Risk Of Placental Abruption Research Articles

Elective delivery versus expectant management for pre-eclampsia: a meta-analysis of RCTs

PurposeTo evaluate the effectiveness and safety of elective delivery versus expectant management for women with pre-eclampsia (PE) and to assess neonatal outcomes before and after 34 weeks gestation.MethodsWe searched Biomed Central, CINAHL, Cochrane Library, Embase, HMIC, Medline, and WHO trial registry, British Nursing Index, ClinicalTrials.gov, Current Controlled Trials, and Web of Science on 16 March, 2016. 1704 citations were identified. Randomised controlled trials comparing elective delivery with expectant management for women with PE were included. Seven studies were included (n = 1501). There were no maternal deaths.ResultsElective delivery lowered incidence of complications in women with PE or hypertension greater than 34 weeks gestation (n = 756; RR, 0.64; 95% CI 0.51–0.80). For women with severe PE less than 34 weeks gestation, elective delivery lowered the incidence of placental abruption (n = 483, 5 RCTs; RR, 0.43; 95% CI 0.19–0.98). For women with PE or hypertension greater than 34 weeks gestation, elective delivery also reduced the need for antihypertensive drug therapy. The need for ventilatory support and the risk of developing neonatal intraventricular hemorrhage or hypoxic ischemic encephalopathy may be increased in infants whose mothers undergo elective delivery for severe PE at less than 34 weeks gestation. However, there was no relevant evidence for women with severe PE over 34 weeks.ConclusionsIn women with PE or gestational hypertension beyond 34 weeks gestation, elective delivery can decrease the incidence of complications, severe hypertension and the need for antihypertensive drug therapy. Elective delivery can also lower the risk of placental abruption in women before 34 weeks gestation with severe PE, however, may be associated with increased risk of neonatal complications.

The effect of placenta location on the safety of pregnant driver and her fetus

ABSTRACTPlacental abruption accounts for more than half of fetal mortality in automobile collisions. In most of the pregnancies, placenta is located at the fundus position of the uterus. However, in real life, placenta can also be found at different locations in the uterus.The goal of this study is to investigate whether the location of the placenta in the uterus of pregnant driver has a role on the risk of placental abruption in motor vehicle accidents. In addition to the most common fundus position, four other placental locations, namely anterior, posterior, lateral left and lateral right, are considered within the computational pregnant driver model ‘Expecting’, and used in collision simulations with impact severities from 15 to 30 kph with 5-kph increments. Scenarios also include four cases where the pregnant driver is fully restrained with three-point seatbelt and airbag, three-point seatbelt only, airbag only and no restraint at all. The maximum strains developed in the utero-placental interface of the model in this set of 64 simulations together with the fundus-location simulations are determined and compared in order to investigate the effect of placental location on the placental abruption prediction.Placenta located at anterior position is found to be at higher risk than other placental positions considered in this investigation. The results demonstrate that being fully restrained is the safest option and the three-point seatbelt is the most effective restraint system whilst the airbag makes a small contribution to the protection of pregnant driver and her fetus.

Maternal smoking during pregnancy and placental abruption risk in Northwest Russia; a MCBR study

Background Placental abruption is a pregnancy complication that leads to separation of placental lining from the uterus before delivery. Two-thirds of placental abruptions are accompanied by fetal or neonatal complications, which includes preterm delivery. International studies show that maternal smoking increases the risk of placenta abruption, but the evidence from Russia is …

Clinical, Ethical, and Legal Considerations in Pregnant Women With Opioid Abuse

(Obstet Gynecol. 2015;126:474–478) Opioid-dependent pregnant women who undergo acute opioid withdrawal during pregnancy are at increased risk for miscarriage, placental abruption, preterm labor, and stillbirth. Physicians should thus have basic familiarity with the medical, ethical, and legal issues surrounding opioid maintenance therapy, which mitigates the risks of frequent withdrawal during gestation and reduces the risk of relapse after delivery. Longer-lasting therapies like methadone and buprenorphine can increase accessibility to care for this population all while preserving confidentiality, decreasing social stigma, and reducing lengthy resource-intensive hospitalizations. Other benefits include lowered risk of bloodborne infection transmission and improved maternal and neonatal health outcomes.

