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Lueth A, Blue N, Silver RM, Allshouse A, Hoffman M, Grobman WA, Simhan HN, Reddy U, Haas DM. Prospective evaluation of placental abruption in nulliparous women. J Matern Fetal Neonatal Med 2022; 35:8603-8610. [PMID: 34814777 PMCID: PMC9678005 DOI: 10.1080/14767058.2021.1989405] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Because most data on placental abruption are derived from retrospective studies, multiple sources of bias may have affected the results. Thus, we aimed to characterize risk factors and outcomes for placental abruption in a large prospective cohort of nulliparous women. METHODS This was a secondary analysis of women enrolled in the Nulliparous Pregnancy Outcomes Study Monitoring-to-be (nuMom2b) study, a prospective observational cohort. Participants were recruited in their first trimester of pregnancy from 8 sites and had 4 study visits, including at delivery. Placental abruption was defined by confirmed clinical criteria. The primary analysis was restricted to abruption identified antepartum and intrapartum. As a secondary analysis, we examined antepartum and intrapartum abruptions separately. We compared risk factors (maternal demographic and clinical characteristics) and outcomes in women with and without placental abruption using univariable and multivariable analyses as appropriate. RESULTS 9450 women were included in the primary analysis. Abruption was identified in 0.66% (n = 62), of which 35 (56%) were antepartum and 27 (44%) intrapartum. For women with abruption, the mean gestational age at delivery was 35.6 ± 4.4 weeks and 38.8 ± 2.2 weeks for women without abruption. Gravidity was associated with abruption (OR 3.1, 95% CI: 1.6-6.0). In univariate analysis, abruption was associated with cesarean delivery (OR 3.7, 95% CI: 2.2-6.0), blood transfusion (OR 3.8, 95% CI: 1.4-10.7), PPROM (OR 9.0, 95% CI: 5.4-15.1), preterm birth (OR 8.5, 95% CI: 5.1-14.2), SGA (OR 4.0, 95% CI: 2.3-6.95), RDS (OR 5.5, 95% CI: 2.6-11.2), IVH 20.2 (OR 20.2, 95% CI: 5.9-68.8) and ROP (OR 12.2, 95% CI: 2.8-52.6). However, after adjustment for confounders including gestational age, abruption was only associated with increased odds of cesarean delivery and blood transfusion. Results were similar when restricted to antepartum and intrapartum abruptions. CONCLUSION Abruption was identified in <1% of nulliparous women. However, few maternal risk factors were identified. Neonatal morbidities were associated with an abruption and were primarily driven by gestational age due to preterm birth.
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Affiliation(s)
- Amir Lueth
- Department of Obstetrics and Gynecology, University of Utah Health Care, Salt Lake City, UT, USA
| | - Nathan Blue
- Department of Obstetrics and Gynecology, University of Utah Health Care, Salt Lake City, UT, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah Health Care, Salt Lake City, UT, USA
| | - Amanda Allshouse
- Department of Obstetrics and Gynecology, University of Utah Health Care, Salt Lake City, UT, USA
| | - Matthew Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA
| | - William A Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - Hyagriv N Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Hospital of UPMC, Pittsburgh, PA, USA
| | - Uma Reddy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
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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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Odendaal H. Association of Concomitant Drinking and Smoking during Pregnancy with Placental Abruption, Fetal Growth Restriction and Sudden Infant Death Syndrome (SIDS). JOURNAL OF PULMONARY MEDICINE 2021; 5:1000111. [PMID: 34308437 PMCID: PMC8301490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Hendrik Odendaal
- Department of Obstetrics and Gynaecology, Stellenbosch University, South Africa
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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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Saquib S, Hamza L, AlSayed A, Saeed F, Abbas M. Prevalence and Its Feto-Maternal Outcome in Placental Abruption: A Retrospective Study for 5 Years from Dubai Hospital. DUBAI MEDICAL JOURNAL 2020. [DOI: 10.1159/000506256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Qiu Y, Wu L, Xiao Y, Zhang X. Clinical analysis and classification of placental abruption. J Matern Fetal Neonatal Med 2019; 34:2952-2956. [PMID: 31608779 DOI: 10.1080/14767058.2019.1675625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the diagnosis, treatment, and maternal and fetal outcomes of placental abruption. MATERIALS AND METHODS We recruited 585 cases of placental abruption from the Women and Children's Hospital Affiliated to Xiamen University between January 2012 and December 2017. Cases were categorized into four groups (class 0-III) according to the clinical guidelines published by the Obstetrics and Gynecology Branch of the Chinese Medical Association. We then compared clinical data and auxiliary examinations across the four groups. RESULTS The differences were statistically significant (p < .01) among the four groups of placental abruption with regard to the incidence of an abnormal ultrasound finding. Positive ultrasound signs were evident in 6.4% of the patients categorized as class 0 and 100.0% of patients categorized as class III. Monitoring showed that fetal heart rate (FHR) was abnormal in class II patients with placental abruption; patients in class III showed no fetal heart sounds. Cesarean section was carried out for 26.6%, 75.1%, 65.2%, and 47.1% of patients in classes 0, I, II, and III, respectively. The rate of cesarean section for classes I and II was the highest, while the lowest rate occurred for class 0. Postpartum hemorrhage occurred in 2.5%, 9.3%, 15.2%, and 29.4% of patients across the four groups, DIC occurred in 0.0%, 1.3%, 2.3%, and 23.5% of cases, and perinatal death occurred in 1.0%, 1.3%, 7.6%, and 100.0% of cases, respectively. The highest incidence of postpartum hemorrhage was in class III (29.4%) and the lowest was in class 0 (2.5%). The highest incidence of DIC was in class III (23.5%) and the lowest was in class 0 (0.0%). The highest incidence of neonatal asphyxia was in class II (34.1%) and the lowest was in class 0 (10.1%). Regarding perinatal death, the highest incidence was in class III (100.0%) and the lowest was in class 0 (1.0%). These data showed significance differences when compared across the four groups of patients (p < .01). CONCLUSIONS We recommend that the diagnosis of placental abruption should consider risk factors, clinical features, FHR monitoring, and dynamic ultrasound monitoring. Early diagnosis and treatment can improve maternal and infant prognosis.
