%0 Journal Article
%T Predictors of Perinatal Mortality Associated with Placenta Previa and Placental Abruption: An Experience from a Low Income Country
%A Yifru Berhan
%J Journal of Pregnancy
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/307043
%X A retrospective cohort study design was used to assess predictors of perinatal mortality in women with placenta previa and abruption between January 2006 and December 2011. Four hundred thirty-two women (253 with placenta previa and 179 with placental abruption) were eligible for analysis. Binary logistic regression, Kaplan-Meier survival curve, and receiver operating characteristic (ROC) curve were used. On admission, 77% of the women were anaemic (<12£¿gm/dL) with mean haemoglobin level of 9.0£¿¡À£¿3.0£¿gm/dL. The proportion of overall severe anaemia increased from about 28% on admission to 41% at discharge. There were 50% perinatal deaths (neonatal deaths of less than seven days of age and fetal deaths after 28 weeks of gestation). In the adjusted odds ratios, lengthy delay in accessing hospital care, prematurity, anaemia in the mothers, and male foetuses were independent predictors of perinatal mortality. The haemoglobin level at admission was more sensitive and more specific than prematurity in the prediction of perinatal mortality. The proportion of severe anaemia and perinatal mortality was probably one of the highest in the world. 1. Introduction Placenta previa (placenta implanted over the internal cervical os) and placental abruption (premature separation of normally implanted placenta) are the major causes of antepartum haemorrhage in the third trimester of pregnancies and major contributors of obstetric haemorrhage in general [1]. Each of these conditions has a prevalence rate of 0.5% to 2% in most parts of the world [2¨C4]. Because of the changes in the lower uterine segment length and placental migration as the pregnancy advances, the prevalence of placenta previa has an inverse relation to the gestational age [5]. In other words, it is suggested that reporting of placenta previa in early gestation is likely to overestimate its actual prevalence at term. Placenta previa and placental abruption have long been recognized as major obstetric complications that result in maternal and fetal mortality as well as morbidity. The effect of these two bloody obstetric complications on perinatal health is multifactorial: blood loss, premature delivery, intrauterine growth restriction, the risk of perinatal asphyxia, the risk of sepsis, and hyperbilirubinemia [2, 6¨C8]. A Danish national cohort study was associated with an increased risk of neonatal mortality, prematurity, low Apgar scores, low birthweight, and transfer to a neonatal intensive care unit [9]. Several other studies from developing countries have also shown that pregnant women complicated by
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