Risk Factors For Placental Abruption Research Articles

The Effect of Preeclampsia on Adverse Maternal Outcomes in Women With Placental Abruption at a Large Urban Hospital in Tennessee From 2019 to 2022 [ID 2683655

INTRODUCTION: Placental abruption is associated with increased pregnancy-related morbidity and mortality. Few studies have explored the effect of individual risk factors for placental abruption on outcomes. Our study evaluates the association of preeclampsia and maternal morbidity in patients with placental abruption. METHODS: We conducted a retrospective case–control study to evaluate the association of preeclampsia with adverse maternal outcomes in the setting of placental abruption. Univariate analyses were used to determine the relationship between preeclampsia and known adverse maternal outcomes of placental abruption. Multivariate logistic regression was then used to evaluate the relationship between preeclampsia and each significantly associated outcome, adjusting for factors including body mass index, gestational age, mode of delivery, race, trauma, diabetes, placental location, cocaine and tobacco use, prior cesarean sections, year of delivery, and parity. Significance was assessed at an alpha of 0.05. RESULTS: Of 147 singleton pregnancies complicated by placental abruption from 2019 to 2022, 37 (25.2%) were complicated by preeclampsia. No significant differences were found between groups in incidence of acute kidney injury, disseminated intracellular coagulation, cesarean delivery, fetal demise, preterm birth, or low birth weight. On adjusted multivariable regression, we found preeclampsia increased the odds of maternal transfusion requirement (adjusted odds ratio [aOR] 3.55; 95% CI: 1.2, 10.4) and postoperative hospital stay greater than 2 days (aOR 4.05; 95% CI: 1.5, 11.2). CONCLUSION: Preeclampsia was an independent predictor of need for blood transfusion and increased duration of hospital stay in patients with placental abruption. Recognition of preeclampsia as an independent risk factor for these outcomes may allow medical optimization, increased preparedness, and lead to decreased pregnancy-related morbidity.

Identifying risk factors for placental abruption in subsequent pregnancy without a history of placental abruption.

To identify first pregnancy risk factors for placental abruption in subsequent pregnancy. In a population-based nested case-control study, cases were defined as women with placental abruption in their second pregnancy, and controls as women without abruption. A total of 43 328 women were included in the study, 0.4% (n= 186) of second pregnancies had placental abruption. Multivariable logistic models were used to study the association between first pregnancy complications and placental abruption in subsequent pregnancy. Having either small for gestational age, preterm delivery, pre-eclampsia or cesarean delivery during first pregnancy were independently associated with increased risk for placental abruption, and the risk was higher with any additional complication (age adjusted odds ratio [aOR] 2.00, 95% confidence interval [CI] 1.46-2.74; aOR 3.61, 95% CI 2.23-5.86; and aOR 3.86, 95% CI 1.56-9.56, for one, two, and three or more complications, respectively). First pregnancy may serve as a window of opportunity to identify women at risk for future placental abruption.

Risk factors for placental abruption.

Our case-control study, aiming at identifying the risk factors for placental abruption (PA), looked at variables including maternal age, daily transportation means, folic acid consumption, smoking, past-history of infertility, number of antenatal visits done, presence of pre-eclampsia and umbilical cord insertion. Significant risk factors for PA were frequent transportation by motorbikes, consumption of haematinic preparation not containing folic acid, passive smoking, past-history of infertility, pre-eclampsia and marginal cord insertion. Pregnant women should be counselled about the above-mentioned risk factors.

Placental abruption: assessing trends in risk factors over time.

To evaluate changes in the independent contribution of different risk factors for placental abruption over time. In this retrospective nested case-control study, trends of change in ORs for known risk factors for placental abruption occurring in three consecutive 8-year intervals were compared. A univariate assessment of factors associated with placental abruption and two multivariable logistic regression models were constructed to identify independent risk factors for placental abruption. Trends of change in the incidence and specific contribution of various risk factors were compared along the study time-period. During the study period, 295,946 pregnancies met the inclusion criteria; of these, 2170 (0.73%) were complicated with placental abruption. Using logistic regression models, previous cesarean delivery, in vitro fertilization (IVF) pregnancy, hypertensive disorders, polyhydramnios, and inadequate prenatal care were recognized as independent risk factors for placental abruption. While the relative contribution of IVF pregnancy and polyhydramnios to the overall risk for abruption decreased over the course of the study, previous cesarean delivery became a stronger contributor for placental abruption. In our study, a change over time in the specific contribution of different risk factors for placental abruption has been demonstrated.

