Join us   Log in   jmsr2014@yahoo.com  


JOURNAL OF MEDICAL AND SURGICAL RESEARCH - Vol. Xl, n 1, June 2024

Pages: 1348-1357
Print Article   Download XML  Download PDF

Placental Abruption:

Unveiling Persistent Challenges and Management Strategies from the Obstetrical Intensive Care Unit Experience in Fes, Morocco

Author: Fatima Zahrae Benchekroun, Ilias Jerrar Oulidi, Kaoutar Chafai, Soufiane Bengelloun Zahr, Djoudline Doughmi, Said Benlamkaddem, Mohamed Adnane Berdai, Mustapha Harandou

Category: JMSR Anesthesiology and IC

Abstract:

Introduction: Postpartum haemorrhage (PPH) remains the leading cause of maternal mortality, with placental abruption (PA) being a serious and challenging etiology. Late diagnosis and inadequate management of PA can exacerbate PPH and worsen maternal outcomes. This work aims to analyse the epidemiological, clinical and Para-clinical profile of PA in the Intensive Care Unit (ICU); as well as to determine the profile of coagulopathy in PPH and to discuss various treatment modalities. Materials & Methods: This retrospective, descriptive, non-interventional study reviews cases of PA requiring ICU admission at Hassan II University Hospital in Fez from January 2019 to December 2023. Results: Forty-two patients met the inclusion criteria, with a mean age of 32 years. Primiparae constituted 33.4% of the cohort. 78.6% lacked prenatal care. The average gestational age was 32 weeks. Preeclampsia was the predominant risk factor (57.1%). Symptoms included mostly slow fetal movements, hemorrhage, and abdominal rigidity. At admission, 26% of patients exhibited hemorrhagic shock. General anesthesia was used in 82.5% of cases. In the operating room, 12% of patients received fibrinogen, and 50% received tranexamic acid. Blood transfusions were administered to 67% of patients, with an average of 2.14 packed red blood cells (PRBCs), 5.3 platelets (PLTs), and 3.5 fresh frozen plasma (FFP). Surgical interventions included hysterectomy, B-Lynch procedure, and vascular ligature. The mean duration of mechanical ventilation in the ICU was 3.66 days. The maternal mortality rate was 9.5%, and five newborns survived to discharge. Conclusion: This study emphasizes the need for a multidisciplinary approach and early intervention to manage PPH from PA effectively, and highlights the importance of national programs to address modifiable risk factors.

Keywords: Fibrinogen, Placental Abruption, Postpartum Hemorrhage, Tranexamic Acid, Transfusion, Morocco