce neonatal mortality. Whethe r emergent cesarean delivery resulted in the birth of compromised fetus can not be evaluated from this study. Composite maternal morbidity is increased when a stillborn fetus is present on admission.