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Ananth CV, Lee R, Valeri L, Ross Z, Graham HL, Khan S, Cabrera J, Rosen T, Kostis WJ. Placental Abruption and Cardiovascular Event Risk (PACER): Design, data linkage, and preliminary findings. Paediatr Perinat Epidemiol 2024; 38:271-286. [PMID: 38273776 PMCID: PMC10978269 DOI: 10.1111/ppe.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Obstetrical complications impact the health of mothers and offspring along the life course, resulting in an increased burden of chronic diseases. One specific complication is abruption, a life-threatening condition with consequences for cardiovascular health that remains poorly studied. OBJECTIVES To describe the design and data linkage algorithms for the Placental Abruption and Cardiovascular Event Risk (PACER) cohort. POPULATION All subjects who delivered in New Jersey, USA, between 1993 and 2020. DESIGN Retrospective, population-based, birth cohort study. METHODS We linked the vital records data of foetal deaths and live births to delivery and all subsequent hospitalisations along the life course for birthing persons and newborns. The linkage was based on a probabilistic record-matching algorithm. PRELIMINARY RESULTS Over the 28 years of follow-up, we identified 1,877,824 birthing persons with 3,093,241 deliveries (1.1%, n = 33,058 abruption prevalence). The linkage rates for live births-hospitalisations and foetal deaths-hospitalisations were 92.4% (n = 2,842,012) and 70.7% (n = 13,796), respectively, for the maternal cohort. The corresponding linkage rate for the live births-hospitalisations for the offspring cohort was 70.3% (n = 2,160,736). The median (interquartile range) follow-up for the maternal and offspring cohorts was 15.4 (8.1, 22.4) and 14.4 (7.4, 21.0) years, respectively. We will undertake multiple imputations for missing data and develop inverse probability weights to account for selection bias owing to unlinked records. CONCLUSIONS Pregnancy offers a unique window to study chronic diseases along the life course and efforts to identify the aetiology of abruption may provide important insights into the causes of future CVD. This project presents an unprecedented opportunity to understand how abruption may predispose women and their offspring to develop CVD complications and chronic conditions later in life.
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Affiliation(s)
- Cande V. Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Rachel Lee
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Linda Valeri
- Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, Inc., Ithaca, NY, USA
| | - Hillary L. Graham
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Clinical Epidemiology Division, Faculty of Medicine at Solna, Karolinska Institutet, Stockholm, Sweden
| | - Shama Khan
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Javier Cabrera
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Statistics, Rutgers University, Piscataway, NJ, USA
| | - Todd Rosen
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - William J. Kostis
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Huang Z, Zhang Q, Zhu L, Xiang H, Zhao D, Yao J. Determinants of low birth weight among newborns delivered in China: a prospective nested case-control study in a mother and infant cohort. J OBSTET GYNAECOL 2023; 43:2197483. [PMID: 37083546 DOI: 10.1080/01443615.2023.2197483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
This nested case-control study aimed to investigate the determinants of low birth weight among newborn babies delivered in Shenzhen, Guangdong, China. We recorded socio-demographic data, health status before pregnancy, pregnancy outcomes and complications in a Shenzhen mother and infant cohort. Among 8951 cases, 401 (4.48%) had low birth weight and 1.65% were full-term with LBW. Maternal body mass index, family income, history of pregnancy, hypertension before pregnancy, vaginal bleeding in 1st trimester, pregnancy-related diabetes, hypertension, placenta previa, placental abruption, premature rupture of membrane, oligohydramnios, and placental types were significantly associated with low birth weight (P < 0.05). In this study, high-risk and mainly preventable factors were linked to low birth weight. Adequate antenatal care, proper maternal nutrition and implementation of proven strategies to prevent high-risk factors may be effective ways to reduce the incidence of low birth weight.
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Affiliation(s)
- Zhuomin Huang
- Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Quanfu Zhang
- Shenzhen Baoan Maternal and Child Health Hospital, Jinan University, Shenzhen, Guangdong, P.R. China
| | - Litong Zhu
- Department of Gynecology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Haishan Xiang
- Department of Science and Education, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Depeng Zhao
- Department of Reproductive Medicine, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Jilong Yao
- Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, P.R. China
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Iijima T, Obata S, Miyagi E, Aoki S. Clinical Features of Preeclampsia Preceded by Fetal Growth Restriction. Cureus 2023; 15:e51275. [PMID: 38288232 PMCID: PMC10823203 DOI: 10.7759/cureus.51275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
AIM This study aimed to clarify the perinatal prognosis of preeclampsia (PE) with fetal growth restriction (FGR) and determine appropriate medical interventions for these conditions. METHODS Singleton births delivered to mothers diagnosed with PE with FGR and hypertension at a tertiary center between January 2010 and June 2021 were included. Only patients with PE were included in the analysis, and patients with superimposed PE were excluded. The FGR-preceding group (group F) included patients who developed FGR first and had elevated blood pressure. The remaining cases were defined as the hypertension-preceding group (group H). The perinatal outcomes between the two groups were then compared. The primary outcome was pregnancy prolongation defined as the time from PE diagnosis to delivery. Secondary outcomes included mode of delivery, maternal outcomes, and neonatal outcomes. RESULTS The mean gestational age at the time of PE diagnosis was 34.7 (26-40.1) weeks for group F and 30.3 (22.6-39.4) weeks for group H (P=0.004). The median pregnancy prolongation from the time of PE diagnosis to delivery was eight (2-30) days in group F and 10.5 (2-43) days in group H, with no significant difference (P=0.52). The incidence of maternal critical complications was 10.4% in group F and 28.1% in group H (P=0.03; odds ratio 3.36; 95% confidence interval 1.13-10). CONCLUSIONS Among patients with PE, group H was more likely to develop serious maternal complications than group F, suggesting different pathogenesis between these types of PE. Both groups required cautious perinatal management, but more stringent maternal management was required for group H.
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Affiliation(s)
- Takayoshi Iijima
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, JPN
| | - Soichiro Obata
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, JPN
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, JPN
| | - Shigeru Aoki
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, JPN
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Brandt JS, Ananth CV. Placental abruption at near-term and term gestations: pathophysiology, epidemiology, diagnosis, and management. Am J Obstet Gynecol 2023; 228:S1313-S1329. [PMID: 37164498 PMCID: PMC10176440 DOI: 10.1016/j.ajog.2022.06.059] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 05/12/2023]
Abstract
Placental abruption is the premature separation of the placenta from its uterine attachment before the delivery of a fetus. The clinical manifestations of abruption typically include vaginal bleeding and abdominal pain with a wide variety of abnormal fetal heart rate patterns. Clinical challenges arise when pregnant people with this condition present with profound vaginal bleeding, necessitating urgent delivery, especially when there is a concern for maternal and fetal compromise and coagulopathy. Abruption occurs in 0.6% to 1.2% of all pregnancies, with nearly half of abruption occurring at term gestations. An exposition of abruption at near-term (defined as the late preterm period from 34 0/7 to 36 6/7 weeks of gestation) and term (defined as ≥37 weeks of gestation) provides unique insights into its direct effects, as risks associated with preterm birth do not impact outcomes. Here, we explore the pathophysiology, epidemiology, and diagnosis of abruption. We discuss the interaction of chronic processes (decidual and uteroplacental vasculopathy) and acute processes (shearing forces applied to the abdomen) that underlie the pathophysiology. Risk factors for abruption and strengths of association are summarized. Sonographic findings of abruption and fetal heart rate tracings are presented. In addition, we propose a management algorithm for acute abruption that incorporates blood loss, vital signs, and urine output, among other factors. Lastly, we discuss blood component therapy, viscoelastic point-of-care testing, disseminated intravascular coagulopathy, and management of abruption complicated by fetal death. The review seeks to provide comprehensive, clinically focused guidance during a gestational age range when neonatal outcomes can often be favorable if rapid and evidence-based care is optimized.
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Affiliation(s)
- Justin S Brandt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
| | - Cande V Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; Cardiovascular Institute of New Jersey and Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
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Maharjan S, Thapa M, Chaudhary B, Shakya S. Abruptio Placenta among Pregnant Women Admitted to the Department of Obstetrics and Gynaecology in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:918-921. [PMID: 36705178 PMCID: PMC9795091 DOI: 10.31729/jnma.7796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Abruptio placenta is the complete or partial separation of the normally implanted placenta before delivery of the foetus. It is one of the commonest causes of antepartum haemorrhage affecting maternal and foetal outcomes. Early detection and timely intervention of abruptio placenta in daily clinical practice are important to improve maternal and perinatal outcomes. The objective of the study was to find out the prevalence of abruptio placenta among the pregnant women admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre. Methods A descriptive cross-sectional study was done among the pregnant women admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre where data from medical records was taken from 1 January, 2021 to 31 December, 2021 after taking ethical approval from the Institutional Review Committee (Reference number: 1102202208). Demographic details of the patients including age and parity were recorded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results Out of 1514 deliveries, abruptio placenta was seen in 10 (0.66%) (0.25-1.07, 95% Confidence Interval) cases. Conclusions The prevalence of abruptio placenta among pregnancies was similar to the studies done in similar settings. Keywords abruptio placenta; epidemiology; fetal outcome; incidence; maternal outcome.
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Affiliation(s)
- Sujata Maharjan
- Department of Obstetrics and Gynaecology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal,Correspondence: Dr Sujata Maharjan, Department of Obstetrics and Gynaecology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal. , Phone: +977-9849350217
| | - Meena Thapa
- Department of Obstetrics and Gynaecology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Babita Chaudhary
- Department of Obstetrics and Gynaecology, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - Subij Shakya
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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Understanding Etiologic Pathways Through Multiple Sequential Mediators: An Application in Perinatal Epidemiology. Epidemiology 2022; 33:854-863. [PMID: 35816125 DOI: 10.1097/ede.0000000000001518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Causal mediation analysis facilitates decomposing the total effect into a direct effect and an indirect effect that operates through an intermediate variable. Recent developments in causal mediation analysis have clarified the process of evaluating how-and to what extent-different pathways via multiple causally ordered mediators link the exposure to the outcome. METHODS Through an application of natural effect models for multiple mediators, we show how placental abruption might affect perinatal mortality using small for gestational age (SGA) birth and preterm delivery as two sequential mediators. We describe methods to disentangle the total effect into the proportions mediated via each of the sequential mediators, when evaluating natural direct and natural indirect effects. RESULTS Under the assumption that SGA births causally precedes preterm delivery, an analysis of 16.7 million singleton pregnancies is consistent with the hypothesis that abruption exerts powerful effects on perinatal mortality (adjusted risk ratio = 11.9; 95% confidence interval = 11.6, 12.1). The proportions of the estimated total effect mediated through SGA birth and preterm delivery were 2% and 58%, respectively. The proportion unmediated via either SGA or preterm delivery was 41%. CONCLUSIONS Through an application of causal mediation analysis with sequential mediators, we uncovered new insights into the pathways along which abruption impacts perinatal mortality.