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Affiliation(s)
- Yu Qiu
- Department of Obstetrics and Gynecology, Xiamen Women and Children's Health Hospital & Women and Children's Hospital Affiliated to Xiamen University, Xiamen, PR China
| | - Lixia Wu
- Department of Obstetrics and Gynecology, Xiamen Women and Children's Health Hospital & Women and Children's Hospital Affiliated to Xiamen University, Xiamen, PR China
| | - Yunshan Xiao
- Department of Obstetrics and Gynecology, Xiamen Women and Children's Health Hospital & Women and Children's Hospital Affiliated to Xiamen University, Xiamen, PR China
| | - Xueqin Zhang
- Department of Obstetrics and Gynecology, Xiamen Women and Children's Health Hospital & Women and Children's Hospital Affiliated to Xiamen University, Xiamen, PR China
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Han M, Liu D, Zeb S, Li C, Tong M, Li X, Chen Q. Are maternal and neonatal outcomes different in placental abruption between women with and without preeclampsia? Placenta 2019; 85:69-73. [DOI: 10.1016/j.placenta.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/30/2019] [Accepted: 07/04/2019] [Indexed: 01/01/2023]
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Özdemirci Ş, Demirdağ E, Kasapoğlu T, Karahanoğlu E, Başer E, Yalvaç S, Tapisiz ÖL. Obstetric outcome of second trimester antenatal bleeding. J Matern Fetal Neonatal Med 2015; 29:3395-9. [PMID: 26692339 DOI: 10.3109/14767058.2015.1130815] [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: 11/13/2022]
Abstract
OBJECTIVE To evaluate the clinical significance of vaginal bleeding in pregnant women between 14th and 22th gestational weeks. METHODS This retrospective case-control study was conducted between September 2010 and December 2013. Two-hundred nineteen pregnant women with vaginal bleeding between 14th and 22th gestational weeks were compared with 325 pregnant women without vaginal bleeding for their maternal and early neonatal outcomes. RESULTS Mean gestational age and birth weight of study group were significantly different from those of the control group respectively (37.9 ± 2.8 versus 38.9 ± 1.4 and 3071 ± 710 versus 3349 ± 446 for groups p < 0.001). Vaginal bleeding between 14th and 22th gestational weeks had increased risk of having preterm birth (PB) and preterm premature rupture of membranes (PPROM) (OR: 10.8, 95% CI: [4.5-26.1]; OR: 12.0, 95% CI: [3.5-40.6], respectively). Gestational diabetes mellitus (GDM) and polyhydramnios ratio in the study group was significantly higher than the control respectively (4.1% versus 1.2%, p = 0.031; 1.9% versus 0%, p = 0.025). CONCLUSION Pregnant women with vaginal bleeding was a significantly risk factor for PB, PPROM, GDM, and polyhydramnios. Consequently, these pregnancies should be closely followed up for maternal and fetus complications.
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Affiliation(s)
- Şafak Özdemirci
- a Department of Obstetrics and Gynecology , Obstetrics Clinic, Etlik Zubeyde Hanım Women's Health Education and Research Hospital , Ankara , Turkey
| | - Erhan Demirdağ
- b Department of Obstetrics and Gynecology , Perinatology & High-Risk Pregnancy Clinic, Etlik Zubeyde Hanım Women's Health Education and Research Hospital , Ankara , Turkey , and
| | - Taner Kasapoğlu
- b Department of Obstetrics and Gynecology , Perinatology & High-Risk Pregnancy Clinic, Etlik Zubeyde Hanım Women's Health Education and Research Hospital , Ankara , Turkey , and.,c Department of Epidemiology , Institute of Health Sciences, Hacettepe University , Ankara , Turkey
| | - Ertuğrul Karahanoğlu
- b Department of Obstetrics and Gynecology , Perinatology & High-Risk Pregnancy Clinic, Etlik Zubeyde Hanım Women's Health Education and Research Hospital , Ankara , Turkey , and
| | - Emre Başer
- a Department of Obstetrics and Gynecology , Obstetrics Clinic, Etlik Zubeyde Hanım Women's Health Education and Research Hospital , Ankara , Turkey
| | - Serdar Yalvaç
- b Department of Obstetrics and Gynecology , Perinatology & High-Risk Pregnancy Clinic, Etlik Zubeyde Hanım Women's Health Education and Research Hospital , Ankara , Turkey , and
| | - Ömer Lütfi Tapisiz
- a Department of Obstetrics and Gynecology , Obstetrics Clinic, Etlik Zubeyde Hanım Women's Health Education and Research Hospital , Ankara , Turkey
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