Effects of pre-pregnancy BMI and gestational weight gain on adverse pregnancy outcomes and complications of GDM

To investigate the effects of pre-pregnancy BMI and gestational weight gain on adverse pregnancy outcomes and complications of gestational diabetes mellitus. 3966 pregnant women were enrolled in this study. Multivariate logistic regression analysis was conducted to estimate the relative risk between pre-pregnancy BMI, gestational weight gain, and adverse pregnancy outcome. Pre-pregnancy BMI was found to be a risk factor for preeclampsia (OR = 1.159), gestational diabetes mellitus (OR = 1.191), gestational hypertension (OR = 1.221), and macrosomia (OR = 1.165). Gestational weight gain was a risk factor for preeclampsia (OR = 1.783), placental abruption (OR = 2.209), and macrosomia (OR = 1.506). Total weight gain during pregnancy cannot be used as a predictor of GDM. Pre-pregnancy BMI is a risk factor for gestational diabetes mellitus complicated with preeclampsia, preterm delivery, gestational hypertension, and macrosomia. Impact statement What is already known on this subject? Obesity during pregnancy includes pre-pregnancy obesity and excessive weight gain during pregnancy. Obese pregnant women have a higher risk of pregnancy complications. What do the results of this study add? We focus on the effects of pre-pregnancy BMI on pregnancy outcomes, classified by Asian criteria. Our findings suggest for the first time that excessive weight gain during pregnancy is a risk factor for placental abruption and we specifically point out that total weight gain during pregnancy cannot be used as a predictor of GDM. What are the implications of these findings for clinical practice and/or further research? This study is helpful to monitor the risk of adverse pregnancy outcomes in the Asian population and suggest the risk of pregnancy complications, such as gestational diabetes mellitus and placental abruption.

Pregnancy Outcomes in Women with Thyroid Diseases.

Introduction: Overt hyperthyroidism and hypothyroidism are associated with pregnancy complications; however, most women with these conditions are diagnosed before conception and are under treatment during pregnancy, especially in high-income countries. The purpose of this study was to investigate pregnancy complications among these women. Methods: A retrospective cohort study was conducted, and data on pregnant women who gave birth to a singleton at Nagoya University Hospital in Japan in 2005-2014 was collected. The pregnancy outcomes were divided and compared among three groups: the control group (n = 3531), the hyperthyroidism group (n = 48), and the hypothyroidism group (n = 61). Additionally, risk factors for placental abruption were evaluated by multivariable logistic regression analysis. Moreover, in hyperthyroidism, thyroid function at the placentation period was compared between placental-related diseases and nonplacental-related disease groups, and the latter group included placental abruption and preeclampsia. Results: The incidence of placental abruption was higher in hyperthyroidism than in control and hypothyroidism groups. Hyperthyroidism was independently associated with an increased risk of placental abruption (adjusted odds ratio, aOR = 8.21, 95% confidence interval, CI: 1.76-38.34), as well as preeclampsia (aOR = 4.10, 95% CI: 1.13-14.76) and preterm labor (aOR = 3.38, 95% CI: 1.19-9.64). Additionally, thyroid-stimulating hormone (TSH) at the placentation period was significantly lower in the placental-related disease group than in the nonplacental-related disease group (p < 0.05). Conclusions: Pregnancy outcomes in women with hyperthyroidism and hypothyroidism would be comparable with those without thyroid disease. Hyperthyroidism was an independent risk factor for placental abruption as well as preterm labor and preeclampsia. However, its frequency was extremely low, and further research is required to validate our findings.

