OBJECTIVE: To compare the incidence of placental abruption (PA), fetal death and the profile of maternal factors associated with fetal death in pregnancies affected by placental abruption during two different time periods in the same hospital. METHODS: retrospective study between January 1, 1994 and December 31, 1997 and April 1, 2001 and March 31, 2005, including singleton pregnancies with a birth weight higher than 500g and gestational age of more than 20 weeks. Factors analyzed were maternal age, race, obstetric history, presence of arterial hypertension or premature rupture of membranes, presence of genital bleeding, presence of amniotic fluid contaminated with blood, characteristics of uterine tonus, occurrence of renal insufficiency, postpartum coagulopathy, puerperal anemia, gestational age and weight at birth. RESULTS: there were7692 births in the 1994-1997 period, placental abruption incidence of 0.78% (60 cases); 8644 births occurred in the 2001-2005 period, placental abruption incidence of 0.59% (51 cases), with no statistical difference. During the 1994-1997 period, proportion of cases without genital bleeding was significantly higher in the group whose fetuses died compared to cases of live born fetuses (57.9% vs 22.0%; p=0.01). During the 2001-2005 period, proportion of cases with uterine hypertonia was significantly higher in the group whose fetuses died compared to cases of live born fetuses (66.7% vs 29.3%; p=0.04). Postpartum maternal complications were more frequent in cases of fetal death during both periods (31.6% vs 4.9%; p=0.009; and 50% vs 5.1%; p=0.001, respectively). CONCLUSION: Placental abruption continues to be a serious obstetric problem, with fatal consequences, especially when the placental abruption area is large. Maternal clinical symptoms are more severe in cases of fetal death.
Pregnancy complications; Fetal death; Placenta; Placental abruption
