Risk factors for hypoxic-ischemic encephalopathy or neonatal death in placental abruption

Abstract

To identify risk factors associated with moderate or severe hypoxic-ischemic encephalopathy (HIE) or neonatal death among women with a symptomatic placental abruption. A retrospective, comparative, bicentric study at two academic tertiary centers in Île-de-France, from 2006 to 2019. Singleton pregnancies complicated by confirmed placental abruption at delivery with a live birth infant were eligible. Primary outcome was the occurrence of moderate or severe HIE or neonatal death. Among 152 women, 44 (29%) women delivered an infant with a moderate or severe HIE or a neonatal death, (HIE/death group) and were compared to 108 women who delivered infants without these outcomes (non-HIE group). One hundred (66%) placental abruptions occurred out of-hospital, and were more frequent in the HIE/death group than in the non-HIE group [39 (89%) vs. 61 (56%), P < 0.01]. Fetal bradycardia was more frequent in the HIE/death group [24 (55%) vs. 19 (18%), P < 0.01]. The decision-to-delivery interval was shorter in the HIE/death group (15 [12–20] vs. 20 [15–30] minutes, P < 0.01). In multivariate analysis, urgent delivery for an out-of-hospital placental abruption (aOR 5.79 [2.07–16.17]) and fetal bradycardia (aOR: 8.55 [3.13–23.32]) were independently associated with an increased risk of moderate or severe HIE or neonatal death. The presence of a bradycardia was the most discriminating factor associated with moderate or severe HIE or death (59%). The highest risk situations were bradycardia and urgent cesarean delivery for an out-of-hospital placental abruption (68%). Out-of-hospital placental abruption is associated with a major risk of moderate or severe HIE or death in the presence of a fetal bradycardia. An optimal decision-to-delivery interval that is difficult to improve does not guarantee the absence of severe neonatal complications.