Predictors of placental abruption during expectant management of premature preterm rupture of membranes

ObjectiveTo predict the risk factors of placental abruption during expectant management of preterm rupture of membranes.BackgroundA frequency of abruption of 4.0%–6.8% has been reported in patients with preterm premature rupture of membranes (PPROM). Antepartum vaginal bleeding occurs during the period of expectant management, the associated risk of developing placental abruption is high. It may be possible to approximate the risk for placental abruption based on these simple prepregnancy risk factors.Patients and methodsAn observational study was conducted on 100 pregnant women. The patients were randomly selected from those attending labor ward at Menoufia University Hospital and Shebin EL-Kom Teaching Hospital. All women included in this study are with PPROM, divided into group I that included 79 without placental abruption and group II included 21 with placental abruption. Full analysis of detailed history and examination and primarily samples are taken during the study period from January 2019 to December 2020.ResultsThere were statistically significant differences among patients with placental abruption than those without placental abruption regarding antepartum or intrapartum fetal distress requiring urgent cesarean section and gestational age. The majority of patients with placental abruption had gestational age more than 32 weeks (P < 0.05). Most of the patients with placental abruption had latency to its occurrence more than 48 h since the time of admission with PPROM with a percentage of 85.71%.ConclusionPlacental abruption is a complex disease. Although several risk factors are known, the etiopathogenesis is not fully understood and its occurrence often remained unpredictable or unpreventable. Placental abruption was absent in 79% of our patients.

Placental Abruption after Fetoscopic Laser Surgery in Twin-Twin Transfusion Syndrome: The Role of the Solomon Technique

Introduction: Twin-twin transfusion syndrome (TTTS) is a complication in monochorionic twin pregnancies which is preferably treated with fetoscopic laser surgery. A few small studies suggested a possible association between the Solomon laser technique and placental abruption. Methods: The objective of this study is to compare the rate of and to explore potential risk factors for placental abruption in TTTS treated with fetoscopic laser surgery according to the Selective and Solomon laser technique. We conducted a large retrospective cohort study of consecutive TTTS-cases treated with fetoscopic laser surgery in Shanghai, China, and Leiden, The Netherlands treated with either the Selective laser technique (Selective group) or Solomon laser technique (Solomon group). Results: The rate of placental abruption in the Selective group versus the Solomon group was 1.7% (5/289) and 3.4% (15/441), respectively (p = 0.184). No risk factors for placental abruption were identified. Placental abruption was associated with lower gestational age at birth (p = 0.003) and severe cerebral injury (p = 0.003). Conclusion: The prevalence of placental abruption in TTTS after fetoscopic laser surgery is low, although it appears higher than in the overall population. Placental abruption is associated with a lower gestational age at birth, which is associated with severe cerebral injury. The rate of placental abruption was not significantly increased with the use of the Solomon technique. Continued research of placental abruption in TTTS is necessary to determine why the rate is higher than in the overall population.

Can a Difference in Gestational Age According to Biparietal Diameter and Abdominal Circumference Predict Intrapartum Placental Abruption?

This study aimed to investigate whether a difference in gestational age according to biparietal diameter (BPD) and abdominal circumference (AC) could be a clinically useful predictor of placental abruption during the intrapartum period. This retrospective cohort study was based on singletons who were delivered after 32 + 0 weeks between July 2015 and July 2020. We only included cases with at least two antepartum sonographies available within 4 weeks of delivery (n = 2790). We divided the study population into two groups according to the presence or absence of placental abruption and compared the clinical variables. The incidence of placental abruption was 2.0% (56/2790) and was associated with an older maternal age, a higher rate of preeclampsia, and being small for the gestational age. A difference of >2 weeks in gestational age according to BPD and AC occurred at a higher rate in the placental abruption group compared to the no abruption group (>2 weeks, 21.4% (12/56) vs. 7.5% (205/2734), p < 0.001; >3 weeks, 12.5% (7/56) vs. 2.0% (56/2734), p < 0.001). Logistic regression analysis revealed that the differences of >2 weeks and >3 weeks were both independent risk factors for placental abruption (odds ratio (OR) (95% confidence interval), 2.289 (1.140–4.600) and 3.918 (1.517–9.771), respectively) after adjusting for maternal age, preeclampsia, and small for gestational age births. We identified that a difference in gestational age of >2 weeks between BPD and AC could be an independent predictor of placental abruption.

Teenage pregnancy as a risk factor for placental abruption: Findings from the prospective Japan environment and children's study.

ObjectivePlacental abruption is a significant obstetric complication that affects both maternal and neonatal mortality and morbidity. The present study examined the effect of maternal age on the incidence of placental abruption.MethodsWe used data of singleton pregnancies from the Japan Environment and Children’s Study, which was a prospective birth cohort study conducted between January 2011 and March 2014 across 15 regional centers in Japan. A multiple regression model was used to identify whether maternal age (<20 years, 20–24 years, 25–29 years, 30–34 years, and ≥35 years) is a risk factor for placental abruption. The analyses were conducted while considering the history of placental abruption, assisted reproductive technology, number of previous deliveries, smoking during pregnancy, body mass index before pregnancy, and chronic hypertension.ResultsA total of 94,410 Japanese women (93,994 without placental abruption and 416 with placental abruption) were recruited. Herein, 764, 8421, 25915, 33517, and 25793 women were aged <20 years, 20–24 years, 25–29 years, 30–34 years, and ≥35 years, respectively. Besides advanced maternal age (≥35 years; adjusted odds ratio: 1.7, 95% confidence interval: 1.1–2.5), teenage pregnancy was also a risk factor for placental abruption (adjusted odds ratio: 2.8, 95% confidence interval: 1.2–6.5) when the maternal age of 20–24 years was set as a reference.ConclusionsIn the Japanese general population, besides advanced maternal age, teenage pregnancy was associated with placental abruption. Recently, the mean maternal age has been changing in Japan. Therefore, it is important for obstetric care providers to provide proper counseling to young women based on up-to-date evidence.

Placental abruption in each hypertensive disorders of pregnancy phenotype: a retrospective cohort study using a national inpatient database in Japan.

We designed a retrospective cohort study using the Diagnosis Procedure Combination database, a national inpatient database for acute-care inpatients in Japan, to examine whether recent global diagnostic criteria for preeclampsia, phenotypes of hypertensive disorders of pregnancy (HDP) and features of the disease are useful as predictors of placental abruption and whether other risk factors are associated with the onset of placental abruption. A total of 85,858 hospitalized patients with a diagnosis of HDP who gave birth during hospitalization between July 2010 and March 2018 were included in this study. We examined the associations between the occurrence of placental abruption after hospitalization and several factors, including gestational age (GA) at placental abruption onset, HDP subtypes, GA on admission, maternal age, body mass index, smoking, multiple pregnancy, prelabor rupture of membranes, diabetes mellitus, emergency admission by ambulance, and consciousness, using a multivariate logistic regression analysis. Placental abruption occurred in 541 patients (0.63%) after hospital admission, and the occurrence increased acutely after 32 weeks GA. A decrease in abruption was significantly associated with maternal BMI on admission (≥30 kg/m2; odds ratio [OR], 0.54; 95% confidence interval [CI], 0.41-0.70) and multiple pregnancy (OR, 0.29; 95% CI, 0.18-0.46). An increase in abruption was associated with earlier GA on admission (<34 weeks' GA; OR, 3.77; 95% CI, 3.13-4.53) and emergency admission by ambulance (OR, 1.34; 95% CI, 1.09-1.65). Individual features of severe PE showed no significant associations with the occurrence of abruption. In conclusion, HDP at an earlier GA was suggested to be a risk factor for placental abruption, and we recommend hospitalization and careful management of such patients to improve their prognosis.

Changing risk factors for placental abruption: A case crossover study using routinely collected data from Finland, Malta and Aberdeen.

