ABRUPTIO PLACENTA: A RETROSPECTIVE STUDY ON MATERNAL AND

PERINATAL OUTCOME
Subha Sivagami Sengodan, Mohana Dhanapal
Department of Obstetrics and Gynecology, Government Mohankumarmangalam Medical
College Salem, Tamil Nadu, India
Received: 10 July 2017
Revised: 05 September 2017
Accepted: 09 September 2017
*Correspondence:
Dr. Subha Sivagami Sengodan,
E-mail: drppsamysubha@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access
article distributed under the terms of the Creative Commons Attribution Non-Commercial
License, which permits unrestricted non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.

ABSTRACT

Background: Abruptio placenta is separation of a normally situated placenta after 20 weeks

of gestation and prior to the birth of the fetus. It is an important cause of antepartum

haemorrhage and presents as an acute abdomen in the third trimester of pregnancy. Obstetrical

haemorrhage is one of the triad (Haemorrhage hypertension and infection) of causes of

maternal deaths in both developed and underdeveloped countries.

Methods: This is a retrospective study of Abruptio Placenta cases carried out between January

2015 and December 2015 at Government Mohan Kumaramangalam Medical College Hospital,

Salem and about its perinatal and maternal outcome.

Results: Incidence of Abruptio placenta is 0.5%. It is most common in the women of age group

26-30yrs. 67% of cases were associated with severe pre-eclampsia. Live births were 69.8%

while stillbirths were 30.2%. PPH occurred in 19.6% of cases. DIC accounts for 16.7% of the

complication.

Conclusions: Abruptio placenta is associated with poor maternal and fetal outcome. Hence

early diagnosis and prompt resuscitative measures would prevent both perinatal and maternal

mortality and morbidity.

Keywords: Abruptio Placenta, Maternal Outcome, Perinatal Outcome

INTRODUCTION

Placental abruption is the most common cause of antepartum haemorrhage and is defined as

premature separation of normally implanted placenta.1 The detached portion of placenta is

unable to exchange gases and nutrients when the remaining fetoplacental unit is unable to

compensate for this loss of function, the fetus is compromised. The incidence appears to be

increasing probably due to increase in prevalence of the risk factors for the disorder. Placental

abruption is due to rupture of uterine spiral artery. Bleeding into deciduas leads to separation

of placenta. Hematoma formation further separates the placenta from the uterine wall causing

compromise of the blood supply to the fetus. The types are-A-Revealed-blood tracks between

the membranes and escapes through the vagina and cervix. B-blood collects behind the placenta

with no evidence of vaginal bleeding. It is a serious obstetric condition that increases maternal

and neonatal morbidity and mortality.2 Abruption occurs in 0.4-1% of pregnancies. Obstetric

haemorrhage accounts for 1/3rd of maternal death. Perinatal mortality is high with abruption

due to its strong association with preterm. Even babies born at 40weeks of gestation, birth

weight of 3.5- 3.9kg had 25-fold higher mortality with abruption.3 Primary cause of abruption

is not known but the main precipitating and predisposing factors of abruption are age, parity,

anemia, poor nutrition, pregnancy induced hypertension, eclampsia, gestational diabetes

mellitus, premature rupture of membrane, and previous medical termination of pregnancy.4

Abruption is a significant cause of maternal and perinatal morbidity and mortality. Placental

abruption may be total or partial, causing pain and vaginal bleeding-which are the hallmarks

of placental abruption. Abruptio placenta is the major cause of haemorrhagic shock, DIC, renal

failure, ischemic necrosis of organs in the mother. Fetal complications include hypoxia,

anemia, growth restriction, prematurity, neurodevelopmental problems and premature death.

Hypertensive disorder of pregnancy is associated with 2.5% to 17.9% of placental separation.5

Maternal and fetal survival depends on early diagnosis and intervention.

