DIFFERENTIAL DIAGNOSIS OF PLACENTA ABRUPTIO AND PLACENTA PREVIA: CLINICAL AND ULTRASONOGRAPHIC CRITERIA

Abstract

Background: Antepartum hemorrhage (APH) is a critical obstetric emergency, with Placenta Abruptio (PA) and Placenta Previa (PP) being the two most common causes. Differentiating between these conditions is vital for maternal and fetal survival but remains challenging due to overlapping symptoms. This study aims to evaluate the diagnostic accuracy of clinical symptoms versus ultrasonography in distinguishing PA from PP in a tertiary care setting. Methods: A prospective comparative study was conducted at the Andijan Regional Perinatal Center involving 200 patients presenting with APH after 28 weeks of gestation. Patients were confirmed postnatally as having either PA (n=110) or PP (n=90). We analyzed clinical parameters (pain, nature of bleeding, uterine tone) and ultrasound findings. Sensitivity and specificity of diagnostic methods were calculated. Results: Clinical presentation of "painful bleeding" had a sensitivity of 85% for PA, while "painless bleeding" had a sensitivity of 92% for PP. Ultrasonography was the gold standard for PP (Sensitivity 98%, Specificity 100%) but showed poor sensitivity for PA (45%). Fetal distress was significantly more common in the PA group (65%) compared to the PP group (15%, p<0.001). Conclusion: While ultrasonography is definitive for excluding Placenta Previa, it is unreliable for diagnosing Placenta Abruptio. The diagnosis of abruption remains primarily clinical. A combination of clinical assessment (uterine tonus, pain) and ultrasound (placental location) is the optimal strategy for differential diagnosis.