Abstract
Aim: To elucidate factors associated with a poor neonatal prognosis in preterm placental abruption. Methods: A multicenter retrospective study was conducted. A total of 247 cases with preterm placental abruption during 2009, derived from an electronic database constructed by the Japan Society of Obstetrics and Gynecology, were investigated as the subjects of this study, and were divided into three groups: very preterm (VPT, n=66) was delivered at 28 to 31 gestational weeks, preterm (n=56) was at 32 and 33 weeks, and late preterm (LPT, n=125) was at 34 to 36 weeks. Risk factors, clinical course, and neonatal/infantile outcomes were compared. Poor neonatal outcome was defined as stillbirth, or neonatal and infantile death, or cases with neurological disability at 2 years of age. Results: The number of subjects who received tocolytic therapy was significantly higher in the VPT group as compared with the LPT group. It was higher in the VPT group even after excluding the 57 stillbirths. Multiple logistic regression analysis revealed that poor prognostic factors were umbilical arterial pH (Δ=0.1) (0.17 [0.069-0.417], p<0.0001) and tocolytic therapy (28.5 [2.014-403.9], p<0.0132). Conclusion: Administration of tocolytic agents is a possible factor in a poor neonatal prognosis in preterm placental abruption. This finding may suggest that differential diagnosis could improve the prognosis.
Highlights
Placental abruption is a disorder that can result in a serious outcome for both the mother and child
We reviewed the computerized chart records from the database of the Japan Perinatal Registry Network, which is managed by the Japan Society of Obstetrics and Gynecology, during the period from January 1 to December 31 in 2009
In terms of information on the course of pregnancy, the number of subjects who received tocolytic therapy was significantly higher in the VPT group as compared with the LPT group
Summary
Placental abruption is a disorder that can result in a serious outcome for both the mother and child It can still result in maternal death in Japan, and it accounts for one-third of perinatal deaths [1,2]. This disorder is expressed in a wide range of forms (onset can be relatively gradual in some cases and very dramatic after retro-placental hematoma in other cases), and there is still no effective strategy for diagnosis and prevention. We found that the most effective markers for predicting a poor perinatal prognosis in placental abruption were Fetal Heart Rate (FHR) monitoring findings, prolonged deceleration and repeated late deceleration [3]. Our findings suggested the importance of early diagnosis by means of fetal heart monitoring and pregnancy termination to improve the prognosis. The reason for this is the fact that the etiology of this disorder has not been adequately elucidated
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