To evaluate the effects of changes in risk factors between the first two pregnancies on the occurrence of placental abruption (PA) in the same woman. Routinely collected obstetric data from Aberdeen Maternity and Neonatal Databank, the Maltese National Obstetric Information System and the Finnish Medical Birth Register were aggregated. Records of the first two singleton pregnancies from women who had PA in one pregnancy but not the other, were identified from this pooled dataset. A case-crossover study design was used; cases were pregnancies with abruption and matched controls were pregnancies without abruption in the same woman. Conditional logistic regression was used to investigate changes in risk factors for placental abruption in pregnancies with and without abruption. A total of 2,991 women were included in the study. Of these 1,506 (50.4%) had PA in their first pregnancy and 1,485 (49.6%) in a second pregnancy. Pregnancies complicated by preeclampsia {194 (6.5%) versus 115 (3.8%) adj OR 1.69; (95% CI 1.23-2.33)}, antepartum haemorrhage of unknown origin {556 (18.6%) versus 69 (2.3%) adjOR 27.05; 95% CI 16.61-44.03)} and placenta praevia {80 (2.7%) versus 21 (0.7%) (adjOR 3.05; 95% CI 1.74-5.36)} were associated with PA. Compared to 20 to 25 years, maternal age of 35-39 years {365 (12.2) versus 323 (10.8) (adjOR 1.32; 95% CI 1.01-1.73) and single marital status (adjOR 1.36; 95% CI 1.04-1.76) were independently associated with PA. Maternal smoking, BMI and fetal gender were not associated with PA. Advanced maternal age, pregnancies complicated with unexplained bleeding in pregnancy, placenta praevia and preeclampsia were independently associated with a higher risk of placental abruption.

INVESTIGATING OUTCOME AND RISK FACTORS OF PLACENTA PREVIA AND PLACENTAL ABRUPTION IN PREGNANT WOMEN REFERRED TO ALI IBN ABITALIB HOSPITAL IN ZAHEDAN

Introduction: Placenta previa and placental abruption are one of the most common causes of late pregnancy and delivery bleeding which is associated with increasing of harm and death of mother and fetus. This study was conducted to investigate the outcome and risk factors of placenta previa and placental abruption in pregnant women. Materials and Methods: This descriptive-analytical study was performed on 188 pregnant mothers between 2016-2017. The study population consisted of mothers who referred to the gynecological ward of the hospital with complaints from pain or bleeding in the third trimester of pregnancy and were treated by an obstetrician with the diagnosis of placenta previa and placental abruption. T-test and Pearson correlation were used to investigate the relationship between variables. Results: The results showed that the incidence of placenta previa in pregnant women was 1.3% and the incidence of placental abruption was 1.1%. The most fetal complications of placental abruption were preterm delivery, and maternal complications were bleeding. The most fetal complications of placenta previa were preterm delivery and maternal complications were bleeding before, after and during delivery. The most risk factors of placental abruption were a history of abortion and the most risk factors of placenta previa was the history of previous cesarean. Conclusion: The history of previous cesarean and abortion and stillbirth have had an important role in the occurrence of these complications. Understanding the relevant factors to reduce placenta previa and placental abruption will be effective in reducing complications and thus the health of the mother and fetus.

Analysis of 62 placental abruption cases: Risk factors and clinical outcomes

ObjectiveThis study aimed to explore the clinical characteristics and outcomes of placental abruption. Materials and methodsA total of 62 placental abruption cases were collected from the Second Hospital of Jilin University between January 2007 and December 2012. A retrospective study was conducted to explore the risk factors for placental abruption, clinical characteristics, and maternal and fetal outcomes. ResultsRisk factors for placental abruption mainly include preeclampsia (39%) and premature rupture of membrane (10%). Abdominal pain (68%) and bleeding (35%) comprise the classical symptoms of placental abruption but the clinical picture varies from asymptomatic, in which the diagnosis is made by inspection of the placenta at delivery, to massive abruption leading to fetal death and severe maternal morbidity. Emergency cesarean section was performed in 45 cases (73%) of placental abruption. Sixty-two placental abruption cases were divided into 2 groups according to whether uteroplacental apoplexy occurred. The incidence of preeclampsia and the duration (time between on-set of clinical symptom and placenta delivery) in the observational group were significantly higher than that of the control group, showing statistical significance (P < 0.01). ConclusionThe diagnosis of placental abruption should consider risk factors, symptoms, physical signs, dynamic ultrasound monitoring, and cardiac care. Early diagnosis and treatment can improve maternal and infant prognosis.

