Преждевременная отслойка плаценты у беременных с преэклампсией. Многоцентровое когортное обсервационное ретроспективное исследование

I.S Rudakova,Republican Perinatal Center, Petrozavodsk, Russian Federation ,R.V Bikkuzhin,Clinical Perinatal Center Of The Saratov Region, Saratov, Russian Federation ,Petrozavodsk State University, Petrozavodsk, Russian Federation ,E.G Prodanchuk,O.V Riazanova,Altai Regional Clinical Perinatal Center, Barnaul, Russian Federation ,N.V Artymuk,R.V Kapustin,K.A Kolmakova,A.V Kulikov,T.Yu Marochko,V.A Bagiyants,G.P Tikhova,Pirogov Russian National Research Medical University, Moscow, Russian Federation ,K.G Eliseeva,N.V Shindyapina,S.A Iozefson,Dzerzhinsk Perinatal Center, Dzerzhinsk, Russian Federation ,Novosibirsk City Clinical Perinatal Center, Novosibirsk, Russian Federation ,G.s.postol Perinatal Center, Khabarovsk, Russian Federation ,A.A Bukhtin,O.B Shulman,A.A Kuverin,Maykop City Clinical Hospital, Maykop, Russian Federation ,A.A Sleta,V.i.razumovsky Saratov State Medical University, Saratov, Russian Federation ,I.M Pozdnyakov,N.M Milyaeva,N.A Barkovskaya,A.I Cherny,Far Eastern State Medical University, Khabarovsk, Russian Federation ,P.V Kokh,Regional Children’s Clinical Hospital “Regional Perinatal Center”, Yekaterinburg, Russian Federation ,Saratov City Clinical Hospital No 8, Saratov, Russian Federation ,T.E Belokrinitskaya,V.D Snezhko,N.Yu Pylaeva,S.V Barinov,Volgograd Regional Clinical Perinatal Center No 1, Volzhsky, Russian Federation ,V.S Gorokhovskiy,D.V Marshalov,A.A Mironchuk,M.G Tupikin,I.V Saveljeva,S.V Ovechkin,I.G Verveyko,N.Yu Katkova,M.f.vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russian Federation ,D.E Gurbanov,A.A Belinina,Kemerovo State University, Kemerovo, Russian Federation ,A.v.vishnevsky National Medical Research Center Of Surgery, Moscow, Russian Federation ,A.A Ivshin,E.N Degtyarev,S.V Novikova,Simferopol Clinical Hospital, Simferopol, Russian Federation ,Adygea Republican Clinical Perinatal Center, Maykop, Russian Federation ,Ural State Medical University, Yekaterinburg, Russian Federation ,A.V Bulavintseva,E.A Bukharova,E.Yu Upryamova,Regional Clinical Hospital, Omsk, Russian Federation ,Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation ,L.V Kuklina,M.A Andriyakhova,Omsk State Medical University, Omsk, Russian Federation ,F.R Barakaeva,A.V Petrov,Chita State Medical Academy, Chita, Russian Federation ,V.i.vernadsky Crimean Federal University, Simferopol, Russian Federation ,E.M Shifman,E.o.mukhin City Clinical Hospital, Moscow, Russian Federation ,E.S Nadezhina

doi:10.20953/1726-1678-2023-4-5-16

Abstract

Placental abruption is a rare complication of pregnancy with a high risk of maternal and neonatal morbidity and mortality. Preeclampsia (PE) is often mentioned among the possible causes of placental abruption. However, the combined effect of PE and placental abruption on maternal and neonatal outcomes has been little studied. Objective. To conduct a comparative analysis of somatic and obstetric histories, pregnancy course, maternal and neonatal outcomes in placental abruption in pregnant women with and without PE. Patients and methods. A total of 1594 cases of placental abruption collected from 22 medical centers in 16 regions of the Russian Federation were included in the study. The number of patients with PE was 509 (31.9% out of the total sample). The study group comprised 509 pregnant women with placental abruption and PE, the control group – 1085 pregnant women with placental abruption without PE. Results. Overweight and obesity (OR = 2.03; 95% CI: 1.64–2.52), chronic arterial hypertension (OR = 6.90; 95% CI: 4.78–9.95), chronic kidney disease (OR = 1.55; 95% CI: 1.07–2.25) and chronic anemia (OR = 1.33; 95% CI: 1.07–1.66) were statistically significantly more common in the group of patients with PE. An association between obstetric and gynecological history and risk of PE was established only for parity of 2 or less (OR = 1.37; 95% CI: 1.11–1.70) and PE in a previous pregnancy (OR = 4.83; 95% CI: 2.59–9.01). During the current pregnancy, patients in the study group were almost 4 times more likely to be diagnosed with intrahepatic cholestasis (OR = 3.88; 95% CI: 1.89–7.95) and about 2 times more likely to have fetal growth restriction (OR = 1.85; 95% CI: 1.48–2.31), low birth weight (OR = 1.72; 95% CI: 1.19–2.48), and anemia of pregnancy (OR = 1.77; 95% CI: 1.43–2.19) compared to patients without PE. The study group was about twice as likely to have severe maternal morbidity (OR = 2.12; 95% CI: 1.41–3.17) and require hysterectomy (OR = 1.82; 95% CI: 1.01–3.29) despite the same mean blood loss (800 mL) in both groups. Patients with PE were almost 3 times more likely to be diagnosed with intrauterine fetal demise (OR = 2.80; 95% CI: 1.92–4.08) and about twice as likely to have hypotrophy (OR = 1.81; 95% CI: 1.45–2.26) and asphyxia (OR = 1.81; 95% CI: 1.44–2.26) compared to controls. Conclusion. It was demonstrated that patients with PE and placental abruption had statistically and clinically significant differences compared to the control group. Key words: placental abruption, pre-eclampsia, maternal outcomes, neonatal outcomes

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