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Tsakiridis I, Giouleka S, Mamopoulos A, Athanasiadis A, Dagklis T. Investigation and management of stillbirth: a descriptive review of major guidelines. J Perinat Med 2022; 50:796-813. [PMID: 35213798 DOI: 10.1515/jpm-2021-0403] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/01/2022] [Indexed: 11/15/2022]
Abstract
Stillbirth is a common and devastating pregnancy complication. The aim of this study was to review and compare the recommendations of the most recently published guidelines on the investigation and management of this adverse outcome. A descriptive review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynecologists (RCOG), the Perinatal Society of Australia and New Zealand (PSANZ), the Society of Obstetricians and Gynecologists of Canada (SOGC) on stillbirth was carried out. Regarding investigation, there is consensus that medical history and postmortem examination are crucial and that determining the etiology may improve care in a subsequent pregnancy. All guidelines recommend histopathological examination of the placenta, genetic analysis and microbiology of fetal and placental tissues, offering less invasive techniques when autopsy is declined and a Kleihauer test to detect large feto-maternal hemorrhage, whereas they discourage routine screening for inherited thrombophilias. RCOG and SOGC also recommend a complete blood count, coagulopathies' testing, anti-Ro and anti-La antibodies' measurement in cases of hydrops and parental karyotyping. Discrepancies exist among the reviewed guidelines on the definition of stillbirth and the usefulness of thyroid function tests and maternal viral screening. Moreover, only ACOG and RCOG discuss the management of stillbirth. They agree that, in the absence of coagulopathies, expectant management should be considered and encourage vaginal birth, but they suggest different labor induction protocols and different management in subsequent pregnancies. It is important to develop consistent international practice protocols, in order to allow effective determination of the underlying causes and optimal management of stillbirths, while identifying the gaps in the current literature may highlight the need for future research.
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Affiliation(s)
- Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sonia Giouleka
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Khan S, Chughani G, Amir F, Bano K. Frequency of Abruptio Placenta in Women With Pregnancy-Induced Hypertension. Cureus 2022; 14:e21524. [PMID: 35106258 PMCID: PMC8786578 DOI: 10.7759/cureus.21524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Bleeding that takes place after premature separation of the normally situated placenta, usually after 20 weeks of pregnancy, is known as abruptio placenta. Factors increasing chances of abruptio placenta are advanced age pregnancy, parity, smoking, pregnancy-induced hypertension, pre-eclampsia, and previous incidence of abruptio. The objective of the study was to find the frequency of abruptio placenta in women with pregnancy-induced hypertension. Methods: This descriptive prospective study was conducted in the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi, from January to July, 2021. Women of gestational age above 20 weeks were included. Patients with blood pressure ≥140/90mmHg were considered as having pregnancy-induced hypertension. Early separation of the normally placed placental from the uterine wall was defined as placental abruption with clinical signs of painful vaginal bleeding (concealed or revealed), uterine contractions, and non-reassuring fetal heart rate. Descriptive statistics were calculated. Stratification was done and the post-stratification chi-square test was applied. P-value ≤ 0.05 was taken as significant. Results: A total of 205 patients were included in the study. The mean age was 24.26±2.92 years. The mean gestational age was 30.82±3.22 weeks. The mean parity was 2.59±0.80 children. Mean systolic blood pressure was 148.48±5.99 mmHg and mean diastolic blood pressure was 94.85±3.05 mmHg. Bleeding was reported in 110 (53.7%) cases. Lower abdominal tenderness in 125 (60.5%) cases. Fetal heart rate was normal in 16.6% of the cases. Abruptio placenta was observed in 29 (14.1%) patients. Conclusion:Abruptio placenta is a life-threatening condition that occurs during pregnancy that can result in both maternal and fetal morbidity and mortality. Adequate and urgent intervention can result in a favourable outcome.
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Mavedatnia D, Tran J, Oltean I, Bijelić V, Moretti F, Lawrence S, El Demellawy D. Impact of Co-Existing Placental Pathologies in Pregnancies Complicated by Placental Abruption and Acute Neonatal Outcomes. J Clin Med 2021; 10:5693. [PMID: 34884395 PMCID: PMC8658381 DOI: 10.3390/jcm10235693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
Placental abruption (PA) is a concern for maternal and neonatal morbidity. Adverse neonatal outcomes in the setting of PA include higher risk of prematurity. Placental pathologies include maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), acute chorioamnionitis, and villitis of unknown etiology (VUE). We aimed to investigate how placental pathology contributes to acute neonatal outcome in PA. A retrospective cohort study of all placentas with PA were identified. Exposures were MVM, FVM, acute chorioamnionitis and VUE. The primary outcome was NICU admission and the secondary outcomes included adverse base deficit and Apgar scores, need for resuscitation, and small-for-gestational age. A total of 287 placentas were identified. There were 160 (59.9%) of placentas with PA alone vs 107 (40.1%) with PA and additional placental pathologies. Odds of NICU admission were more than two times higher in pregnancies with placental pathologies (OR = 2.37, 95% CI 1.28-4.52). These estimates were in large part mediated by prematurity and birthweight, indirect effect acting through prematurity was OR 1.79 (95% CI 1.12-2.75) and through birthweight OR 2.12 (95% CI 1.40-3.18). Odds of Apgar score ≤ 5 was more than four times higher among pregnancies with placental pathologies (OR = 4.56, 95% CI 1.28-21.26). Coexisting placental pathology may impact Apgar scores in pregnancies complicated by PA. This knowledge could be used by neonatal teams to mobilize resources in anticipation of the need for neonatal resuscitation.
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Affiliation(s)
- Dorsa Mavedatnia
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
| | - Jason Tran
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
| | - Irina Oltean
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (I.O.); (V.B.)
- Department of Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Vid Bijelić
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (I.O.); (V.B.)
| | - Felipe Moretti
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
| | - Sarah Lawrence
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
| | - Dina El Demellawy
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
- Department of Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
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Ananth CV, Patrick HS, Ananth S, Zhang Y, Kostis WJ, Schuster M. Maternal Cardiovascular and Cerebrovascular Health After Placental Abruption: A Systematic Review and Meta-Analysis (CHAP-SR). Am J Epidemiol 2021; 190:2718-2729. [PMID: 34263291 DOI: 10.1093/aje/kwab206] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/25/2022] Open
Abstract
Placental abruption and cardiovascular disease (CVD) have common etiological underpinnings, and there is accumulating evidence that abruption may be associated with future CVD. We estimated associations between abruption and coronary heart disease (CHD) and stroke. The meta-analysis was based on the random-effects risk ratio (RR) and 95% confidence interval (CI) as the effect measure. We conducted a bias analysis to account for abruption misclassification, selection bias, and unmeasured confounding. We included 11 cohort studies comprising 6,325,152 pregnancies, 69,759 abruptions, and 49,265 CHD and stroke cases (1967-2016). Risks of combined CVD morbidity-mortality among abruption and nonabruption groups were 16.7 and 9.3 per 1,000 births, respectively (RR = 1.76, 95% CI: 1.24, 2.50; I2 = 94%; τ2 = 0.22). Women who suffered abruption were at 2.65-fold (95% CI: 1.55, 4.54; I2 = 85%; τ2 = 0.36) higher risk of death related to CHD/stroke than nonfatal CHD/stroke complications (RR = 1.32, 95% CI: 0.91, 1.92; I2 = 93%; τ2 = 0.15). Abruption was associated with higher mortality from CHD (RR = 2.64, 95% CI: 1.57, 4.44; I2 = 76%; τ2 = 0.31) than stroke (RR = 1.70, 95% CI: 1.19, 2.42; I2 = 40%; τ2 = 0.05). Corrections for the aforementioned biases increased these estimates. Women with pregnancies complicated by placental abruption may benefit from postpartum screening or therapeutic interventions to help mitigate CVD risks.
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Steane SE, Young SL, Clifton VL, Gallo LA, Akison LK, Moritz KM. Prenatal alcohol consumption and placental outcomes: a systematic review and meta-analysis of clinical studies. Am J Obstet Gynecol 2021; 225:607.e1-607.e22. [PMID: 34181895 DOI: 10.1016/j.ajog.2021.06.078] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE A systematic review was conducted to determine placental outcomes following prenatal alcohol exposure in women. DATA SOURCES The search terms "maternal OR prenatal OR pregnant OR periconception" AND "placenta" AND "alcohol OR ethanol" were used across 5 databases (PubMed, Embase, Cochrane Library, Web of Science, and CINAHL) from inception until November 2020. STUDY ELIGIBILITY CRITERIA Articles were included if they reported placental outcomes in an alcohol exposure group compared with a control group. Studies were excluded if placentas were from elective termination before 20 weeks' gestation, animal studies, in vitro studies, case studies, or coexposure studies. METHODS Study quality was assessed by 2 reviewers using the Newcastle-Ottawa Quality Assessment Scale. Title and abstract screening was conducted by 2 reviewers to remove duplicates and irrelevant studies. Remaining full text articles were screened by 2 reviewers against inclusion and exclusion criteria. Placental outcome data were extracted and tabulated separately for studies of placentation, placental weight, placental morphology, and placental molecular studies. Meta-analyses were conducted for outcomes reported by >3 studies. RESULTS Database searching retrieved 640 unique records. Screening against inclusion and exclusion criteria resulted in 33 included studies. The quality assessment identified that 61% of studies were high quality, 30% were average quality, and 9% were low quality. Meta-analyses indicated that prenatal alcohol exposure increased the likelihood of placental abruption (odds ratio, 1.48; 95% confidence interval, 1.37-1.60) but not placenta previa (odds ratio, 1.14; 95% confidence interval, 0.84-1.34) and resulted in a reduction in placental weight of 51 g (95% confidence interval, -82.8 to -19.3). Reports of altered placental vasculature, placental DNA methylation, and gene expression following prenatal alcohol exposure were identified. A single study examined placentas from male and female infants separately and found sex-specific placental outcomes. CONCLUSION Prenatal alcohol exposure increases the likelihood of placental abruption and is associated with decreased placental weight, altered placental vasculature, DNA methylation, and molecular pathways. Given the critical role of the placenta in determining pregnancy outcomes, further studies investigating the molecular mechanisms underlying alcohol-induced placental dysfunction are required. Sex-specific placental adaptations to adverse conditions in utero have been well documented; thus, future studies should examine prenatal alcohol exposure-associated placental outcomes separately by sex.
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Can a Difference in Gestational Age According to Biparietal Diameter and Abdominal Circumference Predict Intrapartum Placental Abruption? J Clin Med 2021; 10:jcm10112413. [PMID: 34072409 PMCID: PMC8199074 DOI: 10.3390/jcm10112413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/15/2021] [Accepted: 05/27/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to investigate whether a difference in gestational age according to biparietal diameter (BPD) and abdominal circumference (AC) could be a clinically useful predictor of placental abruption during the intrapartum period. This retrospective cohort study was based on singletons who were delivered after 32 + 0 weeks between July 2015 and July 2020. We only included cases with at least two antepartum sonographies available within 4 weeks of delivery (n = 2790). We divided the study population into two groups according to the presence or absence of placental abruption and compared the clinical variables. The incidence of placental abruption was 2.0% (56/2790) and was associated with an older maternal age, a higher rate of preeclampsia, and being small for the gestational age. A difference of >2 weeks in gestational age according to BPD and AC occurred at a higher rate in the placental abruption group compared to the no abruption group (>2 weeks, 21.4% (12/56) vs. 7.5% (205/2734), p < 0.001; >3 weeks, 12.5% (7/56) vs. 2.0% (56/2734), p < 0.001). Logistic regression analysis revealed that the differences of >2 weeks and >3 weeks were both independent risk factors for placental abruption (odds ratio (OR) (95% confidence interval), 2.289 (1.140-4.600) and 3.918 (1.517-9.771), respectively) after adjusting for maternal age, preeclampsia, and small for gestational age births. We identified that a difference in gestational age of >2 weeks between BPD and AC could be an independent predictor of placental abruption.
