[Abruptio placentae. Management in a reference Nigerien maternity. Prospective study about 118 cases during one year]

Placental abruption is a syndrome, which occurs in the third trimester of the pregnancy or during labour. It is the main cause of pregnancy last term bleeding and is also responsible for a high stillbirth rate. The objective is to describe the epidemiological, clinical, paraclinical and therapeutic characteristics in order to decrease the fetal and maternal mortality and morbidity.

It is a prospective and descriptive study in continuous series, over a twelve-month period, from 1st January 2003 to 31st December 2003, at Issaka Gazobi maternity of Niamey, Niger.

During the study period, 3255 deliveries have been done. One hundred and eighteen placental abruptions have been observed, which corresponds to a frequency of 3.6% with the highest rate during raining season. The average age and parity were: 31 years and 5th with a predominance of grand multiparous (38.2%). The majority of the patients were in-utero transfers (83,1%) and had done at least 10 km before arriving. One hundred and eleven patients had a caesarean section (94,1%) and 7 delivered through the vaginal route (5.9%). The fetal prognosis was characterized by a high stillbirth rate of 71.3% (87/122), fetal hypotrophy (64.8%) and prematurity (23.8%). The main cause of maternal morbidity was anaemia (76.3%) and Disseminated Intravascular Coagulation (5.9%). Further, 81 patients have been transfused (68.7%). The maternal mortality was 5.1% (6/118).

Placental abruption, a medical and obstetrical emergency, is a serious obstetric condition, especially in our country. Physicians must be aware that patients with high blood pressure, preeclampsia, eclampsia, particularly in case of multiparity are at increased risk of placental abruption. Early diagnosis, prenatal follow-up and caesarean section improve the maternal and fetal prognosis.