[Maternal and fetal morbidity and mortality in premature abruptio placentae--a retrospective analysis]

The frequency of abruptio placentae has nearly tripled in our clinic since 1974 and now stands at 1.4% of all deliveries. In a retrospective analysis it was investigated whether improved diagnostic and therapeutic methods have decreased the morbidity and mortality of this severe obstetrical complication. During 3 stages of observation--1974-1979, 1980-1985 and 1986-6/1990--we registered 123 cases. The division into time intervals was based on the introduction of sensitive ultrasonic methods in 1980 and the vaginal scan in 1986. Important risk factors of abruptio placentae were found to be bleeding in pregnancy (32%), previous curettages (38%), premature labour (29%), and pre-eclampsia (14%). The diagnostic sensitivity of sonography rose from 40% in the first to 78% in the third interval of observation. The rate of vaginal deliveries decreased from 15% to 2%. Simultaneously, the perinatal mortality decreased, despite increasing foetal prematurity, from 30% to 2%. The improvement in foetal outcome could be demonstrated by 1- and 5-minute Apgar score values. During the entire period, we lost one mother with abruptio placentae complicated by fulminant lung embolism intra operationem. The frequency of serious stages of abruptio placentae (Page 2-3) decreased from 69% to 33%. While 54% of the mothers developed shock (shock index > or = 1) during delivery in the first observation period, this figure was finally only 10.5%. At the same time the frequency of coagulation disorders decreased from 31% to 4%.