Epidemiological characteristics and related risk factors on placental abruption in Hebei province

Objective: The aim of this study was to assess the risk factors and epidemiological characteristics of placental abruption (PA) in Hebei province. Methods: A cross-sectional survey was conducted to collect data on 218 880 pregnant women who were hospitalized in 22 hospitals which were under a monitoring program, in Hebei province, from January 1, 2013 to December 31, 2016. Data regarding epidemiological characteristics as time distribution, population distribution and related risk factors of placental abruption were gathered and analyzed. Results: In this cohort study, 218 880 women were included, with 669 (0.31%) of the pregnant women having PA. The overall prevalence rates were higher in the South than in the north parts of the area and higher in more developed regional economic centers. The average age of women having the episode was (27.87±4.50) years and presented "J" distribution on the prevalence of maternal age. Results from the multivariate regression analysis showed that the following factors were independently at risk for placental abruption: pregnancy the including hypertension (OR=1.65, 95%CI: 1.09-2.50), mild preeclampsia (OR=3.65, 95%CI: 2.40-5.56), severe preeclampsia (OR=4.72, 95%CI: 3.86-5.76) and anemia (OR=2.41, 95%CI: 2.05-2.83) which were all increased in pregnant women with PA compared with the normal female population without placental abruption. Conclusions: Placental abruption seemed to be associated with a moderate increasing risk of age, and was seen higher in those population older than 35 or younger than 20 year-olds. It was suggested that appropriate inoculation programs should be taken in different regions, especially on high-risk groups. Health education on related disease was of great significance for improving the prenatal outcome.

Risk Factors for Placental Abruption Between Singleton and Twin Gestations [28L

INTRODUCTION: The incidence of placental abruption is increased in twin when compared to singletons, but there is a paucity of data regarding other risk factors that might contribute to this increase. Our aim was to determine whether the incidence of and risk factors for abruption were different between singleton and twin deliveries. METHODS: Secondary analysis of a multicenter trial of magnesium sulfate for prevention of cerebral palsy. We included women between 18 and 39 years old, non-anomalous singleton and twin gestations, with placental abruption. Risk factors for placental abruption such as smoking, drug use, premature rupture of membranes (PPROM), chorioamnionitis and preterm labor were evaluated. Chi-square or Fisher exact test were used where appropriate. Adjusted odds ratio (aOR) with 95% confidence intervals (CI) were calculated. RESULTS: There were 20 cases of abruption among 203 twin gestations (9.8%) and 162 cases among 2,238 twin gestations (7.2%), P=.17. Of these, 153 were included. The incidence of smoking, alcohol and drug use, preeclampsia and diabetes did not differ between singleton and twin gestations. Twin gestations had significantly higher incidence of preterm labor (44% versus 13%, P&lt;.01) and chorioamnionitis (44% versus 4%, P&lt;.01). Fifty-seven percent (n=8) of women with abruption and chorioamnionitis carried twins. After adjusting for preterm labor, the incidence of chorioamnionitis was still significantly increased for twin gestations (aOR 17.4, CI 5.0–60.4). CONCLUSION: Twin gestations have a higher rate of abruption than singletons. However, they both have similar risk factors except that abruption was more likely to be associated with chorioamnionitis in twins.

184: Risk factors for placental abruption during expectant management of preterm premature rupture of membranes

Acknowledged risk factors of abruption include African American ethnicity, cigarette or drug use, hypertensive disorders and preterm premature rupture of membranes (PPROM). There is a paucity of reports on risk factors for abruption during expectant management of PPROM. The objective of this analysis was to identify risk factors associated with placental abruption during expectant management of PPROM. This was a secondary analysis of a multicenter trial of magnesium sulfate for prevention of cerebral palsy. Women with singleton gestation, PPROM and enrollment between 24 and 31.6 wks were included. Exclusion criteria included anomalies. Data analysis included acknowledged risk factors for abruption, race and gestational age (GA) < 28 wks at delivery. Univariate and multivariate analysis was performed; adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated. Of 1539 women meeting inclusion criteria, 128 (8%) had placental abruption. The rate was significantly higher in those with GA < 28 wks at delivery, as compared to those ≥ 28 wks (13% vs 7%, P < 0.01). Maternal factors including age, presence of prenatal care, parity and magnesium use were not significantly different between those with and without abruption. Smoking, alcohol, drug use and preeclampsia or gestational hypertension were also similar between the two groups (Table 1). Race, however, was significantly different; African American (aOR 0.56, 95% CI 0.37-0.84) and Hispanic (aOR 0.37, 95% CI 0.18-0.74) women with PPROM had lower risk of abruption compared to Caucasian women with PPROM (Table 2). Acknowledged risk factors for abruption were not associated with increased risk of placental abruption in women with preterm premature rupture receiving expectant management, suggesting that the increased risk is due to the pathophysiology of PPROM. The increased rate of abruption among Caucasian women was unexpected.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The association between Müllerian anomalies and perinatal outcome