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Kyozuka H, Murata T, Fukusda T, Yamaguchi A, Kanno A, Yasuda S, Sato A, Ogata Y, Endo Y, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Teenage pregnancy as a risk factor for placental abruption: Findings from the prospective Japan environment and children's study. PLoS One 2021; 16:e0251428. [PMID: 33984034 PMCID: PMC8118252 DOI: 10.1371/journal.pone.0251428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Placental abruption is a significant obstetric complication that affects both maternal and neonatal mortality and morbidity. The present study examined the effect of maternal age on the incidence of placental abruption. Methods We used data of singleton pregnancies from the Japan Environment and Children’s Study, which was a prospective birth cohort study conducted between January 2011 and March 2014 across 15 regional centers in Japan. A multiple regression model was used to identify whether maternal age (<20 years, 20–24 years, 25–29 years, 30–34 years, and ≥35 years) is a risk factor for placental abruption. The analyses were conducted while considering the history of placental abruption, assisted reproductive technology, number of previous deliveries, smoking during pregnancy, body mass index before pregnancy, and chronic hypertension. Results A total of 94,410 Japanese women (93,994 without placental abruption and 416 with placental abruption) were recruited. Herein, 764, 8421, 25915, 33517, and 25793 women were aged <20 years, 20–24 years, 25–29 years, 30–34 years, and ≥35 years, respectively. Besides advanced maternal age (≥35 years; adjusted odds ratio: 1.7, 95% confidence interval: 1.1–2.5), teenage pregnancy was also a risk factor for placental abruption (adjusted odds ratio: 2.8, 95% confidence interval: 1.2–6.5) when the maternal age of 20–24 years was set as a reference. Conclusions In the Japanese general population, besides advanced maternal age, teenage pregnancy was associated with placental abruption. Recently, the mean maternal age has been changing in Japan. Therefore, it is important for obstetric care providers to provide proper counseling to young women based on up-to-date evidence.
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Affiliation(s)
- Hyo Kyozuka
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
- * E-mail:
| | - Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toma Fukusda
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Yamaguchi
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Aya Kanno
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shun Yasuda
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
| | - Yuta Endo
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Fukushima Medical Center for Children and Women, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Odendaal H, Wright C, Schubert P, Boyd TK, Roberts DJ, Brink L, Nel D, Groenewald C. Associations of maternal smoking and drinking with fetal growth and placental abruption. Eur J Obstet Gynecol Reprod Biol 2020; 253:95-102. [PMID: 32862031 DOI: 10.1016/j.ejogrb.2020.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate pregnant women from the Safe Passage Study for the individual and combined effects of smoking and drinking during pregnancy on the prevalence of clinical placental abruption. STUDY DESIGN The aim of the original Safe Passage Study was to investigate the association of alcohol use during pregnancy with stillbirths and sudden infant deaths. Recruitment for this longitudinal study occurred between August 2007 and October 2016. Information on smoking and drinking was collected prospectively at up to 4 occasions during pregnancy where a modified timeline follow-back method was used to assess the exposure to alcohol. Placentas were examined histologically in a subset of pregnant women. For this study we examined the effects of smoking and drinking on fetal growth and the prevalence rate of placental abruption. High smoking constituted of 10 or more cigarettes per day and high drinking of four or more binge drinking episodes or 32 and more standard drinks during pregnancy. Placental abruption was diagnosed in two ways, by the clinical picture or the macroscopic and microscopic examination of the placenta. RESULTS When compared to the non-drinking/non-smoking group, the high drinking/high smoking group were significantly older, had a higher gravidity, had a lower household income and booked later for prenatal care; fewer of them were employed and had toilet and running water facilities in their houses. Clinical placental abruption was diagnosed in 49 (0.87 %) of 5806 pregnancies. Histological examination was done in 1319 placentas; macroscopic and microscopic diagnosis of placental abruption was made in 8.2 % and 11.9 % of placentas respectively. These 49 cases were then correlated with seven smoking/drinking patterns during pregnancy. When compared to rates for no smoking/no drinking (0.11 %) and low smoking/no drinking (0.55 %), the prevalence rate of placental abruption was significantly higher (p < .005) in the low smoking/low drinking group (1.25 %). There was also a significant relationship between low maternal employment and methamphetamine use with placental abruption. CONCLUSION As many conditions and habits are associated with placental abruption, it is impossible to single out one specific cause but concomitant drinking and smoking seem to increase the risk of placental abruption.
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Affiliation(s)
- Hein Odendaal
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.
| | - Colleen Wright
- Lancet Laboratories, Johannesburg, South Africa; Division of Anatomical Pathology, Stellenbosch University, Cape Town, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Stellenbosch University, Cape Town, South Africa
| | - Theonia K Boyd
- Department of Pathology, Boston Children's Hospital, Boston, MA, United States
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States
| | - Lucy Brink
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa
| | - Daan Nel
- Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa
| | - Coen Groenewald
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa
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Changing risk factors for placental abruption: A case crossover study using routinely collected data from Finland, Malta and Aberdeen. PLoS One 2020; 15:e0233641. [PMID: 32525937 PMCID: PMC7289359 DOI: 10.1371/journal.pone.0233641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the effects of changes in risk factors between the first two pregnancies on the occurrence of placental abruption (PA) in the same woman. Methods Routinely collected obstetric data from Aberdeen Maternity and Neonatal Databank, the Maltese National Obstetric Information System and the Finnish Medical Birth Register were aggregated. Records of the first two singleton pregnancies from women who had PA in one pregnancy but not the other, were identified from this pooled dataset. A case-crossover study design was used; cases were pregnancies with abruption and matched controls were pregnancies without abruption in the same woman. Conditional logistic regression was used to investigate changes in risk factors for placental abruption in pregnancies with and without abruption. Results A total of 2,991 women were included in the study. Of these 1,506 (50.4%) had PA in their first pregnancy and 1,485 (49.6%) in a second pregnancy. Pregnancies complicated by preeclampsia {194 (6.5%) versus 115 (3.8%) adj OR 1.69; (95% CI 1.23–2.33)}, antepartum haemorrhage of unknown origin {556 (18.6%) versus 69 (2.3%) adjOR 27.05; 95% CI 16.61–44.03)} and placenta praevia {80 (2.7%) versus 21 (0.7%) (adjOR 3.05; 95% CI 1.74–5.36)} were associated with PA. Compared to 20 to 25 years, maternal age of 35–39 years {365 (12.2) versus 323 (10.8) (adjOR 1.32; 95% CI 1.01–1.73) and single marital status (adjOR 1.36; 95% CI 1.04–1.76) were independently associated with PA. Maternal smoking, BMI and fetal gender were not associated with PA. Conclusion Advanced maternal age, pregnancies complicated with unexplained bleeding in pregnancy, placenta praevia and preeclampsia were independently associated with a higher risk of placental abruption.
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Histologic chorioamnionitis concomitant placental abruption and its effects on pregnancy outcome. Placenta 2020; 94:39-43. [PMID: 32421533 DOI: 10.1016/j.placenta.2020.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Two possible causative pathways have been suggested to participate in the development of placental abruption (PA), an acute inflammatory pathway and placental vascular derived, a chronic pathway. We aimed to study the impact of the inflammatory pathway on maternal and neonatal outcome. METHODS The computerized medical files and placental reports of all pregnancies diagnosed with PA, between 11/2008-1/2019, at 24-42 weeks, were reviewed. Placental lesions were classified according to "Amsterdam" criteria into maternal and fetal vascular malperfusion lesions, acute inflammatory responses and chronic villitis. Composite neonatal morbidity included ≥1 of the following: seizures, intra-ventricular hemorrhage (IVH), hypoxic-ischemic encephalopathy, periventricular leukomalacia (PVL), blood transfusion, necrotizing enterocolitis (NEC), neonatal sepsis, respiratory distress syndrome, or neonatal death. Maternal and neonatal outcome were compared between PA with and without histologic chorioamnionitis (HC). RESULTS As compared to the PA without HC group (n = 267), the PA with HC group (n = 77) was characterized by lower gestational age (GA) at delivery (32.9 ± 5.5 vs. 35.6 ± 4.1 weeks, p < 0.001), higher rates of oligohydramnios (p < 0.001), bloody amniotic fluid at labor (p < 0.001), maternal postpartum fever (p < 0.001), longer maternal hospitalization (<0.001), and increased composite adverse neonatal morbidity (41.6% vs. 22.8%, p = 0.002). By multivariate analysis, GA and HC were found to be independently associated with adverse neonatal outcome, aOR 0.63 95% CI 0.43-0.78, p < 0.001, and aOR1.12, 95% CI 1.02-3.87, p = 0.04, respectively. DISCUSSION The involvement of the inflammatory causative pathway in the development of placental abruption, is associated with increased maternal and neonatal morbidity.
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Obstetric Care Consensus #10: Management of Stillbirth: (Replaces Practice Bulletin Number 102, March 2009). Am J Obstet Gynecol 2020; 222:B2-B20. [PMID: 32004519 DOI: 10.1016/j.ajog.2020.01.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. In developed countries, the most prevalent risk factors associated with stillbirth are non-Hispanic black race, nulliparity, advanced maternal age, obesity, preexisting diabetes, chronic hypertension, smoking, alcohol use, having a pregnancy using assisted reproductive technology, multiple gestation, male fetal sex, unmarried status, and past obstetric history. Although some of these factors may be modifiable (such as smoking), many are not. The study of specific causes of stillbirth has been hampered by the lack of uniform protocols to evaluate and classify stillbirths and by decreasing autopsy rates. In any specific case, it may be difficult to assign a definite cause to a stillbirth. A significant proportion of stillbirths remains unexplained, even after a thorough evaluation. Evaluation of a stillbirth should include fetal autopsy; gross and histologic examination of the placenta, umbilical cord, and membranes; and genetic evaluation. The method and timing of delivery after a stillbirth depend on the gestational age at which the death occurred, maternal obstetric history (eg, previous hysterotomy), and maternal preference. Health care providers should weigh the risks and benefits of each strategy in a given clinical scenario and consider available institutional expertise. Patient support should include emotional support and clear communication of test results. Referral to a bereavement counselor, peer support group, or mental health professional may be advisable for management of grief and depression.
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Abstract
Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. In developed countries, the most prevalent risk factors associated with stillbirth are non-Hispanic black race, nulliparity, advanced maternal age, obesity, preexisting diabetes, chronic hypertension, smoking, alcohol use, having a pregnancy using assisted reproductive technology, multiple gestation, male fetal sex, unmarried status, and past obstetric history. Although some of these factors may be modifiable (such as smoking), many are not. The study of specific causes of stillbirth has been hampered by the lack of uniform protocols to evaluate and classify stillbirths and by decreasing autopsy rates. In any specific case, it may be difficult to assign a definite cause to a stillbirth. A significant proportion of stillbirths remains unexplained even after a thorough evaluation. Evaluation of a stillbirth should include fetal autopsy; gross and histologic examination of the placenta, umbilical cord, and membranes; and genetic evaluation. The method and timing of delivery after a stillbirth depend on the gestational age at which the death occurred, maternal obstetric history (eg, previous hysterotomy), and maternal preference. Health care providers should weigh the risks and benefits of each strategy in a given clinical scenario and consider available institutional expertise. Patient support should include emotional support and clear communication of test results. Referral to a bereavement counselor, peer support group, or mental health professional may be advisable for management of grief and depression.