METHODS

This is a retrospective study by analysing the case sheets of abruptio placenta in Government

Mohan Kumaramangalam Medical College Hospital, Salem from January 2015 to December

2015. From those case records, details regarding the age of the patient, parity and maternal

high-risk factors were collected. All other causes of APH like placenta previa and other

extraplacental causes were excluded. All study patients underwent a complete obstetrical

examination and clinical workup including history, general physical examination and

abdominal and pelvic examination. Detailed obstetric history was obtained and maternal high-

risk factors like PIH, GDM, polyhydramnios was noted. As 95% patients were admitted as

emergencies, placental abruption was suspected depending on clinical features of vaginal

bleeding, uterine tenderness, hypertonic uterus and diagnosis was confirmed by retroplacental

clots. After initial resuscitation mode of delivery was decided depending upon state of mother

and fetus. Relevant investigations such as lab tests and imaging were performed.

Socioeconomic status of the patient was calculated as per modified kuppusamy’s scale. Fetal

well-being was assessed with ultrasonography and cardiotocography. Diagnosis was confirmed

by the presence of retroplacental clots which was used to estimate the amount of bleeding and

severity of abruption. Patients were managed according to the fetal and maternal conditions.

All information’s were gathered and results were analysed. Maternal complications studied

were PPH, DIC, ARF, shock, pulmonary edema and infections. Fetal outcome in the form of

perinatal mortality (still births and neonatal deaths), prematurity and admission to the neonatal

care unit were studied.

RESULTS

Total number of deliveries from January 2015-December 2015 were 6917. Total number of

abruptio placenta cases from January 2015- December 2015 were 40. The results of the present

study showed increased incidence of severe preeclampsia with abruption. Increasing age has

been implicated as a predisposing factor in Abruptio placenta. Mean age of patients of APH

was 26-30 years. Most of the patients were unbooked and not taking antenatal care. Incidence

was high in multiparous women.

Mainly abruption was seen in term pregnancy. Most of them were associated with anemia and

PIH, and the mode of delivery varied accordingly. Major complication on maternal side were

shock.

Table 1: Age.

Age %

<20 years 9.3

20-25 years 34.7

26-30 years 40.6

>30 years 15.4

Most of the abruptio placenta cases were between 26 to 30 years 40.6%. Next most common

age group were between 20 to 25 years. Least incidence was seen among the age group

<20yrs.

Table 2: Parity.

Parity %

Primi 22

G2 42.4

G3 26
G4, G5 9.6

Maximun number of abruptio placenta cases were 2nd Gravida. Incidence of abruption was

high in multiparous women and mainly abruption was seen in term pregnancy.

Table 3: Association with PIH.

Type %

Severe Pre-eclampsia 67

Eclampsia 8.6

Chronic-HT 7

Normal BP 17.4

Abruption was more common among patients who had severe preeclampsia than who were

normotensive. Most of them were associated with anemia and PIH. Even normotensive

groups had Abruption which was about 17.4%.

Table 4: Fetal outcome.

Fetal outcome %

Still birth 30.2

Live birth 69.8

69.8% had live birth. 30.2% had still born. Among them 5 died in early neonatal period due

to prematurity. Fetal complications included hypoxia, anemia, growth restriction,

prematurity, neurodevelopmental problems, prematurity and fetal death.

Table 5: Maternal complications.

Complications %

PPH 19.6

DIC 16.7

ARF 11.3

Shock 10.5

Pulmonary edema 10.2

Infections 9.8

Others 21.9

Maternal complications associated with Abruption were Postpartum haemorrhage (PPH),

Disseminated Intravascular Coagulation (DIC), Acute renal failure (ARF), Shock,

Pulmonary edema, Infection. Among which Postpartum hemorrhage contributes the majority

of complications (19.6%).

