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.
Highlights
Placental abruption remains a critical concern for maternal, fetal, and neonatal morbidity and mortality [1,2]
villitis of unknown etiology (VUE) can impede fetal growth and contribute to recurrent reproductive loss [38]. The aim of this present study is to investigate if placental pathologies can adversely affect acute neonatal outcome in pregnancies complicated with Placental abruption (PA)
Women in both groups were around 30 years of age and had similar lifestyle behaviours, though a higher percentage of hypertensive diseases of pregnancy were reported in placentas with additional pathologies vs PA alone
Summary
Placental abruption remains a critical concern for maternal, fetal, and neonatal morbidity and mortality [1,2]. It is a rare but serious complication affecting 3 to 10 per 1000 pregnancies worldwide [3], accounting for around 10–20% of all neonatal deaths in developed countries [4]. Maternal complications associated with placental abruption include hemorrhagic shock, disseminated intravascular coagulation (DIC), kidney failure, organ ischemia and necrosis, and death, related to coronary heart disease and stroke [5,6]. Adverse neonatal outcomes in cases of severe placental abruption, include higher risk of fetal-growth restriction, stillbirth, prematurity, and birth asphyxia [7,8,9,10,11]. In the context of placental abruption, obstetricians may face difficulties in deciding when to intervene and deliver
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