title: Frequency, risk factors and feto-maternal outcomes of abruptio placentae in Northern Tanzania: a registry-based retrospective cohort study.
abstract: BACKGROUND
  Abruptio placentae remains a major cause of maternal and perinatal morbidity and mortality in developing countries. Little is known about the burden of abruptio placentae in Tanzania. This study aimed to determine frequency, risk factors for abruptio placentae and subsequent feto-maternal outcomes in women with abruptio placentae.
  
  
  METHODS
  We designed a retrospective cohort study using maternally-linked data from Kilimanjaro Christian Medical Centre (KCMC) medical birth registry. Data on all women who delivered live infants and stillbirths at 28 or more weeks of gestation at KCMC hospital from July 2000 to December 2010 (n = 39,993) were analysed. Multivariate logistic models were used to calculate odds ratios (OR) and 95% confidence intervals (CIs) for risk factors, and feto-maternal outcomes associated with abruptio placentae.
  
  
  RESULTS
  The frequency of abruptio placentae was 0.3% (112/39,993). Risk factors for abruptio placentae were chronic hypertension (OR 4.1; 95% CI 1.3-12.8), preeclampsia/eclampsia (OR 2.1; 95% CI 1.1-4.1), previous caesarean delivery (OR 1.3; 95% CI 1.2-4.2), previous abruptio placentae (OR 2.3; 95% CI 1.8-3.4), fewer antenatal care visits (OR 1.3; 95% 1.1-2.4) and high parity (OR 1.4; 95% CI 1.2-8.6). Maternal complications associated with abruptio placentae were antepartum haemorrhage (OR 11.5; 95% CI 6.3-21.2), postpartum haemorrhage (OR 17.9; 95% 8.8-36.4),), caesarean delivery (OR 5.6; 95% CI 3.6-8.8), need for blood transfusions (OR 9.6; 95% CI 6.5-14.1), altered liver function (OR 5.3; 95% CI 1.3-21.6) and maternal death (OR 1.6; 95% CI 1.5-1.8). In addition, women with abruptio placentae had prolonged duration of hospital stay (more than 4 days) and were more likely to have been referred during labour. Adverse fetal outcomes associated with abruptio placentae include low birth weight (OR 5.9; 95% CI 3.9-8.7), perinatal death (OR 17.6; 95% CI 11.3-27.3) and low Apgar score (below 7) at 1 and 5 min.
  
  
  CONCLUSIONS
  Frequency of abruptio placentae is comparable with local and international studies. Chronic hypertension, preeclampsia, prior caesarean section delivery, prior abruptio placentae, poor attendance to antenatal care and high parity were independently associated with abruptio placentae. Abruptio placentae was associated with adverse maternal and foetal outcomes. Clinicians should identify risk factors for abruptio placentae during prenatal care when managing pregnant women to prevent adverse maternal and foetal outcomes.
authors.affiliation: Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre (KCMC)/Kilimanjaro Christian Medical Collage (KCM College), Moshi, Tanzania. machekusg@yahoo.com.
authors.forename: Godwin S
authors.initials: GS
authors.lastname: Macheku
authors.affiliation: Department of Paediatrics, Kilimanjaro Christian Medical Centre (KCMC)/Kilimanjaro Christian Medical Collage (KCM College), Moshi, Tanzania. rphilemon@yahoo.co.uk.
authors.forename: Rune Nathaniel
authors.initials: RN
authors.lastname: Philemon
authors.affiliation: Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre (KCMC)/Kilimanjaro Christian Medical Collage (KCM College), Moshi, Tanzania. ololaoneko03@gmail.com.|Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, 2240, Moshi, Tanzania. ololaoneko03@gmail.com.
authors.forename: Olola
authors.initials: O
authors.lastname: Oneko
authors.affiliation: Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre (KCMC)/Kilimanjaro Christian Medical Collage (KCM College), Moshi, Tanzania. pendomlay1975@gmail.com.|Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, 2240, Moshi, Tanzania. pendomlay1975@gmail.com.
authors.forename: Pendo S
authors.initials: PS
authors.lastname: Mlay
authors.affiliation: Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre (KCMC)/Kilimanjaro Christian Medical Collage (KCM College), Moshi, Tanzania. drgmasenga@yahoo.com.|Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, 2240, Moshi, Tanzania. drgmasenga@yahoo.com.
authors.forename: Gileard
authors.initials: G
authors.lastname: Masenga
authors.affiliation: Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre (KCMC)/Kilimanjaro Christian Medical Collage (KCM College), Moshi, Tanzania. jobure2002us@yahoo.com.
authors.forename: Joseph
authors.initials: J
authors.lastname: Obure
authors.affiliation: Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, 2240, Moshi, Tanzania. jmmahande@gmail.com.
authors.forename: Michael Johnson
authors.initials: MJ
authors.lastname: Mahande
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D001034:Apgar Score; D001803:Blood Transfusion; D002585:Cesarean Section; D002908:Chronic Disease; D003906:Developing Countries; D004461:Eclampsia / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007902:Length of Stay; D008099:Liver / Q000503:physiopathology; D010298:Parity; D066087:Perinatal Death; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011295:Prenatal Care; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult