Risk Factors For Abruptio Placentae Research Articles

An audit of patients with abruptio placentae in the Pretoria Academic Complex

Background . Obstetric hemorrhage is the third most common cause of maternal death in South Africa. Abruptio placentae (AP) contributed to 12.9% of deaths caused by haemorrhage between 2017 and 2018. Objective. To investigate the risk factors, management and outcomes of pregnancies affected by AP. Methods. We conducted a prospective descriptive study in a one-year period at the Pretoria Academic Complex (PAC). All patients who presented with AP were recruited for the study. The demographics, risk factors, management, complications and outcomes were reported using descriptive statistics. Results. One hundred women with AP presented during the study period, representing an incidence of 1% of pregnancies at PAC. Sixtyone percent of the women had caesarean delivery while 37% had vaginal delivery. A minority of women presented with known risk factors of AP in this setting. Two comparison groups were defined based on the degree of placental separation from the decidua, i.e. >50% and <50%. A woody hard abdomen occurred more frequently in patients with >50% AP (43% v. 57%; p=0.002). More women had postpartum haemorrhage in the >50% group (67% v. 33%; p=0.001). Fifty-eight (58%) live babies and 44 (44%) stillborn babies were delivered. Conclusion. The known risk factors of AP were largely absent in women with AP in this setting. The typical clinical findings of AP were late signs associated with severe placental separation. Early resuscitation and delivery of the fetus can positively influence perinatal and maternal morbidity and mortality

A Clinical Study of Maternal and Fetal Outcome in Abruptio Placenta - Couvelaire Uterus a Preventable Obstetric Catastrophe

Introduction : Hemorrhage is the single most important cause of maternal death worldwide. Obstetrical hemorrhage accounts for almost half of all postpartum deaths in developing countries. Among them Abruptio placenta occurs in around 1% of all pregnancies. Aim of this study was to determine the maternal and fetal outcome in pregnancy complicated by abruption placenta in relation to the risk factors. Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology, Mamata medical college, khammam from January 2010 to December 2014 for a period of five years. All pregnant women who were diagnosed with abruptio placenta after 28 weeks of gestation were included in the study. Patients were identified from the admission and labour room registers. Results: Total number of deliveries during the study period were 4000. Patients identified with abruptio placenta were 100, giving a frequency of 2.5%. Majority women were multigravidae and 56% of all the between 26-30 years of age. The mean gestational age at diagnosis was 34 ± 4.21 weeks. Vaginal bleeding was the most common clinical finding seen in 80% of the women, followed by blood stained amniotic fluid in 16% suggesting concealed abruption placenta. Fetal heart sounds were absent on admission in 65% of the women. Most common cause of abruption 44% was either patients with past history of pre – eclampsia or PIH in the present pregnancy. 9 patients with couvelaire uterus were identified and treated effectively. Among them, two patients died due to postpartum hemorrhage. Parity and gestational age were found to be significant risk factors for abruptio placentae. Conclusion: Abruptio placenta was associated with poor maternal and fetal outcomes. Early diagnosis and significant treatment of pre eclampsia during the antenatal period would prevent abruption and related complications. Sri Lanka Journal of Obstetrics and Gynaecology Vol.37(3) 2015: 38-41

ABRUPTIO PLACENTAE: TO MINIMIZE THE RISK

The analysis of the state of health of pregnant women was made and several risk factors for abruptio placentae were identified. The research was based on a retrospective analysis of 65 birth stories for 2014-2015 on the basis of Regional Perinatal Center of Kursk. We studied the medical history, concomitant somatic pathology and the results of monitoring of pregnancy and childbirth. In the group of studied women 45 (69.23%) of them had a complicated obstetrical and gynecological anamnesis, every second pregnancy was against the background of the threat of interruption, all patients had from 1 to 4 complications of pregnancy; high percentage extragenital primarily to changes in the vascular system of the maternal organism. An increase of various types of pathology complicates the course of pregnancy, including increasing abruptio placentae. This requires pregravid preparation, timely diagnostics and correction of violations, as well as ensuring a close relationship and succession between doctors.

Outcome of pregnancy subsequent to abruptio placentae

Introduction: The process of child bearing is a beautiful experience for a woman but unfortunately it is fraught with some unpredictable dangers. One of them is an abruptio placenta which is defined as “the premature separation of a normally implanted placenta, before the delivery of the fetus. It occurs in up to 1.0% of all pregnancy and can be associated with severe maternal and fetal complications. Material and Methods: The study done on antenatal patients of Sultania Zanana Hospital, Bhopal from 1stapril 2008 to 31st march 2009. Patients clinically diagnosed as abruptio placentae were included in the study and were followed throughout their stay in the hospital. Result: The study showed the incidence of abruptio placenta to be 1.6%. It was found 1.8 times more commonly in multigravida than primigravida patients. Incidence was found much higher in patients with PIH, Pre-eclempsia and eclempsia (4.35%?). The association of maternal smoking and placental abruption has been well documented and in our study 9.6% of patients were found to be smokers. The incidence of abruptio placentae was 2.3% among multifetal gestation which is 1.43 times the incidence in general population. Preterm deliveries showed an increased incidence of abruptio placentae. Mortality rate of babies in our study was 52.05%. Conclusion: This study denoted that high parity, younger age,,PIH, pre-eclempsia, eclempsia, multifetal gestation and smoking are the major risk factors for abruptio placentae. Thus proper antenatal care, proper booking, screening of high risk factors, timely referral are the various pillars need to be strengthened in our population to reduce the occurrence and the complication arising out of this catastrophe.

Frequency, risk factors and feto-maternal outcomes of abruptio placentae in Northern Tanzania: a registry-based retrospective cohort study.

BackgroundAbruptio placentae remains a major cause of maternal and perinatal morbidity and mortality in developing countries. Little is known about the burden of abruptio placentae in Tanzania. This study aimed to determine frequency, risk factors for abruptio placentae and subsequent feto-maternal outcomes in women with abruptio placentae.MethodsWe designed a retrospective cohort study using maternally-linked data from Kilimanjaro Christian Medical Centre (KCMC) medical birth registry. Data on all women who delivered live infants and stillbirths at 28 or more weeks of gestation at KCMC hospital from July 2000 to December 2010 (n = 39,993) were analysed. Multivariate logistic models were used to calculate odds ratios (OR) and 95 % confidence intervals (CIs) for risk factors, and feto-maternal outcomes associated with abruptio placentae.ResultsThe frequency of abruptio placentae was 0.3 % (112/39,993). Risk factors for abruptio placentae were chronic hypertension (OR 4.1; 95 % CI 1.3–12.8), preeclampsia/eclampsia (OR 2.1; 95 % CI 1.1–4.1), previous caesarean delivery (OR 1.3; 95 % CI 1.2–4.2), previous abruptio placentae (OR 2.3; 95 % CI 1.8–3.4), fewer antenatal care visits (OR 1.3; 95 % 1.1–2.4) and high parity (OR 1.4; 95 % CI 1.2–8.6). Maternal complications associated with abruptio placentae were antepartum haemorrhage (OR 11.5; 95 % CI 6.3–21.2), postpartum haemorrhage (OR 17.9; 95 % 8.8–36.4),), caesarean delivery (OR 5.6; 95 % CI 3.6–8.8), need for blood transfusions (OR 9.6; 95 % CI 6.5–14.1), altered liver function (OR 5.3; 95 % CI 1.3–21.6) and maternal death (OR 1.6; 95 % CI 1.5–1.8). In addition, women with abruptio placentae had prolonged duration of hospital stay (more than 4 days) and were more likely to have been referred during labour. Adverse fetal outcomes associated with abruptio placentae include low birth weight (OR 5.9; 95 % CI 3.9–8.7), perinatal death (OR 17.6; 95 % CI 11.3–27.3) and low Apgar score (below 7) at 1 and 5 min.ConclusionsFrequency of abruptio placentae is comparable with local and international studies. Chronic hypertension, preeclampsia, prior caesarean section delivery, prior abruptio placentae, poor attendance to antenatal care and high parity were independently associated with abruptio placentae. Abruptio placentae was associated with adverse maternal and foetal outcomes. Clinicians should identify risk factors for abruptio placentae during prenatal care when managing pregnant women to prevent adverse maternal and foetal outcomes.

Do uterotonic drugs increase risk of abruptio placentae and eclampsia?

To determine whether the use of uterotonics, including oxytocin and prostaglandins, increases the risk of abruptio placentae and eclampsia. A retrospective analysis was conducted among 260,174 Japanese women at term. Demographic characteristics were studied as possible candidates for risk factors of abruptio placentae and eclampsia using multivariate logistic regression analyses. A total of 1,058 (0.41 %) and 147 (0.06 %) women developed abruptio placentae and eclampsia, respectively. Abruptio placentae and eclampsia occurred in 177 (0.29 %) and 42 (0.07 %) of the 61,857 women treated with uterotonics, respectively. Multivariate regression analyses indicated that uterotonics did not increase risk of developing either abruptio placentae or eclampsia. Primiparity [odds ratio (95 % confidence interval) 1.41 (1.24-1.60)], age ≥35 years [1.17 (1.03-1.33)], and presence of hypertension [2.42 (1.93-3.03)] were significant independent risk factors for abruptio placentae, while advancing gestation [0.67 (0.63-0.71)] decreased risk of abruptio placentae. Primiparity [odds ratio (95 % confidence interval) 4.06 (2.49-6.63)], age <20 years [2.44 (1.07-5.58)], presence of hypertension [28.7 (20.5-40.1)], and advancing gestation [1.28 (1.11-1.47)] were significant independent risk factors for eclampsia. The use of uterotonics did not increase the risk of abruptio placentae and eclampsia.

Risk factors of abruptio placentae among Peruvian women

We examined the relation of maternal sociodemographic, medical, and behavioral characteristics with risk of abruptio placentae in Peruvian women. This case-control study included 255 abruptio placentae cases and 258 pregnant controls. Multivariable logistic regression models were fit to calculate odds ratios (OR) and 95% CIs adjusted for putative abruptio placentae risk factors. History of delivering a stillborn infant (OR 10.0; 95%CI 4.0-25.2), pregnancy complicated by preeclampsia/eclampsia (OR 3.7; 95%CI 2.2-6.3); and a low rate of pregnancy weight gain (<0.15 kg/wk) (OR 2.5; 95%CI 1.3-4.7), were associated with significantly increased risk of abruptio placentae. Advanced maternal age, low educational attainment, male infant gender, cigarette smoking, and grand multiparty were not risk factors of abruptio placentae in this population. At present, the constellation of abruptio placentae risk factors do not provide clinically meaningful opportunities for identifying high-risk patients.

502: Risk Factors of Abruptio Placentae among Peruvian Women

502: Risk Factors of Abruptio Placentae among Peruvian Women

Placental abruption and perinatal death.

Studies of risk factors for abruptio placentae (AP) are partly conflicting and studies of risk factors for perinatal death in these pregnancies are scarce. Using the population-based Swedish Birth Registry from 1987 to 1993, we were able to study these risks in 795,459 singleton pregnancies. Logistic regression analysis was used to estimate odds ratios (OR) for risk of AP and risk of perinatal death in pregnancies with and without AP. Risk factors for AP were: age, primiparity, high parity, not cohabiting with infant's father, low education, smoking, infertility, pregestational diabetes, essential hypertension, pregnancy-induced hypertensive diseases, preterm premature rupture of membranes, preterm birth and small-for-gestational-age (SGA) births. Risk factors for perinatal death in pregnancies with placental abruption were smoking (1--9 and > or =10 cigarettes/day; OR 1.4 and 1.7 respectively), severe pre-eclampsia (OR 2.0) and SGA (OR 1.9), whereas in pregnancies without abruption, risks were also increased in maternal age > or =35 years, primiparity, infertility, essential hypertension and pregestational diabetes. These findings support the theory that, in cases of AP, a general impairment of the placenta and/or a defect placentation may be fatal.

Risk factors for abruptio placentae and eclampsia: Analysis of 445 consecutively managed women with severe preeclampsia and eclampsia

Objective: Our purpose was to characterize the clinical presentation or laboratory variables predictive of either abruptio placentae or eclampsia in women with severe preeclampsia. Study Design: Prospective collection of perinatal data from 445 consecutively managed women with severe preeclampsia and eclampsia. Univariate analysis was used to determine which of the independent variables were significantly different between the groups (abruptio placentae vs no abruptio placentae; eclampsia vs no eclampsia). Those with significant differences were then entered into multiple logistic regression analysis to determine those characteristics that were independently related to the outcome variable (abruptio placentae or eclampsia). Before multivariate analysis, the independent variables with an interval scale of measurement were converted to a dichotomous scale, with the receiver-operator characteristic curve used to determine a cutoff level. Results: Univariate analysis revealed statistical significance for the following variables associated with eclampsia: uric acid concentration, > 8.1 mg/dL; proteinuria (>3+); headache; visual symptoms; deep tendon reflexes >3+; serum albumin concentration, <3 mg/dL; and serum creatinine concentration, >1.3 mg/dL. However, with subsequent multivariate analysis, only headache and deep tendon reflexes >3+ remained significant. Univariate analysis for variables associated with abruptio placentae revealed an association between bleeding and platelet count <60,000/mm 3. There was no association between abruptio placentae and eclampsia and systolic, diastolic, or mean arterial pressure, quantitative proteinuria, epigastric pain, bleeding, gestational age at delivery, history of preeclampsia, or chronic hypertension. Conclusion: Quantitative proteinuria and degree of blood pressure elevation were not predictive of either abruptio placentae or eclampsia, as has previously been suggested. The greatest morbidity associated with eclampsia occurred in women with preterm gestations not receiving medical attention. (Am J Obstet Gynecol 1999;180:1322-9.)

Verbeterde voorgeboortesorg by Tygerberg Hospitaal

Because the high perinatal mortality rate of Cape Coloured patients served by Tygerberg Hospital was of great concern, we initiated several research projects to address this problem. At first we planned three separate studies to ascertain the causes of perinatal deaths. Abruptio placentae and preterm labour were identified as the two most common causes. Several studies were then done to assess risk factors for abruptio placentae and to establish how foetal distress due to abruptio placentae could be detected earlier. At the same time we also concentrated on improving our antenatal care and foetal assessment. All relevant findings of our research projects were immediately implemented clinically. A marked decrease in the perinatal mortality rate of patients with severe pre-eclampsia was achieved, as well as a decline in the overall rate.

Maternal and fetal morbidity and mortality in premature abruptio placentae--a retrospective analysis

The frequency of abruptio placentae has nearly tripled in our clinic since 1974 and now stands at 1.4% of all deliveries. In a retrospective analysis it was investigated whether improved diagnostic and therapeutic methods have decreased the morbidity and mortality of this severe obstetrical complication. During 3 stages of observation--1974-1979, 1980-1985 and 1986-6/1990--we registered 123 cases. The division into time intervals was based on the introduction of sensitive ultrasonic methods in 1980 and the vaginal scan in 1986. Important risk factors of abruptio placentae were found to be bleeding in pregnancy (32%), previous curettages (38%), premature labour (29%), and pre-eclampsia (14%). The diagnostic sensitivity of sonography rose from 40% in the first to 78% in the third interval of observation. The rate of vaginal deliveries decreased from 15% to 2%. Simultaneously, the perinatal mortality decreased, despite increasing foetal prematurity, from 30% to 2%. The improvement in foetal outcome could be demonstrated by 1- and 5-minute Apgar score values. During the entire period, we lost one mother with abruptio placentae complicated by fulminant lung embolism intra operationem. The frequency of serious stages of abruptio placentae (Page 2-3) decreased from 69% to 33%. While 54% of the mothers developed shock (shock index > or = 1) during delivery in the first observation period, this figure was finally only 10.5%. At the same time the frequency of coagulation disorders decreased from 31% to 4%.

CHRONIC HYPERTENSION, CIGARETTE SMOKING, AND ABRUPTIO PLACENTAE

We investigated the importance of maternal hypertension and cigarette smoking, and their interaction, as risk factors for abruptio placentae, using Massachusetts birth certificate data for 1987-1988. We used multiple logistic regression procedures to model data from 943 abruptio placentae cases and 10,648 randomly selected births. Risk of abruption was associated with a history of chronic hypertension (adjusted OR = 2.3, 95% CI: 1.5-3.5) and cigarette smoking during pregnancy (adjusted OR = 1.7, 95% CI: 1.5-2.0). There was also evidence of interaction between chronic hypertension and cigarette smoking. The hypoxemia that results from exposure to cigarette smoke and the alterations in uterine blood flow that result from hypertension may lead to placental lesions that cause abruption.