TITLE:
Abruptio Placentae 116 Cases: Role of PGE1 in Cervical Ripening and Induction of Labor, January 2006-August 2006
AUTHORS:
Pratibha Devabhaktuni, M. G. S. Nagasree
KEYWORDS:
Placental Abruption, Antepartum Haemorrhage, PGE1, Misoprostol, Labor Induction
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.8 No.6,
June
13,
2018
ABSTRACT: OBJECTIVES: In the very high risk obstetric cases of placental abruption,
expediting delivery is of utmost urgency, since the complications are related
to the abruption delivery interval. Before the introduction of prostaglandins
for labor induction, it was a routine practice to do amniotomy and use oxytocin
drip to accelerate labor when vaginal delivery was contemplated. We present 116
cases of placental abruption, including
the severe cases, managed in the year 2006 during a period of 8 months, at
Modern Government Maternity Hospital, which was the biggest maternity hospital
in the combined state of Andhra Pradesh, and is the biggest in the state of
Telangana, attached to Osmania Medical College. The role of prostaglandin E1 (PGE1), for
cervical ripening and labor induction/augmentation has been analyzed in this
observational study. A variety of variables including age, parity, gestational
age, severity of abruption and maternal and fetal status, associated
preeclampsia, Bishop score, availability of blood and blood products,
associated complications, all factors influence the management adopted. MATERIAL METHODS: The response to PGE1 induction has been
studied in terms of efficacy, the
total number of doses of vaginal PGE1 in relation to parity, induction delivery
interval, successful vaginal delivery rate, the indications for caesarean
delivery, perinatal outcome and complications. A decision was made for either
abdominal delivery or vaginal delivery on a case to case basis. A routine
amniotomy was performed when the cervical os was open, both for confirmation of
diagnosis and to release intra uterine pressure, and also it would help in the
acceleration of labor. When the Bishop score was more than six, amniotomy was
performed and an oxytocin intravenous drip was started. If the Bishop score was
less than six, 25/50
mcg. Misoprostol (PGE1) was placed high in the vagina. OBSERVATIONS:
Primies that had abruption were 27/116 = 23.27% and multies were 89/116 = 76.72%. In
our study 68/116, (58.62%) had preeclamsia. In our series, gestational age at
abruption was less than 36 weeks in 89/116, (76.72%) and >36 weeks in 27/116
(23.27%) at presentation. It is significant to note that 100/116 (86.2%) were
unbooked and 16/116 (13.79%) were booked cases at our institute. Vaginal deliveries were 84
(74.2%) and caesarean deliveries were 30 (25.8%) in 116 placental abruptions.
There were four maternal deaths 3.4%, two died undelivered. Perinatal mortality
in our series was 92/116 (79.3%). PGE1 induced labours—49: When PGE1 was
used for labor induction in 49 women, 40 (81.63%) had vaginal delivery and
caesarean delivery was done in 9 (18.36%) cases for non progress of labor.
Induction delivery interval was less than 12 hours in 45 (91.83%), more than 12 hours in 4
(8.1%). Preterm delivery in PGE1 induced cases was 40/49 = 81.63% versus preterm in 116 cases, 76.72%. This indicates that
more numbers of
preterm deliveries were allowed vaginal delivery. DISCUSSION: Maternal
mortality: Better facilities of transfusion of blood products may have
reduced maternal mortality in our series. Government maternity hospital is a
public sector tertiary health facility providing free treatment. Early referral
would make some difference. Acute defibrination leading to disseminated
intravascular cougulation was the cause of three deaths, irreversible haemorrhagic shock in another. CONCLUSION:
Induction of labor with PGE1 was useful and effective when cervix was unfavorable
and Bishop score was less than six. With PGE1 induction (49) 91.83% delivered
in less than 12 hours. There were no maternal deaths and PPH in 49 women
induced with PGE1. Hence PGE1 was safe to use in these emergency high-risk obstetric patients.
PGE1 usage to expedite delivery can reduce Caesarean section rate.