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Eubanks AA, Walz S, Thiel LM. Maternal risk factors and neonatal outcomes in placental abruption among patients with equal access to health care. J Matern Fetal Neonatal Med 2019; 34:2101-2106. [PMID: 31416373 DOI: 10.1080/14767058.2019.1657088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Placental abruption complicates 1% of pregnancies, and is associated with significant morbidity and mortality. The objective was to examine risk factors and outcomes in pregnancies complicated by abruption in a health care system with equal access to care. METHODS This was a retrospective cohort study of all deliveries at Walter Reed National Military Medical Center (WRNMMC) between 1 January 2014 and 1 June 2017. The primary outcome was maternal factors that influenced abruption. The secondary outcome evaluated the neonatal outcomes after abruption. RESULTS A total of 4351 patients delivered at WRNMMC and met the inclusion criteria. 52 patients (1.2%) had a pathology confirmed abruption. There was an association with smoking (p < .05; OR 4.25) and African American race (p = .005). Neonatal variables demonstrated an association between abruption and gestational age at delivery, low birth weight, Apgar scores, NICU admissions, and fetal demise all with p < .005. CONCLUSIONS Our results demonstrate an association between both smoking and African American race with placental abruption. Unlike previous studies, there were no barriers to access to care. Further, there was no association with age, hypertension, diabetes, autoimmune disease, or trauma. Results did reaffirm an association between abruption and preterm birth, low birth weight, lower Apgars, NICU admissions, and fetal demise.PrécisIn a medical system with no barriers to access to care, maternal risk factors and neonatal outcomes associated with placental abruptions were investigated in over 4300 deliveries.
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Affiliation(s)
- Allison A Eubanks
- Department of Obstetrics & Gynecology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Sarah Walz
- Department of Obstetrics & Gynecology, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Lisa M Thiel
- Department of Maternal Fetal Medicine, Spectrum Health, Grand Rapids, MI, USA
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Ananth CV, Hansen AV, Elkind MSV, Williams MA, Rich-Edwards JW, Nybo Andersen AM. Cerebrovascular disease after placental abruption: A population-based prospective cohort study. Neurology 2019; 93:e1148-e1158. [PMID: 31420459 DOI: 10.1212/wnl.0000000000008122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/22/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To test whether abruption during pregnancy is associated with long-term cerebrovascular disease by assessing the incidence and mortality from stroke among women with abruption. METHODS We designed a population-based prospective cohort study of women who delivered in Denmark from 1978 to 2010. We used data from the National Patient Registry, Causes of Death Registry, and Danish Birth Registry to identify women with abruption, cerebrovascular events, and deaths. The outcomes included deaths resulting from stroke and nonfatal ischemic and hemorrhagic strokes. We fit Cox proportional hazards regression models for stroke outcomes, adjusting for the delivery year, parity, education, and smoking. RESULTS The median (interquartile range) follow-up in the nonabruption and abruption groups was 15.9 (7.8-23.8) and 16.2 (9.6-23.1) years, respectively, among 828,289 women with 13,231,559 person-years of follow-up. Cerebrovascular mortality rates were 0.8 and 0.5 per 10,000 person-years among women with and without abruption, respectively (hazard ratio [HR] 1.6, 95% confidence interval [CI] 0.9-3.0). Abruption was associated with increased rates of nonfatal ischemic stroke (HR 1.4, 95% CI 1.1-1.7) and hemorrhagic stroke (HR 1.4, 95% CI 1.1-1.9). The association of abruption and stroke was increased with delivery at <34 weeks, when accompanied by ischemic placental disease, and among women with ≥2 abruptions. These associations are less likely to have been affected by unmeasured confounding. CONCLUSION Abruption is associated with increased risk of cerebrovascular morbidity and mortality. Disruption of the hemostatic system manifesting as ischemia and hemorrhage may indicate shared etiologies between abruption and cerebrovascular complications.
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Affiliation(s)
- Cande V Ananth
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences (C.V.A.), Division of Epidemiology and Biostatistics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Health Policy and Administration, Joseph L. Mailman School of Public Health (C.V.A.), Department of Neurology (M.S.V.E.), Division of Neurology Clinical Outcomes Research and Population Sciences (NeuroCORPS), and Department of Epidemiology (M.S.V.E.), Joseph L. Mailman School of Public Health, Columbia University, New York, NY; Department of Public Health (A.V.H., A.-M.N.A.), University of Copenhagen, Denmark; Department of Epidemiology (M.A.W., J.W.R.-E.), Harvard TH Chan School of Public Health; and Department of Medicine (J.W.R.-E.), Division of Women's Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Anne Vinkel Hansen
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences (C.V.A.), Division of Epidemiology and Biostatistics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Health Policy and Administration, Joseph L. Mailman School of Public Health (C.V.A.), Department of Neurology (M.S.V.E.), Division of Neurology Clinical Outcomes Research and Population Sciences (NeuroCORPS), and Department of Epidemiology (M.S.V.E.), Joseph L. Mailman School of Public Health, Columbia University, New York, NY; Department of Public Health (A.V.H., A.-M.N.A.), University of Copenhagen, Denmark; Department of Epidemiology (M.A.W., J.W.R.-E.), Harvard TH Chan School of Public Health; and Department of Medicine (J.W.R.-E.), Division of Women's Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Mitchell S V Elkind
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences (C.V.A.), Division of Epidemiology and Biostatistics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Health Policy and Administration, Joseph L. Mailman School of Public Health (C.V.A.), Department of Neurology (M.S.V.E.), Division of Neurology Clinical Outcomes Research and Population Sciences (NeuroCORPS), and Department of Epidemiology (M.S.V.E.), Joseph L. Mailman School of Public Health, Columbia University, New York, NY; Department of Public Health (A.V.H., A.-M.N.A.), University of Copenhagen, Denmark; Department of Epidemiology (M.A.W., J.W.R.-E.), Harvard TH Chan School of Public Health; and Department of Medicine (J.W.R.-E.), Division of Women's Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michelle A Williams
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences (C.V.A.), Division of Epidemiology and Biostatistics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Health Policy and Administration, Joseph L. Mailman School of Public Health (C.V.A.), Department of Neurology (M.S.V.E.), Division of Neurology Clinical Outcomes Research and Population Sciences (NeuroCORPS), and Department of Epidemiology (M.S.V.E.), Joseph L. Mailman School of Public Health, Columbia University, New York, NY; Department of Public Health (A.V.H., A.-M.N.A.), University of Copenhagen, Denmark; Department of Epidemiology (M.A.W., J.W.R.-E.), Harvard TH Chan School of Public Health; and Department of Medicine (J.W.R.-E.), Division of Women's Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Janet W Rich-Edwards
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences (C.V.A.), Division of Epidemiology and Biostatistics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Health Policy and Administration, Joseph L. Mailman School of Public Health (C.V.A.), Department of Neurology (M.S.V.E.), Division of Neurology Clinical Outcomes Research and Population Sciences (NeuroCORPS), and Department of Epidemiology (M.S.V.E.), Joseph L. Mailman School of Public Health, Columbia University, New York, NY; Department of Public Health (A.V.H., A.-M.N.A.), University of Copenhagen, Denmark; Department of Epidemiology (M.A.W., J.W.R.-E.), Harvard TH Chan School of Public Health; and Department of Medicine (J.W.R.-E.), Division of Women's Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Anne-Marie Nybo Andersen
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences (C.V.A.), Division of Epidemiology and Biostatistics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Health Policy and Administration, Joseph L. Mailman School of Public Health (C.V.A.), Department of Neurology (M.S.V.E.), Division of Neurology Clinical Outcomes Research and Population Sciences (NeuroCORPS), and Department of Epidemiology (M.S.V.E.), Joseph L. Mailman School of Public Health, Columbia University, New York, NY; Department of Public Health (A.V.H., A.-M.N.A.), University of Copenhagen, Denmark; Department of Epidemiology (M.A.W., J.W.R.-E.), Harvard TH Chan School of Public Health; and Department of Medicine (J.W.R.-E.), Division of Women's Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Harada T, Taniguchi F, Amano H, Kurozawa Y, Ideno Y, Hayashi K, Harada T. Adverse obstetrical outcomes for women with endometriosis and adenomyosis: A large cohort of the Japan Environment and Children's Study. PLoS One 2019; 14:e0220256. [PMID: 31374085 PMCID: PMC6677302 DOI: 10.1371/journal.pone.0220256] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Because of the increased number of diagnosed cases of endometriosis or adenomyosis resulting in infertility, many women require assisted reproductive technology (ART) to become pregnant. However, incidences of obstetric complications are increased for women who conceive using ART. There has been no prospective cohort study examining the influence of endometriosis and adenomyosis on obstetric outcomes after adjusting for the confounding influence of ART therapy. OBJECTIVE This study evaluated the impact of endometriosis and adenomyosis on the incidence of adverse pregnancy outcomes. STUDY DESIGN Data were obtained from a prospective cohort study, known as the Japan Environment and Children's Study (JECS), of the incidence of obstetric complications for women with endometriosis and adenomyosis. The data of 103,099 pregnancies that resulted in live birth or stillbirth or that were terminated through abortion between February 2011 and July 2014 in Japan were included. RESULTS Women with endometriosis or adenomyosis were at increased risk for complications during pregnancy compared to those without a medical history of endometriosis (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.23 to 1.41) or adenomyosis (OR, 1.72; 95% CI, 1.37 to 2.16). Our analysis showed that the adjusted ORs for obstetric complications of pregnant women who conceived naturally or after infertility treatment that did not involve ART therapy were 1.26 (CI, 1.17 to 1.35) for pregnant women with a history of endometriosis and 1.52 (CI, 1.19 to 1.94) for those with a history of adenomyosis. CONCLUSIONS The presence of endometriosis and adenomyosis significantly increased the prevalence of obstetric complications after adjusting for the influence of ART outcomes.
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Affiliation(s)
- Takashi Harada
- Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hiroki Amano
- Department of Public Health, Tottori University Faculty of Medicine, Yonago, Japan
| | - Youichi Kurozawa
- Department of Public Health, Tottori University Faculty of Medicine, Yonago, Japan
| | - Yuki Ideno
- Department of Laboratory Science and Environmental Health Sciences, Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Kunihiko Hayashi
- Department of Laboratory Science and Environmental Health Sciences, Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan
- * E-mail:
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Placental findings among newborns with hypoxic ischemic encephalopathy. J Perinatol 2019; 39:563-570. [PMID: 30770878 DOI: 10.1038/s41372-019-0334-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/14/2019] [Accepted: 01/30/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine if pre-specified placental abnormalities among newborns with hypoxic-ischemic encephalopathy (HIE) differ compared to newborns admitted to a NICU without encephalopathy. STUDY DESIGN Retrospective case-control study of newborns with HIE (2006-2014) and controls matched for birth year, gestational age, weight, and gender. One pathologist reviewed archived placental sections using pre-specified criteria. RESULTS Sixty-seven newborns had HIE, 46 had available placentas and were matched with 92 controls. HIE had more maternal vascular malperfusion (46% vs 25%, p = 0.02), fetal vascular malperfusion (13% vs 0%, p < 0.001), and clinical abruption (22% vs 4%, p = 0.001). Controls had more normal placentas (29% vs 7%, p = 0.002), and chorioamnionitis (30% vs 9%, p = 0.005). Pre-specified placental lesions occurred in 87% of HIE and 65% of controls (p = 0.008) and identified >90% of primary diagnoses. CONCLUSIONS Pre-specified placental lesions identified nearly all abnormalities in HIE and represented both acute and chronic processes.
