[Fetal death in placental abruption: comparison of two different time periods].
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 500 g 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 were 7692 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).


CONCLUSIONS
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.
Cabar
Fábio Roberto
FR
Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo- USP, São Paulo, SP. fabiocabar@uol.com.br
Nomura
Roseli Mieko Yamamoto
RM
Machado
Tânia Regina Schupp
TR
Zugaib
Marcelo
M
D000037:Abruptio Placentae / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology* / Q000209:etiology; D005865:Gestational Age; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D015994:Incidence; D007231:Infant, Newborn; D008423:Maternal Age; D008428:Maternal Mortality; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors