Early Adverse Perinatal Outcomes Among Women With Placental Abruption: A Multicenter Prospective Cohort Study in Uganda.

BACKGROUND AND AIMS: Placental abruption is one of the leading causes of perinatal morbidity and mortality, particularly in low- and middle-income countries. In 2015, the World Health Organization prioritized improving maternal and newborn care to reduce preventable deaths. This study is aimed at determining the proportion of early adverse perinatal outcomes and identifying the factors associated with these outcomes among women with placental abruption delivering at three tertiary hospitals in Uganda. METHODS: This prospective cohort study was conducted from September 30, 2023, to January 30, 2024, at Jinja, Fort Portal, and Mubende Regional Referral Hospitals. A total of 110 consecutive women with clinically diagnosed placental abruption were enrolled in labor suites. Data were collected via pretested questionnaires and analyzed via STATA Version 14.2. Descriptive statistics were used to determine the incidence and describe adverse perinatal outcomes. Associations between variables were assessed using bivariate and multivariate analyses, with a significance level set at p < 0.05 and a 95% confidence interval. The results were presented using pie charts, bar graphs, and tables. RESULTS: Among the 110 women with confirmed placental abruption, 70 (63.6%) experienced at least one early adverse perinatal outcome. The most frequent adverse outcomes were neonatal intensive care unit admission (37.1%), stillbirth (27.1%), neonatal death within 48 h (14.3%), low Apgar score (11.4%), and low birth weight (10.0%). Mothers with abnormal fetal heart rates at admission, either abnormally high (adjusted risk ratio [aRR] = 2.80, 95% CI: 1.61-3.22, p = 0.005) or low (aRR = 2.56, 95% CI: 1.50-3.10, p = 0.004), were significantly more likely to experience early adverse perinatal outcomes. Mothers who delivered via spontaneous vaginal delivery were less likely to have adverse outcomes (aRR = 0.335, 95% CI: 0.105-0.923, p = 0.032). Additionally, mothers with > 50% placental detachment were 8 times more likely to experience adverse outcomes (aRR = 2.59, 95% CI: 1.48-3.13, p = 0.005). CONCLUSIONS: Women with placental abruption experienced a high burden of early adverse perinatal outcomes. Abnormal fetal heart rate at admission, mode of delivery, and extent of placental detachment were independently associated with these outcomes. These findings highlight the importance of timely diagnosis, close fetal monitoring, and prompt obstetric management among women presenting with placental abruption.