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Suzumori N, Sekizawa A, Ebara T, Samura O, Sasaki A, Akaishi R, Wada S, Hamanoue H, Hirahara F, Izumi H, Sawai H, Nakamura H, Yamada T, Miura K, Masuzaki H, Yamashita T, Okai T, Kamei Y, Namba A, Murotsuki J, Tanemoto T, Fukushima A, Haino K, Tairaku S, Matsubara K, Maeda K, Kaji T, Ogawa M, Osada H, Nishizawa H, Okamoto Y, Kanagawa T, Kakigano A, Kitagawa M, Ogawa M, Izumi S, Katagiri Y, Takeshita N, Kasai Y, Naruse K, Neki R, Masuyama H, Hyodo M, Kawano Y, Ohba T, Ichizuka K, Nagamatsu T, Watanabe A, Shirato N, Yotsumoto J, Nishiyama M, Hirose T, Sago H. Fetal cell-free DNA fraction in maternal plasma for the prediction of hypertensive disorders of pregnancy. Eur J Obstet Gynecol Reprod Biol 2018; 224:165-169. [DOI: 10.1016/j.ejogrb.2018.03.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/20/2018] [Accepted: 03/23/2018] [Indexed: 12/22/2022]
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Hasegawa J, Ikeda T, Toyokawa S, Jojima E, Satoh S, Ichizuka K, Tamiya N, Nakai A, Fujimori K, Maeda T, Masuzaki H, Takeda S, Suzuki H, Ueda S, Ikenoue T. Relevant obstetric factors associated with fetal heart rate monitoring for cerebral palsy in pregnant women with hypertensive disorder of pregnancy. J Obstet Gynaecol Res 2018; 44:647-654. [PMID: 29363232 PMCID: PMC5900742 DOI: 10.1111/jog.13555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/21/2017] [Indexed: 11/30/2022]
Abstract
AIM The study identifies the relevant obstetric factors associated with fetal heart rate (FHR) monitoring for cerebral palsy (CP) in pregnant women with hypertensive disorders of pregnancy (HDP). METHODS The subjects were neonates with CP (birth weight ≥ 2000 g, gestational age ≥ 33 weeks) who were approved for compensation for CP by the Operating Organization of the Japan Obstetric Compensation System between 2009 and 2012. After selection of women with antepartum HDP, obstetric characteristics associated with FHR monitoring were analyzed. RESULTS The subjects included 33 neonates with CP whose mothers suffered from HDP during pregnancy and 450 neonates whose mothers did not develop HDP. The rates of placental abruption (48.5% vs. 20%; P < 0.001) and light-for-gestational age (12.1% vs. 2.2%; P = 0.011) were significantly higher in women with HDP than in those without HDP. Regarding FHR pattern analysis, fetal bradycardia was observed on admission to hospital in 94% of women with placental abruption. In women without placental abruption, FHR was likely to indicate a favorable pattern on admission, but became worse with the progression of labor. CONCLUSION This is first study to clinically demonstrate FHR patterns in CP cases in association with HDP. Although antepartum CP is undetectable, pregnant women with HDP should be placed under strict observation and management to minimize fetal hypoxic conditions during labor.
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Affiliation(s)
- Junichi Hasegawa
- Department of Obstetrics and GynecologySt. Marianna University School of MedicineKawasakiJapan
| | - Tomoaki Ikeda
- Department of Obstetrics and GynecologyMie University Graduate School of MedicineTsuJapan
| | | | - Emi Jojima
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated FoundationJapan Council for Quality Health CareTokyoJapan
| | - Shoji Satoh
- Maternal and Perinatal Care CenterOita Prefectural HospitalOitaJapan
| | - Kiyotake Ichizuka
- Department of Obstetrics and GynecologyShowa University Northern Yokohama HospitalYokohamaJapan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Akihito Nakai
- Department of Obstetrics and GynecologyNippon Medical SchoolTokyoJapan
| | - Keiya Fujimori
- Department of Obstetrics and GynecologyFukushima Medical UniversityFukushimaJapan
| | - Tsugio Maeda
- Maeda ClinicIncorporated Association Anzu‐kaiYaizuJapan
| | - Hideaki Masuzaki
- Department of Obstetrics and GynecologyThe University of NagasakiNagasakiJapan
| | - Satoru Takeda
- Department of Obstetrics & GynecologyJuntendo UniversityTokyoJapan
| | - Hideaki Suzuki
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated FoundationJapan Council for Quality Health CareTokyoJapan
| | - Shigeru Ueda
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated FoundationJapan Council for Quality Health CareTokyoJapan
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Masoumi Z, Familari M, Källén K, Ranstam J, Olofsson P, Hansson SR. Fetal hemoglobin in umbilical cord blood in preeclamptic and normotensive pregnancies: A cross-sectional comparative study. PLoS One 2017; 12:e0176697. [PMID: 28453539 PMCID: PMC5409527 DOI: 10.1371/journal.pone.0176697] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/14/2017] [Indexed: 12/14/2022] Open
Abstract
Preeclampsia (PE) is associated with increased fetal hemoglobin (HbF) in the maternal circulation but its source is unknown. To investigate whether excessive HbF is produced in the placenta or the fetus, the concentration of HbF (cHbF) in the arterial and venous umbilical cord blood (UCB) was compared in 15825 normotensive and 444 PE pregnancies. The effect of fetal gender on cHbF was also evaluated in both groups. Arterial and venous UCB sampled immediately after birth at 36-42 weeks of gestation were analyzed for total Hb concentration (ctHb) (g/L) and HbF% using a Radiometer blood gas analyzer. Non-parametric tests were used for statistical comparison and P values < 0.05 were considered significant. Our results indicated higher cHbF in venous compared to arterial UCB in both normotensive (118.90 vs 117.30) and PE (126.75 vs 120.12) groups. In PE compared to normotensive pregnancies, a significant increase was observed in arterial and venous ctHb (171.00 vs 166.00 and 168.00 vs 163.00, respectively) while cHbF was only significantly increased in venous UCB (126.75 vs 118.90). The pattern was similar in both genders. These results indicate a substantial placental contribution to HbF levels in UCB, which increases in PE and is independent of fetal gender, suggesting the elevated cHbF evident in PE results from placental dysfunction.
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Affiliation(s)
- Zahra Masoumi
- Department of Clinical Sciences Lund, Division of Obstetrics and Gynecology, Lund University, Lund, Sweden
| | - Mary Familari
- School of Biosciences, University of Melbourne, Parkville, Australia
| | - Karin Källén
- Center for Reproductive Epidemiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jonas Ranstam
- Department of Clinical Sciences Lund, Division of Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Per Olofsson
- Department of Clinical Sciences Malmö, Division of Obstetrics and Gynecology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Stefan R. Hansson
- Department of Clinical Sciences Lund, Division of Obstetrics and Gynecology, Lund University, Lund, Sweden
- Department of Clinical Sciences Malmö, Division of Obstetrics and Gynecology, Lund University, Skåne University Hospital, Malmö, Sweden
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Gelaye B, Sumner SJ, McRitchie S, Carlson JE, Ananth CV, Enquobahrie DA, Qiu C, Sorensen TK, Williams MA. Maternal Early Pregnancy Serum Metabolomics Profile and Abnormal Vaginal Bleeding as Predictors of Placental Abruption: A Prospective Study. PLoS One 2016; 11:e0156755. [PMID: 27300725 PMCID: PMC4907440 DOI: 10.1371/journal.pone.0156755] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/19/2016] [Indexed: 01/22/2023] Open
Abstract
Background & Objective Placental abruption, an ischemic placental disorder, complicates about 1 in 100 pregnancies, and is an important cause of maternal and perinatal morbidity and mortality worldwide. Metabolomics holds promise for improving the phenotyping, prediction and understanding of pathophysiologic mechanisms of complex clinical disorders including abruption. We sought to evaluate maternal early pregnancy pre-diagnostic serum metabolic profiles and abnormal vaginal bleeding as predictors of abruption later in pregnancy. Methods Maternal serum was collected in early pregnancy (mean 16 weeks, range 15 to 22 weeks) from 51 abruption cases and 51 controls. Quantitative targeted metabolic profiles of serum were acquired using electrospray ionization liquid chromatography-mass spectrometry (ESI-LC-MS/MS) and the Absolute IDQ® p180 kit. Maternal sociodemographic characteristics and reproductive history were abstracted from medical records. Stepwise logistic regression models were developed to evaluate the extent to which metabolites aid in the prediction of abruption. We evaluated the predictive performance of the set of selected metabolites using a receiver operating characteristics (ROC) curve analysis and area under the curve (AUC). Results Early pregnancy vaginal bleeding, dodecanoylcarnitine/dodecenoylcarnitine (C12 / C12:1), and phosphatidylcholine acyl-alkyl C 38:1 (PC ae C38:1) strongly predict abruption risk. The AUC for these metabolites alone was 0.68, for early pregnancy vaginal bleeding alone was 0.65, and combined the AUC improved to 0.75 with the addition of quantitative metabolite data (P = 0.003). Conclusion Metabolomic profiles of early pregnancy maternal serum samples in addition to the clinical symptom, vaginal bleeding, may serve as important markers for the prediction of abruption. Larger studies are necessary to corroborate and validate these findings in other cohorts.