DISCUSSION

Placental abruption is one of the serious complications of pregnancy, as it leads to both poor

maternal and fetal outcome. The incidence of abruptio placenta was 0.5% in our study, which

is similar to study by Wasnik SK.7 The signs and symptoms of abruptio placenta vary

depending upon the severity of bleeding and the degree of separation of the placenta. Abruption

can occur at any stage in pregnancy but 32-36 weeks appears to be the most vulnerable period

8. We found 67% of patients with severe preeclampsia, 8.6% of patients with eclampsia, 7%

of patients with chronic hypertension developed abruption in our study. Among the maternal

complications, Postpartum Hemorrhage(PPH) was commonest followed by Disseminated

Intravascular coagulation (DIC), Acute Renal Failure (ARF), shock, pulmonary edema and

infection. PPH occurred in 19.6% of patients in our study, were as study by Talpur NN reported
PPH in 28% of patients.9 DIC was associated with 16.7% of the patients in our study. Sher G

observed DIC in 10-20% of his study patients with severe abruption and fetal demise which is

comparable to our study.10 Renal failure is one of the major causes of maternal death.11 We

found ARF is reported in 11.3% of the cases and Shock in 10.5% were as study from

Shrivatsava V reported 24.6% shock cases.12 Pulmonary edema occurred in 10.2% of patients

in our study which is comparable to study by Subramaniyan V were it is reported in 9.3% of

the cases.13 Puerperal sepsis was found to be in 17.5% of patients in the study by Choudhary

V, in our study it is reported in 9.8% of the patients.14 Regarding fetal outcome, 69.8 % were

born alive and 30.2% were still births. Abruption was not an independent risk factor for poor

outcome among infants born before 32 weeks of gestation. A premature delivery can increase

the fetal morbidity in cases of abruption.15-19 Routine antenatal check-up, correction of

anemia, timely referral, timely caesarean section, liberal blood and blood components

transfusion and good neonatal intensive care unit will help further to lower the perinatal and

maternal morbidity and mortality.

CONCLUSION

This study reveals that Severe pre-eclampsia, eclampsia, chronic hypertension, high parity are

independent risk factors for abruptio placenta. Antenatal care which identifies the risk factors

like PIH plays an important role in decreasing the incidence of abruptio placenta and improving

the maternal and fetal outcome. Regular antenatal checkup, anemia correction, early diagnosis

& identification of gestational hypertension would prevent the maternal and perinatal morbidity

and mortality. It should be managed in centers where advanced maternal and neonatal facilities

are available. Though maternal morbidity is reduced with modern management of abruptio

placenta, timely diagnosis and intervention is necessary. Early detection and active

management will reduce morbidity. Team efforts by obstetricians, intensivists and

neonatologist is required for better maternal and fetal outcome.

REFERENCES

1. Konje JC, Taylor DJ. Bleeding in later pregnancy. In: James DK, Steer PJ, Weiner CP, Gonik

B editors. High risk pregnancy 3rd ed. Philadelphia: Pennsylvania; 2006. 1266-71.

2. Pitaphrom A, Sukcharoen N. Pregnancy outcomes in placental abruption. J Med Oncolassoc

Thai. 2006; 1572-8.

3. Ananth CV, Lavery JA, Vintzileos AM. Severe Placental Abruption:Clinical definition and

associations with maternal complications. Am J Obstet Gynaecol. 2016;214;272.e1-9

4. Kyrklund-Bloomberg BN, Gennser G, Cnattinguis S. Placental abruption and perinatal

death. Paediatr Perinat Epidemiol. 2001;15:290-7.

5. Willium A, Lieberman E, Mittendorf R. Risk factors of abruption placentae. A J of

Epidemiol. 1991; 134(9):965-72.

6. Menom MK, Sokshi SK. Accidental haemorrhage in teaching hospital. J Obstet Gynaecol

Ind. 1961; 11:335-41.

7. Wasnik SN and Naiknaware SV. Antepartum Haemorrhage: Causes and its effects on

Mother Child: An Evaluation. Obstetri Gynaecol Internat J. 2015;3(1):00072.

8. Bibi S, Ghaffer S, Pir MA, Yousfani S. Risk factors and clinical outcome in placental

abruption: a retrospective analysis J Pak Medic Associat. 2009:59(10):672-4.

9. Talpur NN, Memon SR, Jamro B, Korejo R. Maternal and fetal morbidity with abruptio

placentae. Rawal Med J. 2011;36(4):297-300.

10. Sher G. Pathogenesis and management of uterine inertia complicating abruptio placentae

with

consumption coagulopathy. Am J Obstet Gynecol. 1977;129:164-70.

