Retroplacental hematoma: epidemiological profile and associated risk factors among Malagasy women at the Soavinandriana Hospital Center (CENHOSOA)
DOI:
https://doi.org/10.18203/2320-6012.ijrms20253940Keywords:
Abdominal massage, Antenatal care, Risk factors, Retroplacental hematoma, Hypertension, Madagascar, PreeclampsiaAbstract
Background: Retroplacental hematoma (RPH) is a severe obstetric emergency that increases maternal and fetal morbidity and mortality. Data on RPH remain scarce in Madagascar. This study aimed to determine its prevalence and identify associated risk factors.
Methods: A descriptive and analytical case–control study was conducted in the Department of Obstetrics and Gynecology, Soavinandriana Hospital Center (CENHOSOA), Antananarivo, from January 2020 to December 2024. Sixty RPH cases and 120 controls (2:1 ratio) were analyzed. Data were retrospectively collected from medical records and analyzed using Epi Info 7.2. Associations were assessed using odds ratios (OR) with 95% confidence intervals (CI).
Results: Among 5,921 deliveries, 60 cases of RPH were identified (prevalence 1.01%). The mean age was 28.7 years (17-40). Farming was significantly associated with RPH (p=0.001; OR=5.75; 95% CI: 1.92-17.21). Lack of antenatal care (p=0.001; OR=6.51; 95% CI: 1.97-21.44), hypertension/preeclampsia (p=0.000; OR=5.68; 95% CI: 2.8-11.5), and abdominal massage during pregnancy (p=0.000; OR=13.57; 95% CI: 5.15-35.73) were major risk factors. Preterm delivery (<37 weeks) was significantly related to RPH (p=0.000; OR=7.97; 95% CI: 3.91-16.25). Cesarean section was required in 83.3% of cases (p=0.000; OR=23.57; 95% CI: 10.31-53.85).
Conclusions: RPH prevalence in this study was higher than reported in other regions. The main risk factors were abdominal massage, hypertensive disorders, absence of antenatal care, and low socioeconomic status. Strengthening antenatal follow-up and discouraging harmful traditional practices may reduce RPH-related complications.
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References
Mushtaq R, Afridi U, Bakhsh FM. A retrospective analysis of risk factors and fetomaternal outcomes of placental abruption. J Ayub Med Coll Abbottabad. 2020;15(5):1-5.
Huang K, Yan J, Li X, Lin X, Zhang Q, Luo J, et al. A risk factor analysis and prediction model of placental abruption. BMC Preg Childb. 2021;21(9):1-9.
Bączkowska M, Kosińska-Kaczyńska K, Zgliczyńska M, Brawura-Biskupski-Samaha R, Rebizant B, Ciebiera M. Epidemiology, risk factors, and perinatal outcomes of placental abruption: detailed annual data and clinical perspectives from a Polish tertiary center. Int J Environ Res Public Health. 2022;19(9):5148. DOI: https://doi.org/10.3390/ijerph19095148
Jenabi E, Salimi Z, Ayubi E, Bashirian S, Salehi AM. Environmental risk factors prior to conception associated with placental abruption: an umbrella review. Syst Rev. 2022;11(1):55. DOI: https://doi.org/10.1186/s13643-022-01915-6
Saquib S, Hamza LK, AlSayed A, Saeed F, Abbas M. Prevalence and fetomaternal outcomes in placental abruption: a five-year retrospective study from Dubai Hospital. Dubai Med J. 2020;3(1):26-31. DOI: https://doi.org/10.1159/000506256
Mæland KS, Morken NH, Schytt E, Aasheim V, Nilen R. Placental abruption in immigrant women: a Norwegian population-based study. Preprints. 2020. DOI: https://doi.org/10.22541/au.160432226.63349040/v1
Li Y, Tian Y, Liu N, Chen Y, Wu F. Analysis of 62 placental abruption cases: risk factors and clinical outcomes. Taiwan J Obstet Gynecol. 2019;58(2):223-226. DOI: https://doi.org/10.1016/j.tjog.2019.01.010
Elkafrawi D, Sisti G, Araji S, Khoury A, Miller J, Rodriguez Echevarria B. Risk factors for neonatal and maternal morbidity and mortality in African American women with placental abruption. Medicina (Kaunas). 2020;56(4):174. DOI: https://doi.org/10.3390/medicina56040174
De Moreuil C, Hannigsberg J, Chauvet J, Remoue A, Tremouilhac C, Merviel P, et al. Factors associated with poor fetal outcome in placental abruption. Pregnancy Hypertens. 2021;23:59-65. DOI: https://doi.org/10.1016/j.preghy.2020.11.004
Page N, Roloff K, Modi AP, Dong F, Neeki MM. Management of placental abruption following blunt abdominal trauma. Cureus. 2020;12(10):e10337. DOI: https://doi.org/10.7759/cureus.10337
Kyozuka H, Murata T, Fukusda T, Yamaguchi A, Kanno A, Yasuda S, et al. Teenage pregnancy as a risk factor for placental abruption: findings from the Japan Environment and Children’s Study. PLoS One. 2021;16(5):e0251428. DOI: https://doi.org/10.1371/journal.pone.0251428
Schur E, Baumfeld Y, Rotem R, Weintraub AY, Pariente G. Placental abruption: assessing trends in risk factors over time. Arch Gynecol Obstetr. 2022;306(5):1547-54. DOI: https://doi.org/10.1007/s00404-022-06638-6
Rakotozanany B, Rafanomezantsoa TA, Johannes RJ, Rasolonjatovo JD, Randriambelomanana JA. Role of surgical treatment and maternal-fetal prognosis of retroplacental hematoma at the Befelatanana Maternity Hospital, Madagascar. Revue d'Anes-Réanim Méd d'Urg Toxicol. 2017;9:10-2.