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Affiliation(s)
- Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- * E-mail:
| | - Susan J. Sumner
- Discovery Sciences, RTI International, Research Triangle Park, NC, United States of America
| | - Susan McRitchie
- Discovery Sciences, RTI International, Research Triangle Park, NC, United States of America
| | - James E. Carlson
- Discovery Sciences, RTI International, Research Triangle Park, NC, United States of America
| | - Cande V. Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Daniel A. Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States of America
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, United States of America
| | - Chunfang Qiu
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, United States of America
| | - Tanya K. Sorensen
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, United States of America
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Gueneuc A, Carles G, Lemonnier M, Dallah F, Jolivet A, Dreyfus M. Hématome rétroplacentaire : terrain et facteurs pronostiques revisités à propos d’une série de 171 cas en Guyane francaise. ACTA ACUST UNITED AC 2016; 45:300-6. [DOI: 10.1016/j.jgyn.2015.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 03/21/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
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Ananth CV, Lavery JA, Vintzileos AM, Skupski DW, Varner M, Saade G, Biggio J, Williams MA, Wapner RJ, Wright JD. Severe placental abruption: clinical definition and associations with maternal complications. Am J Obstet Gynecol 2016; 214:272.e1-272.e9. [PMID: 26393335 DOI: 10.1016/j.ajog.2015.09.069] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 09/14/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Placental abruption traditionally is defined as the premature separation of the implanted placenta before the delivery of the fetus. The existing clinical criteria of severity rely exclusively on fetal (fetal distress or fetal death) and maternal complications without consideration of neonatal or preterm delivery-related complications. However, two-thirds of abruption cases are accompanied by fetal or neonatal complications, including preterm delivery. A clinically meaningful classification for abruption therefore should include not only maternal complications but also adverse fetal and neonatal outcomes that include intrauterine growth restriction and preterm delivery. OBJECTIVES The purpose of this study was to define severe placental abruption and to compare serious maternal morbidity profiles of such cases with all other cases of abruption (ie, mild abruption) and nonabruption cases. STUDY DESIGN We performed a retrospective cohort analysis using the Premier database of hospitalizations that resulted in singleton births in the United States between 2006 and 2012 (n = 27,796,465). Severe abruption was defined as abruption accompanied by at least 1 of the following events: maternal (disseminated intravascular coagulation, hypovolemic shock, blood transfusion, hysterectomy, renal failure, or in-hospital death), fetal (nonreassuring fetal status, intrauterine growth restriction, or fetal death), or neonatal (neonatal death, preterm delivery or small for gestational age) complications. Abruption cases that did not qualify as being severe were classified as mild abruption cases. The morbidity profile included amniotic fluid embolism, pulmonary edema, acute respiratory or heart failure, acute myocardial infarction, cardiomyopathy, puerperal cerebrovascular disorders, or coma. Associations were expressed as rate ratios with 95% confidence intervals that were derived from fitting log-linear Poisson regression models. RESULTS The overall prevalence rate of abruption was 9.6 per 1000, of which two-thirds of cases were classified as being severe (6.5 per 1000). Serious maternal complications occurred in 15.4, 33.3, and 141.7 per 10,000 among nonabruption cases and mild and severe abruption cases, respectively. In comparison with no abruption, the rate ratio for serious maternal complications were 1.52 (95% confidence interval, 1.35-1.72) and 4.29 (95% confidence interval, 4.11-4.47) in women with mild and severe placental abruption, respectively. Rate ratios for the individual complications were 2- to 7-fold higher among severe abruption cases. Furthermore, the rate ratios for serious maternal complications among severe abruption cases compared with mild abruption cases was 3.47 (95% confidence interval, 3.05-3.95). This association was considerably stronger for virtually all maternal complications among cases with severe abruption compared with mild abruption. Annual rates of mild and severe abruption were fairly constant during the study period. Although the maternal complication rate among non-abruption births was stable from 2006-2012, the rate of complications among mild abruption cases dropped from 2006-2008 and then leveled off thereafter. In contrast, the rate of serious complications among severe abruption cases remained fairly stable from 2006-2010 and increased sharply thereafter. CONCLUSIONS Severe abruption was associated with a distinctively higher morbidity risk profile compared with the other 2 groups. The clinical characteristics and morbidity profile of mild abruption were more similar to those of women without an abruption. These findings suggest that the definition of severe placental abruption based on the proposed specific criteria is clinically relevant and may facilitate epidemiologic and genetic research.
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Affiliation(s)
- Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY; Biostatistics Coordinating Center, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY.
| | - Jessica A Lavery
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY; Biostatistics Coordinating Center, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Anthony M Vintzileos
- Department of Obstetrics and Gynecology, Winthrop-University Hospital, Mineola, NY
| | - Daniel W Skupski
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - George Saade
- Department of Obstetrics and Gynecology, University of Texas, Galveston, TX
| | - Joseph Biggio
- Department of Obstetrics and Gynecology, University of Alabama, Birmingham, AL
| | - Michelle A Williams
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jason D Wright
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
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Macheku GS, Philemon RN, Oneko O, Mlay PS, Masenga G, Obure J, Mahande MJ. Frequency, risk factors and feto-maternal outcomes of abruptio placentae in Northern Tanzania: a registry-based retrospective cohort study. BMC Pregnancy Childbirth 2015; 15:242. [PMID: 26446879 PMCID: PMC4597387 DOI: 10.1186/s12884-015-0678-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 10/02/2015] [Indexed: 11/17/2022] Open
Abstract
Background Abruptio placentae remains a major cause of maternal and perinatal morbidity and mortality in developing countries. Little is known about the burden of abruptio placentae in Tanzania. This study aimed to determine frequency, risk factors for abruptio placentae and subsequent feto-maternal outcomes in women with abruptio placentae. Methods We designed a retrospective cohort study using maternally-linked data from Kilimanjaro Christian Medical Centre (KCMC) medical birth registry. Data on all women who delivered live infants and stillbirths at 28 or more weeks of gestation at KCMC hospital from July 2000 to December 2010 (n = 39,993) were analysed. Multivariate logistic models were used to calculate odds ratios (OR) and 95 % confidence intervals (CIs) for risk factors, and feto-maternal outcomes associated with abruptio placentae. Results The frequency of abruptio placentae was 0.3 % (112/39,993). Risk factors for abruptio placentae were chronic hypertension (OR 4.1; 95 % CI 1.3–12.8), preeclampsia/eclampsia (OR 2.1; 95 % CI 1.1–4.1), previous caesarean delivery (OR 1.3; 95 % CI 1.2–4.2), previous abruptio placentae (OR 2.3; 95 % CI 1.8–3.4), fewer antenatal care visits (OR 1.3; 95 % 1.1–2.4) and high parity (OR 1.4; 95 % CI 1.2–8.6). Maternal complications associated with abruptio placentae were antepartum haemorrhage (OR 11.5; 95 % CI 6.3–21.2), postpartum haemorrhage (OR 17.9; 95 % 8.8–36.4),), caesarean delivery (OR 5.6; 95 % CI 3.6–8.8), need for blood transfusions (OR 9.6; 95 % CI 6.5–14.1), altered liver function (OR 5.3; 95 % CI 1.3–21.6) and maternal death (OR 1.6; 95 % CI 1.5–1.8). In addition, women with abruptio placentae had prolonged duration of hospital stay (more than 4 days) and were more likely to have been referred during labour. Adverse fetal outcomes associated with abruptio placentae include low birth weight (OR 5.9; 95 % CI 3.9–8.7), perinatal death (OR 17.6; 95 % CI 11.3–27.3) and low Apgar score (below 7) at 1 and 5 min. Conclusions Frequency of abruptio placentae is comparable with local and international studies. Chronic hypertension, preeclampsia, prior caesarean section delivery, prior abruptio placentae, poor attendance to antenatal care and high parity were independently associated with abruptio placentae. Abruptio placentae was associated with adverse maternal and foetal outcomes. Clinicians should identify risk factors for abruptio placentae during prenatal care when managing pregnant women to prevent adverse maternal and foetal outcomes.
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Affiliation(s)
- Godwin S Macheku
- Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre (KCMC)/Kilimanjaro Christian Medical Collage (KCM College), Moshi, Tanzania.
| | - Rune Nathaniel Philemon
- Department of Paediatrics, Kilimanjaro Christian Medical Centre (KCMC)/Kilimanjaro Christian Medical Collage (KCM College), Moshi, Tanzania.
| | - Olola Oneko
- Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre (KCMC)/Kilimanjaro Christian Medical Collage (KCM College), Moshi, Tanzania. .,Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, 2240, Moshi, Tanzania.
| | - Pendo S Mlay
- Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre (KCMC)/Kilimanjaro Christian Medical Collage (KCM College), Moshi, Tanzania. .,Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, 2240, Moshi, Tanzania.
| | - Gileard Masenga
- Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre (KCMC)/Kilimanjaro Christian Medical Collage (KCM College), Moshi, Tanzania. .,Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, 2240, Moshi, Tanzania.
| | - Joseph Obure
- Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre (KCMC)/Kilimanjaro Christian Medical Collage (KCM College), Moshi, Tanzania.
| | - Michael Johnson Mahande
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, 2240, Moshi, Tanzania.
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Qiu C, Sanchez SE, Hevner K, Enquobahrie DA, Williams MA. Placental mitochondrial DNA content and placental abruption: a pilot study. BMC Res Notes 2015; 8:447. [PMID: 26377917 PMCID: PMC4571073 DOI: 10.1186/s13104-015-1340-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/12/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mitochondrial biogenesis and adequate energy production are important for embryogenesis and placentation. Previous studies documented alterations in maternal blood mitochondrial DNA (mtDNA) copy number-a marker of mitochondrial dysfunction-in pregnancies complicated by placental abruption. To further understand the role of mitochondrial dysfunction in the pathogenesis of placental abruption, we conducted a pilot study using placental specimen collected from 103 placental abruption cases and 102 non-abruption controls. Real-time quantitative polymerase chain reaction (PCR) was used to assess the relative copy number of mtDNA in DNA extracted from placental samples collected immediately after delivery. Logistic regression procedures were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). RESULTS Higher odds of placental abruption was observed with increasing mtDNA copy number (p value for trend = 0.05). The odds of placental abruption was elevated among women who delivered placentas with higher mtDNA copy number (≥120.5, the median) as compared with those with lower values (<120.5) (adjusted OR = 2.38; 95% CI 1.11-5.08). CONCLUSION We found preliminary evidence for associations of target tissue-specific mitochondrial dysfunction with an adverse perinatal outcome, placental abruption. Larger studies and replication of findings in other populations will further our understanding of relationships between cellular and genomic biomarkers of normal and abnormal placental function and vascular placental disorders.
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Affiliation(s)
- Chunfang Qiu
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA.
| | - Sixto E Sanchez
- Sección de Post Grado, Facultad de Medicina Humana, Universidad San Martín de Porres, Lima, Peru. .,A.C. PROESA, Lima, Peru.
| | - Karin Hevner
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA.
| | - Daniel A Enquobahrie
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA. .,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Michelle A Williams
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
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Ananth CV, Keyes KM, Hamilton A, Gissler M, Wu C, Liu S, Luque-Fernandez MA, Skjærven R, Williams MA, Tikkanen M, Cnattingius S. An international contrast of rates of placental abruption: an age-period-cohort analysis. PLoS One 2015; 10:e0125246. [PMID: 26018653 PMCID: PMC4446321 DOI: 10.1371/journal.pone.0125246] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/22/2015] [Indexed: 11/25/2022] Open
Abstract
Background Although rare, placental abruption is implicated in disproportionately high rates of perinatal morbidity and mortality. Understanding geographic and temporal variations may provide insights into possible amenable factors of abruption. We examined abruption frequencies by maternal age, delivery year, and maternal birth cohorts over three decades across seven countries. Methods Women that delivered in the US (n = 863,879; 1979–10), Canada (4 provinces, n = 5,407,463; 1982–11), Sweden (n = 3,266,742; 1978–10), Denmark (n = 1,773,895; 1978–08), Norway (n = 1,780,271, 1978–09), Finland (n = 1,411,867; 1987–10), and Spain (n = 6,151,508; 1999–12) were analyzed. Abruption diagnosis was based on ICD coding. Rates were modeled using Poisson regression within the framework of an age-period-cohort analysis, and multi-level models to examine the contribution of smoking in four countries. Results Abruption rates varied across the seven countries (3–10 per 1000), Maternal age showed a consistent J-shaped pattern with increased rates at the extremes of the age distribution. In comparison to births in 2000, births after 2000 in European countries had lower abruption rates; in the US there was an increase in rate up to 2000 and a plateau thereafter. No birth cohort effects were evident. Changes in smoking prevalence partially explained the period effect in the US (P = 0.01) and Sweden (P<0.01). Conclusions There is a strong maternal age effect on abruption. While the abruption rate has plateaued since 2000 in the US, all other countries show declining rates. These findings suggest considerable variation in abruption frequencies across countries; differences in the distribution of risk factors, especially smoking, may help guide policy to reduce abruption rates.