11. Campbell S, Lee C. Disorders of placentation. In: Obstetrics by ten teacher 17th ed. Arnold

London 2002.p.171-3.
12. Shrivastava V, Kotur P, Jauhari A. Maternal and Fetal outcome among Abruptio Placentae

at a rural tertiary hospital in Karnataka, India: A Retrospective analysis. Int J Res Med

Sci. 2014;2(4):1655-8.

13. Subramaniyan V, Pachamuthu U, Dhanapal M, Abruptio Placentae: A Retrospective Study.

2016;5:10.

14. Choudhary V. Rathi Somani S, Somani S. Evaluation of Risk factors and Obstetric and

Perinatal Outcome in Abruptio Placentae. 2015;14(5):36-9.

15. Humayun S, Nahid F. Comparison of pregnancy outcome among placenta praevia and

abruption, Ann King Edward Med Coll. 2005;11(1):58-9.

16. Pitaphrom A, Sukcharoen N. Pregnancy outcome in placental abruption. J Med Assoc Thai.

2006;89(10):1572-8.

17. Sheiner E, Shoham-Vardi I, Hadar, Hallak M. Incidence, obstetric risk factors and

pregnancy outcome of preterm placental abruption: a retrospective analysis. J Matern

Fetal Neonatal Med. 2002;11(1):34-9.

18. Allred LS, Batton D. The effect of placental abruption on the short-term outcome of

premature infants. Am J Perinatol. 2004:21(3):157-62.

19. Ananth CV, Getahun D, Peltier MR, Smulian JC. Placental abruption in term and preterm

gestations: evidence for hetrogenicity in clinical pathways. Obstet Gynecol.

2006;107(4):785-92.
ABRUPTIO PLASENTA: STUDI RETROSPEKTIF DAMPAK PADA MATERNAL

DAN PERINATAL

ABSTRAK

Latar Belakang: Abruptio plasenta adalah pemisahan dari plasenta yang biasanya terjadi

setelah 20 minggu kehamilan dan sebelum kelahiran janin. Ini adalah penyebab penting

perdarahan antepartum dan timbul sebagai akut abdomen pada trimester ketiga kehamilan.

Perdarahan obstetrik adalah salah satu dari triad (hipertensi Haemorrhage dan infeksi)

penyebab kematian ibu di negara maju dan berkembang.

Metode: Ini adalah penelitian retrospektif dari kasus Abruptio Plasenta yang dilakukan antara

Januari 2015 dan Desember 2015 di Rumah Sakit Universitas Kedokteran Mohan

Kumaramangalam, Salem dan tentang dampaknya pada perinatal dan maternal.

Hasil: Insidensi abruptio plasenta adalah 0,5%. Ini paling sering terjadi pada wanita dari

kelompok usia 26-30 tahun. 67% kasus dikaitkan dengan pre-eklamsia berat. Kelahiran hidup

adalah 69,8% sementara bayi lahir mati adalah 30,2%. PPH terjadi pada 19,6% kasus. DIC

terjadi 16,7% sebagai komplikasi.

Kesimpulan: Plasenta abdominal berhubungan dengan dampak pada maternal dan perinatal

yang buruk. Oleh karena itu diagnosis dini dan tindakan resusitasi yang cepat akan mencegah

kematian dan morbiditas perinatal dan maternal.

Kata kunci: Abruptio Placenta, Maternal Outcome, Perinatal Outcome

A. PENDAHULUAN

Abrupsi plasenta adalah penyebab perdarahan antepartum yang paling umum dan didefinisikan

sebagai pemisahan prematur dari plasenta yang sudah tertanam.1 Bagian plasenta yang terlepas

tidak dapat menukar oksigen dan karbondioksida dan nutrisi sehingga fetoplacental yang

tersisa tidak dapat mengkompensasi hilangnya fungsi ini. Insiden tampaknya meningkat

mungkin karena peningkatan prevalensi faktor risiko untuk gangguan tersebut. Solusio

plasenta terjadi karena ruptur arteri spiral uterus. Perdarahan ke desidua menyebabkan

