460 Placental-abruption with and without sonographic evidence of placental hematoma – pregnancy outcomes and placental pathology

Abstract

Placental abruption is traditionally diagnosed based on clinical symptoms. The role of ultrasound in the diagnosis (through evidence of hematomas) remains questionable. Therefore, we aimed to compare pregnancy outcomes and placental histopathology in cases of placental abruption (PA) with and without sonographic evidence of placental hematoma. Pregnancy and placental reports of all pregnancies complicated by PA (diagnosed clinically) between 11/2008-7/2019 in a single tertiary center were reviewed. All ultrasound scans of each patient throughout the pregnancy were reviewed for sonographic evidence of placental hematoma (of any size, location, and timepoint during pregnancy). Maternal background characteristics, pregnancy outcomes, and placental histopathology lesions were compared between cases of PA with and without sonographic evidence of a placental hematoma. Placental lesions were classified according to the current "Amsterdam" criteria. A total of 307 PA cases were included. Of them, 270 (87.9%) in the PA without a placental hematoma group and 37 (12.1%) in the PA with placental hematoma group. Maternal demographics including maternal age, hypertensive diseases, diabetes, and smoking did not differ between the groups. The PA with placental hematoma group was characterized by an earlier gestational age at delivery (32.8 ± 4.8 vs 36.8 ± 4 weeks, p< 0.001), and higher rates of NICU admissions (p=0.034), respiratory distress syndrome (p=0.007), phototherapy (0.014), and neonatal sepsis (p=0.040). Placentas from the PA with placental hematoma group were characterized by lower fetoplacental ratio (p<0.001) and higher rates of histologic chorioamnionitis (p<0.001) and chronic villitis (p<0.001). The presence of a sonographic placental hematoma in cases of PA was associated with a significantly lower gestational age at delivery and a higher rate of adverse neonatal outcomes. This association may be attributed to differences in placentation and inflammation as both acute and chronic inflammatory placental lesions were higher in this subgroup of PA.View Large Image Figure ViewerDownload Hi-res image Download (PPT)