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Affiliation(s)
- Cande V. Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Ava Hamilton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Mika Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland and NHV Nordic School of Public Health, Gothenburg, Sweden
| | - Chunsen Wu
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Shiliang Liu
- Health Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Canada
| | - Miguel Angel Luque-Fernandez
- Department of Epidemiology, School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Rolv Skjærven
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
| | - Michelle A. Williams
- Department of Epidemiology, School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Minna Tikkanen
- Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland
| | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Ananth CV, Skjaerven R, Klunssoyr K. Change in paternity, risk of placental abruption and confounding by birth interval: a population-based prospective cohort study in Norway, 1967-2009. BMJ Open 2015; 5:e007023. [PMID: 25670732 PMCID: PMC4325127 DOI: 10.1136/bmjopen-2014-007023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We examined abruption risk in relation to change in paternity, and evaluated if birth interval confounds this association. SETTING Population-based study of singleton births in Norway between 1967 and 2009. PARTICIPANTS Women who had their first two (n=747 566) singleton births in the Norwegian Medical Birth Registry. The associations between partner change between pregnancies and birth interval were examined in relation to abruption in a series of logistic regression models. PRIMARY OUTCOME MEASURES Risk, as well as unadjusted and adjusted OR of placental abruption in relation to change in paternity and interval between births. RESULTS Among women without abruption in their first pregnancy, the risks of abruption in the second pregnancy were 4.7 and 6.5 per 1000 in women who had the same and different partners, respectively (OR=1.39, 95% CI 1.26 to 1.53). After adjustments for confounders including birth interval and smoking, partner change was not associated with abruption (OR=1.01, 95% CI 0.79 to 1.32). Among women with abruption in the first pregnancy, the association between partner change and abruption in the second pregnancy was 0.98 (95% CI 0.75 to 1.28). Interval <1 year was associated with increased abruption risk in the second pregnancy among women with the same as well as different partners, but interval over 4 years was only associated with increased risk among women with the same partner. No such patterns were seen for recurrent abruption. CONCLUSIONS We find no evidence that a change in partner is associated with increased abruption risk. Theories supporting an immune maladaptation hypothesis afforded by change in paternity are not supported insofar as abruption is concerned.
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Affiliation(s)
- Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York, USA Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Rolv Skjaerven
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
| | - Kari Klunssoyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
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Ganor-Paz Y, Kailer D, Shechter-Maor G, Regev R, Fejgin MD, Biron-Shental T. Obstetric and neonatal outcomes after preterm premature rupture of membranes among women carrying group B streptococcus. Int J Gynaecol Obstet 2014; 129:13-6. [PMID: 25585859 DOI: 10.1016/j.ijgo.2014.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 09/28/2014] [Accepted: 12/09/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate whether carriers of group B streptococcus (GBS) have adverse obstetric and neonatal outcomes when preterm premature rupture of membranes (PPROM) occurs. METHODS In a retrospective study, data were reviewed for women with a singleton pregnancy and PPROM before 34 weeks who attended the Meir Medical Center, Kfar Saba, Israel, between 2005 and 2012. All women received roxithromycin for 1 week, and ampicillin until GBS culture results were available. Ampicillin was continued to 1 week if the GBS culture was positive. The primary study outcome measure was the latency period (time from rupture of membranes to active/induced labor). RESULTS Among 116 eligible patients, 21 (18.1%) were GBS carriers and 95 (81.9%) noncarriers. The latency period was 11.2 ± 18.1 days for GBS carriers versus 7.5 ± 9.6 days for noncarriers (P=0.93). However, there was a correlation between the length of ampicillin treatment and the latency period (Spearman correlation coefficient 0.7; P<0.001). There were no differences in early neonatal outcomes. CONCLUSION GBS carriers with PPROM did not have adverse outcomes. Longer treatment with ampicillin among GBS carriers prolonged the latency period.
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Affiliation(s)
- Yael Ganor-Paz
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Kailer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Shechter-Maor
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rivka Regev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Neonatology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Moshe D Fejgin
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Mukherjee S, Bawa AK, Sharma S, Nandanwar YS, Gadam M. Retrospective study of risk factors and maternal and fetal outcome in patients with abruptio placentae. J Nat Sci Biol Med 2014; 5:425-8. [PMID: 25097428 PMCID: PMC4121928 DOI: 10.4103/0976-9668.136217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Abruptio placentae (AP) which is a major cause of maternal morbidity and perinatal mortality globally is of serious concern in the developing world. We retrospectively analyzed the AP cases and evaluated its impact on fetal and maternal outcomes. Materials and Methods: The present study was undertaken from September 2007-August 2009 at a tertiary care center attached to medical college; patients of AP were selected from all cases with minimum of 28 weeks of gestation, presenting with antepartum hemorrhage. Patients underwent complete obstetrical investigations and were managed according to maternal and fetal condition. Results: 4.4% incidence rate of AP was documented accounting for 318 cases during the study period. Most of cases were unbooked, with an average age of 34.5 years (range, 18-44) and nearly two-third of the patients were from lower socioeconomic class. Anemia was observed in 96% of patients, with 3.5 and 68% incidence of maternal and fetal mortality, respectively. Conclusion: We observed a higher than expected frequency of AP and neonatal mortality in our study population, which is of major concern. We envisage need for mass information regarding the importance of antenatal maternal care and improvement in nutritional status, which may reduce the frequency of maternal and fetal morbidity and mortality associated with AP.
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Affiliation(s)
- Soma Mukherjee
- Department of Obstetrics and Gynaecology, R. N. Cooper Municipal General Hospital, Vile Parle West, Mumbai, Maharashtra, India
| | - Amarjeet Kaur Bawa
- Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College and Sion Hospital, Sion, Mumbai, Maharashtra, India
| | - Surbhi Sharma
- Department of Obstetrics and Gynaecology Mahatma Gandhi Memorial Medical College and Maharaja Yashwantrao Hospital, Indore, Madhya Pradesh, India
| | - Yogeshwar S Nandanwar
- Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College and Sion Hospital, Sion, Mumbai, Maharashtra, India
| | - Mohan Gadam
- Department of Obstetrics and Gynaecology, R. N. Cooper Municipal General Hospital, Vile Parle West, Mumbai, Maharashtra, India
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Abstract
Preeclampsia, placental abruption, and intrauterine growth restriction (IUGR) have collectively been termed ischemic placental disease (IPD) due to a suspected common biological pathway involving poor placentation in early pregnancy and subsequent placental insufficiency. Despite decades of research, the etiologies of these conditions remain largely unknown and preventive and therapeutic strategies are lacking. It has been suggested that the underpinnings of IPD lie primarily in preterm gestations and that classification of these conditions based on the gestational age at onset will facilitate etiologic research. The purpose of this review is to describe our current knowledge regarding the risk factors, co-occurrence, and recurrence of the conditions of IPD with a specific focus on the preterm gestational window.
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Affiliation(s)
- Samantha E. Parker
- Corresponding author: Department of Epidemiology, Boston University School of Public Health, 1010 Commonwealth Ave, Boston, MA 02215. (S.E. Parker)
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Is maternal anemia associated with small placental volume in the first trimester? Arch Gynecol Obstet 2014; 289:1207-9. [DOI: 10.1007/s00404-014-3154-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/09/2014] [Indexed: 11/26/2022]
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Salihu HM, Diamond E, August EM, Rahman S, Mogos MF, Mbah AK. Maternal pregnancy weight gain and the risk of placental abruption. Nutr Rev 2013; 71 Suppl 1:S9-17. [DOI: 10.1111/nure.12063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
| | - Elise Diamond
- University of South Florida; College of Public Health; Department of Epidemiology and Biostatistics; Tampa; Florida; USA
| | | | - Shams Rahman
- University of South Florida; College of Public Health; Department of Epidemiology and Biostatistics; Tampa; Florida; USA
| | - Mulubrhan F Mogos
- University of South Florida; College of Public Health; Department of Epidemiology and Biostatistics; Tampa; Florida; USA
| | - Alfred K Mbah
- University of South Florida; College of Public Health; Department of Epidemiology and Biostatistics; Tampa; Florida; USA
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Abstract
Intrapartum hemorrhage is a serious and sometimes life-threatening event. Several etiologies are known and include placental abruption, uterine atony, placenta accreta, and genital tract lacerations. Prompt recognition of blood loss, identification of the source of the hemorrhage, volume resuscitation, including red blood cells and blood products when required, will result in excellent maternal outcomes.
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Affiliation(s)
- James M Alexander
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9032, USA.
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Matsuda Y, Ogawa M, Konno J, Mitani M, Matsui H. Prediction of fetal acidemia in placental abruption. BMC Pregnancy Childbirth 2013; 13:156. [PMID: 23915223 PMCID: PMC3735466 DOI: 10.1186/1471-2393-13-156] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 07/31/2013] [Indexed: 11/10/2022] Open
Abstract
Background To determine the major predictive factors for fetal acidemia in placental abruption. Methods A retrospective review of pregnancies with placental abruption was performed using a logistic regression model. Fetal acidemia was defined as a pH of less than 7.0 in umbilical artery. The severe abruption score, which was derived from a linear discriminant function, was calculated to determine the probability of fetal acidemia. Results Fetal acidemia was seen in 43 survivors (43/222, 19%). A logistic regression model showed bradycardia (OR (odds ratio) 50.34, 95% CI 11.07 – 228.93), and late decelerations (OR 15.13, 3.05 – 74.97), but not abnormal ultrasonographic findings were to be associated with the occurrence of fetal acidemia. The severe abruption score was calculated for the occurrence of fetal acidemia, using 6 items including vaginal bleeding, gestational age, abdominal pain, abnormal ultrasonographic finding, late decelerations, and bradycardia. Conclusions An abnormal FHR pattern, especially bradycardia is the most significant risk factor in placental abruption predicting fetal acidemia, regardless of the presence of abnormal ultrasonographic findings or gestational age.
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Affiliation(s)
- Yoshio Matsuda
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Kawada-cho, 8-1, Shinjuku-ku, Tokyo 162-8666, Japan.
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Hasegawa J, Nakamura M, Hamada S, Ichizuka K, Matsuoka R, Sekizawa A, Okai T. Capable of identifying risk factors for placental abruption. J Matern Fetal Neonatal Med 2013; 27:52-6. [DOI: 10.3109/14767058.2013.799659] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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De Leon-Luis J, Perez R, Pintado Recarte P, Avellaneda Fernandez A, Romero Roman C, Antolin Alvarado E, Ortiz-Quintana L, Izquierdo Martinez M. Second trimester amniotic fluid adiponectin level is affected by maternal tobacco exposure, insulin, and PAPP-A level. Eur J Obstet Gynecol Reprod Biol 2012; 165:189-93. [DOI: 10.1016/j.ejogrb.2012.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 07/02/2012] [Accepted: 07/29/2012] [Indexed: 01/20/2023]
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Abstract
Complications of late pregnancy are managed infrequently in the emergency department and, thus, can pose a challenge when the emergency physician encounters acute presentations. An expert understanding of the anatomic and physiologic changes and possible complications of late pregnancy is vital to ensure proper evaluation and care for both mother and fetus. This article focuses on the late pregnancy issues that the emergency physician will face, from the bleeding and instability of abruptio placentae to the wide spectrum of complications and management strategies encountered with preterm labor.
