The Impact of Decision-Delivery Interval on Feto-Maternal Outcome of Women Presenting with Severe Placental Abruption in Northern Nigeria Feto-maternal outcome of severe placental abruption Section Original Articles

Abstract

Abstract

Background: Severe placental abruption, which is the commonest form seen in referral hospitals in our environment, is a major cause of maternal and perinatal morbidity and mortality. Such patients require prompt resuscitation and delivery to save the life of the mother, and the fetus where it is still alive. Objectives: The aim of this study is to evaluate the impact of decision-delivery interval (DDI) on the feto-maternal outcomes of severe abruptio.

Methods: This is a prospective study of all women presenting with severe placental abruption at the labour wards of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Bauchi and the Federal Medical Centre (FMC) Azare, Bauchi state. The sociodemographic data of the patients as well as their clinical presentation were captured on a research proforma. After the consultant decided on the mode of delivery, the patients were monitored regularly by research assistants, looking for co-morbidities, complications, and feto-maternal outcomes. The mothers, and the babies where alive, were followed up until discharged from hospital or for 7 days if still on admission. The data obtained was entered into SPSS version 25 software, coded and analyzed.

Results: There was a total of 2,460 deliveries during the study period, with 95 cases of severe abruptio, giving an incidence of 3.9%. Sixty-one (67%) of patients had co-morbidities, most of which were hypertensive disorders of pregnancy occurring in 52.8% of cases. Most patients presented with vaginal bleeding and abdominal pain as occurred in 97.6% and 81.3% of cases respectively. Abdominal tenderness was elicited in 54.9% of patients, while the uterus was characteristically tense on palpation in 52.7% of patients. DDI of less than 30 minutes was associated with the best maternal outcome. As the DDI increased, complications also increased with a high possibility of maternal death if delivery was delayed for more than 2 hours. Similarly, for mothers presenting with live fetus, delivery within 30 minutes gave the best fetal outcome. As the DDI increased, the fetal outcome worsened with birth asphyxia, SCBU admission and early neonatal death increasing with time.

Conclusion: The early causes of delay for caesarean section for women with live fetuses were delay in obtaining consent for surgery and delay in resuscitation. As time went on, the delay in obtaining results of laboratory investigations became an issue. Because of the busy obstetric theatre, the delay in obtaining operation space and logistics of moving the patients to the theatre became problematic. It is recommended that obstetric emergency services in our referral centers be revamped to perform better. The NHIS services should also be extended to the poor masses to enable women access free or subsidized health care.