pemisahan plasenta. Pembentukan hematoma lebih lanjut memisahkan plasenta dari dinding

rahim yang menyebabkan gangguan suplai darah ke janin. Jenis-jenisnya adalah A-Jalur darah

yang tampak antara membran dan lolos melalui vagina dan leher rahim. B Pengumpulan darah

di belakang plasenta tanpa bukti pendarahan vagina. Ini adalah kondisi obstetri yang serius

yang meningkatkan morbiditas dan mortalitas ibu dan bayi.2 Abrupsi terjadi pada 0,4-1%

kehamilan. Obstetric haemorrhage menyumbang 1/3 kematian maternal. Kematian perinatal

tinggi dengan gangguan karena hubungannya yang kuat dengan prematur. Bahkan bayi yang

lahir pada usia kehamilan 40 minggu, berat lahir 3,5-3,9 kg memiliki mortalitas 25 kali lipat

lebih tinggi dengan abruption.3 Penyebab utama abrupsi tidak diketahui tetapi faktor pemicu

utama dan predisposisi abrupsi adalah usia, paritas, anemia, gizi buruk, hipertensi yang

diinduksi kehamilan, eklamsia, diabetes melitus gestasional, ketuban pecah dini, dan terminasi

medis sebelumnya pada kehamilan.4 Abrupsi merupakan penyebab signifikan morbiditas dan

mortalitas ibu dan perinatal. Abrupsi plasenta bisa total atau parsial, menyebabkan rasa sakit

dan perdarahan vagina - yang merupakan ciri khas dari abrupsi plasenta. Abruptio plasenta

adalah penyebab utama syok hemoragik, DIC, gagal ginjal, nekrosis iskemik organ pada ibu.

Komplikasi janin termasuk hipoksia, anemia, hambatan pertumbuhan, prematuritas, masalah

perkembangan saraf dan kematian dini. Gangguan kehamilan hipertensi berhubungan dengan
2,5% hingga 17,9% dari pemisahan plasenta. Kelangsungan hidup ibu dan janin tergantung

pada diagnosis dini dan intervensi.

B. METODE

Ini adalah penelitian retrospektif dengan menganalisis kasus abruptio plasenta di Rumah

Sakit Medical Mohan Kumaramangalam Medical College, Salem dari Januari 2015 hingga

Desember 2015. Dari catatan kasus tersebut, perincian mengenai usia pasien, paritas, dan faktor

risiko tinggi ibu. dikumpulkan. Semua penyebab lain APH seperti plasenta previa dan

penyebab ekstraplasental lainnya dikeluarkan. Semua pasien penelitian menjalani pemeriksaan

obstetris lengkap dan pemeriksaan klinis termasuk riwayat, pemeriksaan fisik umum dan

pemeriksaan perut dan panggul. Riwayat obstetrik rinci diperoleh dan faktor risiko tinggi ibu

seperti PIH, GDM, polihidramnion dicatat. Seperti 95% pasien yang dirawat sebagai keadaan

darurat, abruptio plasenta dicurigai tergantung pada gambaran klinis perdarahan vagina, nyeri

tekan uterus, uterus hipertonik dan diagnosis dikonfirmasi oleh pembekuan retroplasental.

Setelah resusitasi awal kelahiran diputuskan tergantung pada keadaan ibu dan janin. Investigasi

yang relevan seperti tes laboratorium dan pencitraan dilakukan. Status sosial ekonomi pasien

dihitung sesuai skala kuppusamy yang dimodifikasi. Kesejahteraan janin dinilai dengan

ultrasonografi dan kardiotokografi. Diagnosis dikonfirmasi oleh adanya penggumpalan

retroplasental yang digunakan untuk memperkirakan jumlah perdarahan dan keparahan

abrupsi. Pasien dikelola sesuai dengan kondisi janin dan ibu. Semua informasi dikumpulkan

dan hasilnya dianalisis. Komplikasi maternal yang diteliti adalah PPH, DIC, ARF, syok, edema

paru dan infeksi. Janin hasil dalam bentuk kematian perinatal (bayi lahir mati dan kematian

neonatal), prematuritas dan masuk ke unit perawatan neonatal dipelajari.