Pregestational body mass index, gestational weight gain, and risks for adverse pregnancy outcomes among Taiwanese women: A retrospective cohort study

ObjectiveTo investigate the associations between maternal pregestational body mass index (BMI), gestational weight gain (GWG), and adverse pregnancy outcomes among Taiwanese women. Materials and MethodsA retrospective cohort study was conducted among all singletons without fetal anomalies delivered to women at Taipei Chang Gung Memorial Hospital between 2009 and 2015. Two study cohorts were selected for analysis: all deliveries after 24 0/7 weeks of gestation (Cohort 1, n=12,064) and all live births after 37 0/7 weeks of gestation excluding maternal overt diabetes mellitus and chronic hypertension (Cohort 2, n=10,973). The associations between pregestational BMI, GWG outside the 2009 Institute of Medicine (IOM) guidelines, and adverse pregnancy outcomes were assessed using multivariable logistic regression analysis. ResultsIn Cohort 1, the prevalence of pregestational underweight, normal weight, overweight, and obesity was 14.0%, 74.8%, 9.0%, and 2.2%, respectively. Compared with the women with normal weight, maternal underweight was associated with increased risk for placental abruption, small-for-gestational age, and low birth weight (<2500 g). In contrast, overweight and obese women were at risk for gestational diabetes mellitus, preeclampsia, dysfunctional labor, cephalopelvic disproportion, large-for-gestational age, and macrosomia (>4000 g). In Cohort 2, GWG below the IOM guidelines were associated with higher rates of gestational diabetes mellitus, small-for-gestational age, and low birth weight, while GWG above the IOM guidelines were with higher rates of primary cesarean delivery, large-for-gestational age, and macrosomia in women with pregestational underweight or normal weight. Normal weight women were more likely to have placental abruption with GWG below the guidelines and to have preeclampsia with GWG above the guidelines. For overweight and obese women, GWG below the guidelines was associated with a higher rate of gestational diabetes mellitus, but GWG above the guidelines was associated with a higher rate of macrosomia. ConclusionsWomen with abnormal pregestational BMI are at risk for adverse maternal and neonatal outcomes. Moreover, GWG has a differential effect on the rates of adverse pregnancy outcomes between women of different pregestational BMI categories.

The effect of including a fetus in the uterus model on the risk of fetus mortality through drop test and frontal crash simulations

ABSTRACTComputational modelling is an effective way of estimating the risk of injuries and fatalities in road traffic accidents. Computational pregnant occupant modelling has an additional important role in the investigation of the risk of fetus mortality in crash test simulations. In this paper, the effect of including the fetus in the uterus of the pregnant occupant model is investigated. First, isolated drop test simulations with the uterus of the computational pregnant occupant model, ‘Expecting’, with and without a fetus are used to show the effect of the presence of fetus in the uterus model. Then ‘Expecting’ with and without the fetus is used with varying levels of restraint system use, such as fully restrained, ‘seatbelt only’, ‘airbag only’ and ‘no restraint’, in frontal crash simulations, representing five levels of impacts. Maximum strains developed in the uteroplacental interface with and without a fetus are compared in every case. Both simulations predict higher risks of placental abruption when the fetus is included in the model. Simulations with and without a fetus model show that inclusion of a 38-week fetus model causes higher strains in the placental region of uterus.

Neonatal and maternal outcome after blastocyst transfer: a population-based registry study

Previous studies have shown a higher risk of birth defects and preterm birth (PTB) in singletons born after blastocyst transfer as compared to singletons born after cleavage-stage transfer. Few studies have investigated the maternal outcomes. We sought to analyze the neonatal and maternal outcome after blastocyst transfer (day 5-6) compared to transfer of cleavage-stage embryos (day 2-3) and spontaneous conception. This was a population-based retrospective registry study including all singleton deliveries after blastocyst transfer in Sweden from 2002 through 2013. The in vitro fertilization register was cross-linked with the Swedish Medical Birth Register, the Register of Birth Defects, and the National Patient Register. Deliveries after blastocyst transfer were compared with deliveries after cleavage-stage transfer and deliveries after spontaneous conception. Outcome measures included birth defects, PTB, low birthweight, small for gestational age, large for gestational age, perinatal mortality, placenta previa, placental abruption, and preeclampsia. Crude and adjusted odds ratios (AOR) with 95% confidence interval (CI) were calculated. Adjustment was made for year of birth of child, maternal age, parity, smoking, body mass index, years of involuntary childlessness, and child's sex and, for cleavage stage, also for number of oocytes retrieved, number of embryos transferred, and fresh/frozen embryo transfer. There were 4819 singletons born after blastocyst transfer, 25,747 after cleavage-stage transfer, and 1,196,394 after spontaneous conception. Singletons born after blastocyst transfer had no increased risk of birth defects compared to singletons born after cleavage-stage transfer (AOR, 0.94; 95% CI, 0.79-1.13) or spontaneous conception (AOR, 1.09; 95% CI, 0.92-1.28). Perinatal mortality was higher in the blastocyst vs the cleavage-stage group (AOR, 1.61; 95% CI, 1.14-2.29). When comparing singletons born after blastocyst transfer to singletons born after spontaneous conception, a higher risk of PTB (<37 weeks) was seen (AOR, 1.17; 95% CI, 1.05-1.31). Singletons born after blastocyst transfer had a lower rate of low birthweight (AOR, 0.83; 95% CI, 0.71-0.97) as compared to cleavage-stage transfer. The rate of being small for gestational age was lower in singletons born after blastocyst transfer as compared to both cleavage-stage and spontaneous conception (AOR, 0.71; 95% CI, 0.56-0.88 and AOR, 0.70; 95% CI, 0.57-0.87, respectively). The risk of placenta previa and placental abruption was higher in pregnancies after blastocyst transfer as compared to pregnancies after cleavage-stage (AOR, 2.08; 95% CI, 1.70-2.55 and AOR, 1.62; 95% CI, 1.15-2.29, respectively) and spontaneous conception (AOR, 6.38; 95% CI, 5.31-7.66 and AOR, 2.31; 95% CI, 1.70-3.13, respectively). No increased risk of birth defects was found in singletons born after blastocyst transfer. Perinatal mortality and risk of placental complications were higher in the blastocyst group as compared to the cleavage-stage group, observations that need further investigations.

