It seems appropriate to consider abruptio placentae as occurring from the 20th week onwards while accepting that the management of an individual case will be influenced by the gestational age at presentation. Abruptio placentae is a premature separation of a normally situated placentae. Abruptio placentae is one of the causes of maternal morbidity and mortality. It is also associated with high perinatal and neonatal morbidity and mortality. There are independent associations between abruptio placentae and severe fetal growth restriction. The main principles of management in the obvious case of abruptio placentae include early delivery, adequate blood transfusion, adequate analgesia, detailed monitoring of maternal condition and assessment of the fetal condition.

Methods. The study was designed as a case control study from live singleton births and singleton fetal death in Wad Medani Teaching Hospital during the period January 1997 through to December 2002. Format for birth certificates and death certificates were designed to include the age of the mother, the gestational age, the parity of the mother, the birth weight, the Apgar score of all life birth and the presence of congenital malformation. The format also included any complication of pregnancy with special reference to abruptio placentae. The gestational age was estimated from the first day of the last normal menstrual cycle or calculated from an ultrasound performed early in the second trimester. Abruptio placentae in all cases were diagnosed clinically and confirmed by the ultrasound which ruled out placenta praevia. The ultrasound was also utilized to detect any apparent congenital malformation of fetuses and confirmed the diagnoses of polyhydramnios. Multiple births were eliminated in order to use statistical techniques that required independent observations. The controls were chosen using systemic random sampling from all singleton live births without abruptio placentae occurring in Wad Medani Teaching Hospital during the same period. The sampling was carried out to pick up the number record. The number was chosen so that the entire file was sampled yielded approximately the desired number of controls. Then the live born infants were cross matched with death certificates from 1st January 1997 through to 31st January 2003, which determined the number of infants who died within the first month following delivery.

Results. During the period January 1997 through to December 2002. The total number of deliveries was 15620, and the total number of abruptio placentae was 1028 showing an incidence of (6.5%) for abruptio placentae. The controls included 884 cases without abruptio placentae. Table 1 showed the characteristics of infants born after abruptio placentae compared with the controls. In that table there were 131 still births 131/1028 (12.7%). The live birth were 897 infants. Those who died within the first 28 days were 77/897 (8.6%). Thus, the combined stillbirths and the first month deaths were 208/1082 (20.2%). Table 1 also showed that the infants of high risk were those with low birth weight and with short gestational age. The lowest risk was associated with infants weighing 3500 gm or more 14/1028 (1.4%), while the highest risk was associated with infants weighing less than 1500 gm 77/1028 (7.5%). Hence, the risk is inversely proportional to the birth weight. It was clear that the infants of high risk were those delivered before the 28th week 77/1028 (7.5%), on the other hand, those delivered after 37 weeks showed the least risk 40/1028 (3.8%). The Apgar score was assessed in the live born infants. The number of infants who died during the first month were born with low Apgar sc

Received 31st December 2003. Accepted for publication in final form 6th April 2004.