C. HASIL

Total jumlah kelahiran dari Januari 2015-Desember 2015 adalah 6917. Jumlah total kasus

abruptio plasenta dari Januari 2015- Desember 2015 adalah 40. Hasil penelitian ini

menunjukkan peningkatan insiden preeklampsia berat dengan abruption plasenta.

Bertambahnya usia telah diimplikasikan sebagai faktor predisposisi pada abruptio

plasentaruptio. Usia rata-rata pasien APH adalah 26-30 tahun. Sebagian besar pasien tidak

tercatat dan tidak menggunakan perawatan antenatal. Insiden tinggi pada wanita

multipara.Terutama abrupsi terlihat pada kehamilan jangka panjang. Sebagian besar terkait

dengan anemia dan PIH, dan cara persalinan bervariasi. Komplikasi utama pada si ibu adalah

syok.

Sebagian besar kasus abruptio plasentaruptio adalah antara 26 hingga 30 tahun 40,6%.

Kelompok usia paling umum berikutnya adalah antara 20 hingga 25 tahun. Insiden yang paling

rendah terlihat di antara kelompok usia <20tahun.

Jumlah maksimal kasus abruptio plasentaruptio adalah Gravida ke-2. Insiden abrupsi tinggi

pada wanita multipara dan terutama abrupsi terlihat pada kehamilan jangka panjang..

Abrupsi lebih umum di antara pasien yang mengalami preeklamsia berat daripada yang

normotensif. Sebagian besar dari mereka dikaitkan dengan anemia dan PIH. Bahkan kelompok

normotensif mengalami Abrupsi yang sekitar 17,4%.

69,8% memiliki kelahiran hidup. 30,2% bayi lahir mati. Di antara mereka 5 meninggal pada

periode neonatal awal karena prematuritas. Komplikasi janin termasuk hipoksia, anemia,

hambatan pertumbuhan, prematuritas, masalah perkembangan saraf, dan kematian janin.

Komplikasi ibu yang terkait dengan Abrupsi adalah Perdarahan Postpartum (PPH),

Disseminated Intravascular Coagulation (DIC), Gagal ginjal akut (GGA), Syok, Edema paru,

Infeksi. Di antaranya Perdarahan postpartum menyumbang sebagian besar komplikasi (19,6%).

D. DISKUSI

Abruptio plasenta adalah salah satu komplikasi serius kehamilan, karena menentukan pada

dampak ibu dan janin yang buruk. Insiden abruptio plasenta adalah 0,5% dalam penelitian

kami, yang mirip dengan studi oleh Wasnik SK.7 Tanda dan gejala abruptio plasenta bervariasi

tergantung pada tingkat keparahan perdarahan dan tingkat pemisahan plasenta. Abrupsi dapat

terjadi pada setiap tahap dalam kehamilan tetapi 32-36 minggu tampaknya menjadi periode

yang paling rentan 8. Kami menemukan 67% pasien dengan preeklampsia berat, 8,6% pasien

dengan eklamsia, 7% pasien dengan hipertensi kronis mengalami abrupsi. Di antara komplikasi

ibu, Perdarahan Postpartum (PPH) adalah yang paling umum diikuti oleh Disseminated

Intravascular Coagulation (DIC), Gagal Ginjal Akut (ISPA), syok, edema paru dan infeksi.

PPH terjadi pada 19,6% pasien dalam penelitian kami, sebagai studi banding oleh Talpur NN

melaporkan PPH pada 28% pasien. DIC dikaitkan dengan 16,7% pasien dalam penelitian kami.