Introduction: Deviation in the development of the female reproductive organs from the normal anatomy has been shown to have an impact on obstetrical outcomes and neonatal morbidity. Material and methods: In this retrospective population-based cohort study, short-term neonatal morbidity and mortality were compared in pregnancies of women with and without uterine anomalies. The analysis included deliveries that occurred between the years 1991 and 2013 in a tertiary medical center. Statistical analysis included multiple logistic regression models. Results: During the study period, 256,299 deliveries met the inclusion criteria; 0.49% (n = 1251) of which occurred in women diagnosed with Müllerian anomalies. In the regression model, Müllerian anomalies were noted as an independent risk factor for placental abruption (adjusted odds ratio, 1.9; 95% confidence interval, 1.3–2.8; p = .001), intrauterine growth restriction (adjusted odds ratio, 1.9; 95% confidence interval, 1.5–2.4; p < .001), pathological presentation (adjusted odds ratio, 13.5; 95% confidence interval, 11.9–15.1; p < .001) and cesarean delivery (adjusted odds ratio, 13.4; 95% confidence interval, 11.5–15.6; p < .001) while controlling for multiple confounders. Perinatal mortality, however, was not found to be increased in the exposed group in a model controlled for gestational age and weight (adjusted odds ratio, 0.6; 95% confidence interval, 0.4–1.02; p = .061). Conclusion: Women with Müllerian anomalies are at an increased risk for multiple adverse pregnancy outcomes, including preterm delivery and intrauterine growth restriction. Perinatal mortality, however, is not increased when controlled for gestational age and weight suggesting that mortality in these pregnancies is mediated by preterm delivery and small for gestational age.

Asymptomatic placental abruption in the third trimester of pregnancy

The article presents 3 clinical cases of asymptomatic placental abruption, diagnosed occasionally during routine ultrasound. There were analyzed risk factors of placental abruption: thrombophlia, diabetes, perinatal losses. All cases demonstrated complete coincidence of ultrasonic and morphological data in placental abruption. The patients had been delivered successfully due to correct diagnostics and severe maternal and fetal complications were not realized.

Etiologies and Risk Factors of Placental Abruption and Neonatal Mortality: A Retrospective Study [6K

INTRODUCTION: Placental abruption is defined as bleeding at the decidual-placental border leading to placental separation prior to delivery of the fetus. Placental abruption is a significant cause of maternal and perinatal mortality. In this retrospective study, we aim to evaluate the correlation between various causes and risk factors of placental abruption and neonatal mortality. METHODS: A retrospective chart review of placental abruption patients at SJRMC between 1986-1996 was conducted. Preeclampsia, eclampsia, HELLP, CHTN, preterm labor and placenta previa were recorded. Smoking, alcohol and cocaine use were assessed. Perinatal morbidity was based on length of NICU stay; neonatal mortality was defined as stillbirth or death. RESULTS: Our sample size was 271 pregnant women with placental abruption. Sixteen of 271 had HELLP (5.90%), 76 of 271 had preeclampsia (28.0%), and 22 of 271 had CHTN (8.11%). Forty of 271 used cocaine (14.7%), 104 of 271 smoked (38.4%) and 45 of 271 used alcohol (16.6%). Nine of 271 pregnant women with placental abruption had placental previa (3.32%). 37 of 271 infants were stillborn (13.6%) and 44 of 271 were dead on discharge (16.2%). HELLP syndrome was directly proportional to infant death (P=0.026; 95% CI, 0.26 to 4.03). Preeclampsia was proportional to neonatal mortality (P=0.000); CHTN was statistically significant for neonatal mortality (P=0.0010). Cocaine and alcohol correlated with increased neonatal mortality (P=0.0057; P=0.0220). CONCLUSION: CHTN, HELLP, preeclampsia, and placenta previa as causes of placental abruptions were found to be statistically significant predictors of neonatal mortality. Smoking, cocaine and alcohol use were directly proportional to neonatal mortality.