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Tikkanen M, Riihimäki O, Gissler M, Luukkaala T, Metsäranta M, Andersson S, Ritvanen A, Paavonen J, Nuutila M. Decreasing incidence of placental abruption in Finland during 1980-2005. Acta Obstet Gynecol Scand 2012; 91:1046-52. [PMID: 22582999 DOI: 10.1111/j.1600-0412.2012.01457.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the incidence trends of placental abruption. DESIGN Register-based retrospective study. SETTING The Finnish Medical Birth Register and Hospital Discharge Register. POPULATION A total of 6231 placental abruption cases among 1 576 051 deliveries. METHODS Data on demographic and pregnancy and delivery associated outcomes were collected. Data on overall incidence and maternal age were available 1980-2005. Data on other variables were available 1987-2005. MAIN OUTCOME MEASURE Placental abruption RESULTS The overall incidence of placental abruption was 395/100 000 (0.4%). The incidence decreased 31%, from 487/100 000 in 1980 to 337/100 000 in 2005 (p < 0.001). The incidence was lowest among women aged 20-24 years (305/100 000) and highest among women aged ≥45 years (1309/100 000). During 1987-2005 the incidence was lowest among women with one or two deliveries (353/100 000) and highest in nulliparous women (382/100 000) and in women with three or more deliveries (595/100 000). The incidence was nearly double (577/100 000) among smoking compared with non-smoking women (341/100 000). The incidence was highest between gestational weeks 26 and 29. Among newborns weighing <1500 g the incidence was higher (5734/100 000) than among those weighing ≥2500 g (251/100 000). The incidence was higher in multiple (903/100 000) than in singleton pregnancies (374/100 000). CONCLUSION The incidence of placental abruption decreased during 1980-2005. The incidence was highest among women aged 45 years or more, multiparous and smoking women, in multiple pregnancies and in women with low birthweight newborns.
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Affiliation(s)
- Minna Tikkanen
- Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland.
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Ananth CV, Smulian JC, Srinivas N, Getahun D, Salihu HM. Risk of Infant Mortality Among Twins in Relation to Placental Abruption: Contributions of Preterm Birth and Restricted Fetal Growth. Twin Res Hum Genet 2012. [DOI: 10.1375/twin.8.5.524] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractWhile preterm birth and restricted fetal growth are strongly associated with infant mortality, the extent to which these associations are modified by placental abruption remains unknown. A retrospective cohort study was carried out to examine the risk of infant mortality among twins in relation to abruption, and explore the independent contributions of preterm birth and restricted fetal growth to these associations. The study was restricted to women who had delivered twins at 22 weeks' gestation or more and fetuses weighing 500 grams or more in the United States (1989–2000). Risks of preterm birth (less than 37 weeks' gestation), fetal growth restriction and infant mortality, in relation to placental abruption, were evaluated. All analyses were adjusted for potential sociodemographic confounding factors. The association between restricted twin fetal growth and abruption was the strongest among the most severely growth-restricted babies (i.e., less than 1 centile), with the strength of association diminishing with increasing birthweight centiles. The risk of preterm birth among pregnancies with and without abruption were 80.1% and 51.9%, respectively (relative risk [RR] 1.5, 95% confidence interval [CI] 1.4–1.6). The risk of small-for-gestational-age (SGA; birthweight of less than the 10th centile for gestational age) among abruption and nonabruption births was 11.7% and 9.2%, respectively (RR 1.3, 95% CI 1.2–1.4). Compared with twins of the appropriate growth delivered at term, the relative risks for infant mortality in the presence of abruption were 9.9 (95% CI 5.4–18.2) for term-SGA, 25.0 (95% CI 22.3–28.1) for preterm-non-SGA, and 36.2 (95% CI 28.4–46.1) for preterm-SGA births. The association between infant mortality and abruption among twins appears largely mediated through preterm birth, and to a lesser extent, through SGA. The association between fetal growth and abruption is strongest among the severely growth-restricted babies, suggesting that the origins of placental abruption may develop in early pregnancy.
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Falcón BJ, Cotechini T, Macdonald-Goodfellow SK, Othman M, Graham CH. Abnormal inflammation leads to maternal coagulopathies associated with placental haemostatic alterations in a rat model of foetal loss. Thromb Haemost 2012; 107:438-47. [PMID: 22234563 DOI: 10.1160/th11-09-0626] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 12/05/2011] [Indexed: 01/08/2023]
Abstract
Spontaneous pregnancy loss is often associated with aberrant maternal inflammation and systemic coagulopathies. However, the role of inflammation in the development of obstetric coagulopathies is poorly understood. Further, questions remain as to whether systemic coagulopathies are linked to placental haemostatic alterations, and whether these local alterations contribute to a negative foetal outcome. Using a model of spontaneous foetal loss in which pregnant rats are given a single injection of bacterial lipopolysaccharide (LPS), we characterised the systemic maternal coagulation status following LPS administration using thromboelastography (TEG), a global haemostatic assay that measures the kinetics of clot formation. Systemic maternal coagulopathy was evident in 82% of LPS-treated rats. Specifically, we observed stage-I, -II, and -III disseminated intravascular coagulation (DIC) and hypercoagulability. Modulation of inflammation through inhibition of tumour necrosis factor α with etanercept resulted in a 62% reduction in the proportion of rats exhibiting coagulopathy. Moreover, inflammation-induced systemic coagulopathies were associated with placental haemostatic alterations, which included increased intravascular, decidual, and labyrinth fibrin deposition in cases of DIC-I and hypercoagulability, and an almost complete absence of fibrin deposition in cases of DIC-III. Furthermore, systemic and placental haemostatic alterations were associated with impaired utero-placental haemodynamics, and inhibition of these haemostatic alterations by etanercept was associated with maintenance of utero-placental haemodynamics. These findings indicate that modulation of maternal inflammation may be useful in the prevention of coagulopathies associated with complications of pregnancy.
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Affiliation(s)
- Bani J Falcón
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
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Ananth CV, Vintzileos AM. Ischemic placental disease: epidemiology and risk factors. Eur J Obstet Gynecol Reprod Biol 2011; 159:77-82. [DOI: 10.1016/j.ejogrb.2011.07.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/13/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
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Aliyu MH, Lynch O, Nana PN, Alio AP, Wilson RE, Marty PJ, Zoorob R, Salihu HM. Alcohol consumption during pregnancy and risk of placental abruption and placenta previa. Matern Child Health J 2011; 15:670-6. [PMID: 20437196 DOI: 10.1007/s10995-010-0615-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to examine the association between prenatal alcohol consumption and the occurrence of placental abruption and placenta previa in a population-based sample. We used linked birth data files to conduct a retrospective cohort study of singleton deliveries in the state of Missouri during the period 1989 through 2005 (n = 1,221,310). The main outcomes of interest were placenta previa, placental abruption and a composite outcome defined as the occurrence of either or both lesions. Multivariate logistic regression was used to generate adjusted odd ratios, with non-drinking mothers as the referent category. Women who consumed alcohol during pregnancy had a 33% greater likelihood for placental abruption during pregnancy (adjusted odds ratio (OR), 95% confidence interval (CI) = 1.33 [1.16-1.54]). No association was observed between prenatal alcohol use and the risk of placenta previa. Alcohol consumption in pregnancy was positively related to the occurrence of either or both placental conditions (adjusted OR [95% CI] = 1.29 [1.14-1.45]). Mothers who consumed alcohol during pregnancy were at elevated risk of experiencing placental abruption, but not placenta previa. Our findings underscore the need for screening and behavioral counseling interventions to combat alcohol use by pregnant women and women of childbearing age.
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Affiliation(s)
- Muktar H Aliyu
- Department of Preventive Medicine, Institute for Global Health, Vanderbilt University, Nashville, TN, USA
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Markhus VH, Rasmussen S, Lie SA, Irgens LM. Placental abruption and premature rupture of membranes. Acta Obstet Gynecol Scand 2011; 90:1024-9. [PMID: 21692757 DOI: 10.1111/j.1600-0412.2011.01224.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess whether premature rupture of membranes (PROM) is associated with placental abruption. DESIGN Population-based study. SETTING Data were extracted from the Medical Birth Registry of Norway. POPULATION All women with PROM (18,889 cases), including 3,077 cases of preterm premature rupture of membranes (p-PROM), among a total of 355 416 singleton births in Norway during 1999-2005 with gestational age 17-44 weeks. METHODS Logistic regression was used to assess whether placental abruption was associated with PROM in preterm and term births. MAIN OUTCOME MEASURES Placental abruption. RESULTS The occurrence of placental abruption in p-PROM was higher than in the total study population, 11.0 per 1,000 (34 of 3 077) vs. 4.2 per 1 000 (1 495 of 355 416; adjusted odds ratio 2.6, 95% confidence interval 1.8-3.7). Restricting the analyses to preterm births, the occurrence of placental abruption was less in p-PROM (11.0 per 1,000) than in births without p-PROM (36.1 per 1 000; adjusted odds ratio 0.3, 95% confidence interval 0.2-0.4). In term births, no statistically significant association was observed. CONCLUSIONS The findings suggest that in p-PROM the risk of placental abruption is not higher than in other preterm births; rather the opposite. However, comparing the risks in p-PROM and the total gestational age range, the present study confirmed results reported in previous studies of a higher risk of placental abruption in p-PROM than in the total birth population.
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Aliyu MH, Salihu HM, Lynch O, Alio AP, Marty PJ. Placental abruption, offspring sex, and birth outcomes in a large cohort of mothers. J Matern Fetal Neonatal Med 2011; 25:248-52. [PMID: 21714694 DOI: 10.3109/14767058.2011.569615] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate stillbirth, neonatal, and perinatal death outcomes in pregnancies complicated by placental abruption, according to fetal sex. METHODS We utilized maternally linked cohort data files of singleton live births to mothers diagnosed with placental abruption during the period 1989 through 2005 (n = 10,014). Logistic regression models were employed to generate adjusted odd ratios and their 95% confidence intervals. Male babies served as the referent category. RESULTS The sex ratio at birth was 1.18. The overall prevalence of stillbirth, neonatal mortality, and perinatal mortality was 7.2%, 4.5%, and 11.8%, respectively. Placental abruption was less likely to occur in mothers carrying female pregnancies than mothers of male infants (adjusted odds ratio [95% confidence interval] = 0.89 [0.86-0.93]). There were no significant sex differences with regards to stillbirth, neonatal mortality, and perinatal mortality. Similar findings were observed for preterm and term infants. CONCLUSIONS Although a preponderance of male infants was discernable among mothers with placental abruption, no sex difference in fetal survival was observed among the offspring of the mothers affected by placental abruption.
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Affiliation(s)
- Muktar H Aliyu
- Department of Preventive Medicine & Institute for Global Health, Vanderbilt University, Nashville, TN, USA
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Shiozaki A, Matsuda Y, Hayashi K, Satoh S, Saito S. Comparison of risk factors for major obstetric complications between Western countries and Japan: A case-cohort study. J Obstet Gynaecol Res 2011; 37:1447-54. [DOI: 10.1111/j.1447-0756.2011.01565.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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