Sher G mengamati DIC pada 10-20% pasien studinya dengan abrupsi berat dan kematian janin

yang sebanding dengan penelitian kami.10 Gagal ginjal adalah salah satu penyebab utama

kematian ibu.11 Kami menemukan ARF dilaporkan pada 11,3% dari Kasus dan syok pada
12
10,5% adalah sebagai studi dari Shrivatsava V melaporkan 24,6% kasus syok. Edema paru

terjadi pada 10,2% pasien dalam penelitian kami yang sebanding dengan penelitian oleh

Subramaniyan V yang dilaporkan pada 9,3% kasus.13 Sepsis puerperalis ditemukan pada 17,5%

pasien dalam penelitian oleh Choudhary V, dalam penelitian kami dilaporkan pada 9,8%

pasien. Mengenai dampak janin, 69,8% lahir hidup dan 30,2% bayi lahir mati. Abrupsi bukan

merupakan faktor risiko independen untuk dampak yang buruk di antara bayi yang lahir

sebelum 32 minggu kehamilan. Persalinan prematur dapat meningkatkan morbiditas janin pada

kasus abrupsi.15-19 Pemeriksaan kehamilan rutin, koreksi anemia, rujukan tepat waktu, operasi

caesar sesegera mungkin, transfusi komponen darah dan dan unit perawatan intensif neonatal
yang baik akan membantu lebih lanjut untuk menurunkan morbiditas dan mortalitas perinatal

dan maternal.

E. KESIMPULAN

Studi ini mengungkapkan bahwa pre-eklamsia berat, eklampsia, hipertensi kronis, paritas

tinggi merupakan faktor risiko independen untuk abruptio plasenta. Perawatan antenatal yang

mengidentifikasi faktor risiko seperti PIH memainkan peran penting dalam mengurangi

kejadian abruptio plasenta dan meningkatkan dampak ibu dan janin. Pemeriksaan antenatal

rutin, koreksi anemia, diagnosis dini & identifikasi hipertensi gestasional akan mencegah

morbiditas dan mortalitas maternal dan perinatal. Ini harus dikelola di pusat-pusat di mana

fasilitas ibu dan neonatal lanjutan tersedia. Meskipun morbiditas ibu berkurang dengan

manajemen modern abruptio plasenta, diagnosis dan intervensi yang tepat waktu masih

diperlukan. Deteksi dini dan manajemen aktif akan mengurangi morbiditas. Upaya tim oleh

ahli obstetri, intensivist dan neonatologist diperlukan untuk efek bagi ibu dan janin yang lebih

baik.
REFERENSI

1. Konje JC, Taylor DJ. Bleeding in later pregnancy. In: James DK, Steer PJ, Weiner CP, Gonik

B editors. High risk pregnancy 3rd ed. Philadelphia: Pennsylvania; 2006. 1266-71.

2. Pitaphrom A, Sukcharoen N. Pregnancy outcomes in placental abruption. J Med Oncolassoc

Thai. 2006; 1572-8.

3. Ananth CV, Lavery JA, Vintzileos AM. Severe Placental Abruption:Clinical definition and

associations with maternal complications. Am J Obstet Gynaecol. 2016;214;272.e1-9

4. Kyrklund-Bloomberg BN, Gennser G, Cnattinguis S. Placental abruption and perinatal

death. Paediatr Perinat Epidemiol. 2001;15:290-7.

5. Willium A, Lieberman E, Mittendorf R. Risk factors of abruption placentae. A J of

Epidemiol. 1991; 134(9):965-72.

6. Menom MK, Sokshi SK. Accidental haemorrhage in teaching hospital. J Obstet Gynaecol

Ind. 1961; 11:335-41.

7. Wasnik SN and Naiknaware SV. Antepartum Haemorrhage: Causes and its effects on

Mother Child: An Evaluation. Obstetri Gynaecol Internat J. 2015;3(1):00072.

8. Bibi S, Ghaffer S, Pir MA, Yousfani S. Risk factors and clinical outcome in placental

abruption: a retrospective analysis J Pak Medic Associat. 2009:59(10):672-4.

9. Talpur NN, Memon SR, Jamro B, Korejo R. Maternal and fetal morbidity with abruptio

placentae. Rawal Med J. 2011;36(4):297-300.

10. Sher G. Pathogenesis and management of uterine inertia complicating abruptio placentae

with

consumption coagulopathy. Am J Obstet Gynecol. 1977;129:164-70.

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