title: Diagnostic Performance of Ultrasonography for Detection of Abruption and Its Clinical Correlation and Maternal and Foetal Outcome.
abstract: BACKGROUND
  Placental abruption complicates about 1% of singleton pregnancies and is an important cause of perinatal mortality and morbidity. Though sensitivity and reliability of ultrasound are poor for detecting or excluding placental abruption, because of the advances in ultrasound resolution, imaging and interpretation, sensitivity of ultrasound is better than what was reported previously.
  
  
  OBJECTIVE
  To determine the diagnostic performance of Ultrasonography (USG) for the detection of placental abruption and whether sonographic results correlate with maternal and foetal management and outcome.
  
  
  METHODS
  Thirty patients with clinical diagnosis of placental abruption were studied in the Obstetrics and Gynaecology Department of Krishna Institute of Medical Sciences, over a period of 6 months. These patients underwent ultrasonography for confirmation. Obstetric and neonatal outcome and sonographic results were compared and reviewed. Sonographic sensitivity and specificity and positive and negative predictive values were calculated.
  
  
  RESULTS
  Incidence of abruption in present study was 1.56% (28 patients out of 1786 total deliveries). Sensitivity of ultrasonography in the diagnosis of abruption was 57% (CI 37.15%-75.57%) while its specificity was 100% (CI 15.81%-100%) with a positive predictive value of 100% (CI 79.42%-100%) and a 14% (CI 1.78% - 42.83%) negative predictive value. An 87.5% of patients(14 out of 16) with a positive USG finding of abruption had Intrauterine foetal Death (IUD)/still birth while 91.6% of patients (11 out of 12) with negative USG findings of abruption gave birth to babies who required NICU admission.
  
  
  CONCLUSIONS
  Sonography is not sensitive for the detection of placental abruption but it is highly specific. Positive sonographic findings are associated with increased maternal morbidity, require more aggressive obstetric management and it is associated with worse perinatal outcome. In case of a negative USG finding, but a strong clinical suspicion of abruption if obstetric intervention is made in due time, foetal as well as maternal outcome are better. Foetal outcome also depends on gestational age. Preterm patients with positive USG and intrapartum findings of abruption have worse foetal outcome compared to full-term patients with abruption.
authors.affiliation: Assistant Professor, Department of Obstetrics and Gynaecology, Krishna Institute of Medical Sciences Deemed University , Karad, Maharashtra, India .
authors.forename: Gauri Raghunath
authors.initials: GR
authors.lastname: Shinde
authors.affiliation: Junior Resident, Department of Obstetrics and Gynaecology, Krishna Institute of Medical Sciences Deemed University , Karad, Maharashtra, India .
authors.forename: Babita Prakash
authors.initials: BP
authors.lastname: Vaswani
authors.affiliation: Head of Department and Professor, Department of Obstetrics and Gynaecology, Krishna Institute of Medical Sciences Deemed University , Karad, Maharashtra, India .
authors.forename: R P
authors.initials: RP
authors.lastname: Patange
authors.affiliation: Associate Professor, Department of Obstetrics and Gynaecology, Krishna Institute of Medical Sciences Deemed University , Karad, Maharashtra, India .
authors.forename: Manisha Manish
authors.initials: MM
authors.lastname: Laddad
authors.affiliation: Senior Resident, Department of Obstetrics and Gynaecology, Krishna Institute of Medical Sciences Deemed University , Karad, Maharashtra, India .
authors.forename: Rajashree Babasaheb
authors.initials: RB
authors.lastname: Bhosale
keywords: Antepartum haemorrhage; USG in antepartum haemorrhage