Razafimandimby AJR, Fenomanana MS, Andrianampanalinarivo HR. Hématome rétroplacentaire: pronostic materno-fœtal au CHUA de Befelatanana, Antananarivo, Madagascar. Thèse Méd. Université d’Antananarivo; 2009. Available at: http://biblio.univ-antananarivo.mg/pdfs/razafimandimbyAndriamilaminarivoJR_MED_DOC_10.pdf. Accessed 01 June 2025.
Ratisirahonanna FS, Andrianirina M, Andrianampanalinarivo HR. Maternal-fetal outcome of patients with severe preeclampsia at the Befelatanana University Hospital, Antananarivo. Medical thesis. University of Antananarivo, 2019. Available at: http://biblio.univ-antananarivo.mg/pdfs/lalanirinaDinaVA_MED_DOC_12.pdf. Accessed 01 June 2025.
Shen TT, DeFranco EA, Stamilio DM, Chang JJ, Muglia LJ. A population-based study of race-specific risk for placental abruption. BMC Pregn Childb. 2008;8(1):43. DOI: https://doi.org/10.1186/1471-2393-8-43
Ananth CV, Wilcox AJ, Savitz DA, Bowes WA, Luther ER. Effect of maternal age and parity on the risk of uteroplacental bleeding disorders in pregnancy. Obstet Gynecol. 1996;88(4 Pt 1):511-6. DOI: https://doi.org/10.1016/0029-7844(96)00236-0
Coface. Madagascar: Country and economic studies. Coface Economic Studies. 2022. Available at: https://www.coface.com/fr/Etudes-economiques-et-risque-pays/Madagascar. Accessed 01 June 2025.
Ekine AA, Adhuze JI, West OL. Influence of culturally based abdominal massage and antenatal care uptake among pregnant women in a tertiary hospital in southern Nigeria. J Adv Med Med Res. 2016;18(6):1-9. DOI: https://doi.org/10.9734/BJMMR/2016/27109
Banul MS, Halu SAN. Analysis of abdominal massage practice performed by traditional birth attendants in Mamba Community Health Center, East Nusa Tenggara. Asian J Midwife. 2019;10(2):45-50.
Mueller SM, Grunwald M. Effects, side effects, and contraindications of relaxation massage during pregnancy: a systematic review of randomized controlled trials. J Clin Med. 2021;10(16):3485. DOI: https://doi.org/10.3390/jcm10163485
Randriambelomanana JA, Botolahy ZA, Harimiadantsoa T, Herinirina SA, Rakotoarijaona A, Randrianampanalinarivo HR. Uterine ruptures: study of 57 cases at the Toamasina University Hospital Center, Madagascar. Rev Méd Antananarivo. 2017;3:1-6.
Andriamady R, Rasamoelisoa J, Ravaonarivo J, Ranjalahy R. Premature rupture of membranes seen at the Befelatanana Maternity Hospital, Antananarivo. Rev Méd Antananarivo. 1998;3:1-5.
Didier P. Valorisation of traditional medicine in Madagascar: the role of traditional healers in research and training on medicinal plants. Autrepart. 2017;81(1):159-72. DOI: https://doi.org/10.3917/autr.081.0159
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