Maternal Risk Factors and Outcomes of Umbilical Cord Prolapse: A Population-Based Study.

Umbilical cord prolapse (UCP) is a rare event believed to be associated with adverse outcomes. The purpose of our study was to use a large administrative database to better identify incidence, predictors, and outcomes of births with UCP. We carried out a retrospective cohort study using data from the National Center for Health Statistics- Linked Birth Infant Death and Fetal Death (United States) data files during the years 2003-2005. The incidence, predictors, and outcomes of births with UCP were compared to births with no UCP. Logistic regression analysis was performed to estimate the adjusted effect of UCP on maternal and neonatal outcomes. There were 16 126 cases of UCP among 10 040 416 births, for an incidence of 16.1 cases per 10 000 births. While most cases occurred at term and in women with one or two previous births, early gestational age, grand multiparity, prolonged labour, and malpresentation were the strongest risk factors. UCP was associated with an increased risk of placental abruption, excessive bleeding, Caesarean sections, lower Apgar scores, requiring assisted ventilation, neonatal seizures, hyaline membrane disease, and fetal injuries. Deliveries by Caesarean section were associated with a greater risk of fetal injuries than vaginal delivery (18.5% vs 8.7%; OR 2.6, 95% CI 2.3 to 2.9, P < 0.001). Although there are established risk factors, UCP occurs most commonly in low risk women at term. When possible, vaginal delivery is preferred in women with UCP because it appears to be associated with a lower risk of fetal injury.

American Association Of Clinical Endocrinologists, American College Of Endocrinology, And Androgen Excess And Pcos Society Disease State Clinical Review: Guide To The Best Practices In The Evaluation And Treatment Of Polycystic Ovary Syndrome - Part 2

Polycystic ovary syndrome (PCOS) is recognized as the most common endocrine disorder of reproductive-aged women around the world. This document, produced by the collaboration of the American Association of Clinical Endocrinologists and the Androgen Excess Society aims to highlight the most important clinical issues confronting physicians and their patients with PCOS. It is a summary of current best practices in 2014. Insulin resistance is believed to play an intrinsic role in the pathogenesis of PCOS. The mechanism by which insulin resistance or insulin give rise to oligomenorrhea and hyperandrogenemia, however, is unclear. Hyperinsulinemic-euglycemic clamp studies have shown that both obese and lean women with PCOS have some degree of insulin resistance. Insulin resistance is implicated in the ovulatory dysfunction of PCOS by disrupting the hypothalamic-pituitary-ovarian axis. Given the association with insulin resistance, all women with PCOS require evaluation for the risk of metabolic syndrome (MetS) and its components, including type 2 diabetes, hypertension, hyperlipidemia, and the possible risk of clinical events, including acute myocardial infarction and stroke. Obese women with PCOS are at increased risk for MetS with impaired glucose tolerance (IGT; 31 to 35%) and type 2 diabetes mellitus (T2DM; 7.5 to 10%). Rates of progression from normal glucose tolerance to IGT, and in turn to T2DM, may be as high as 5 to 15% within 3 years. Data suggest the need for baseline oral glucose tolerance test every 1 to 2 years based on family history of T2DM as well as body mass index (BMI) and yearly in women with IGT. Compared with BMI- and age-matched controls, young, lean PCOS women have lower high-density lipoprotein (HDL) size, higher very-low-density lipoprotein particle number, higher low-density lipoprotein (LDL) particle number, and borderline lower LDL size. Statins have been shown to lower testosterone levels either alone or in combination with oral contraceptives (OCPs) but have not shown improvement in menses, spontaneous ovulation, hirsutism, or acne. Statins reduce total and LDL cholesterol but have no effect on HDL, C-reactive protein, fasting insulin, or homeostasis model assessment of insulin resistance in PCOS women, in contrast to the general population. There have been no long-term studies of statins on clinical cardiac outcomes in women with PCOS. Coronary calcification is more prevalent and more severe in PCOS than in controls. In women under 60 years of age undergoing coronary angiography, the presence of polycystic ovaries on sonography has been associated with more arterial segments with >50% stenosis, but the relationship between PCOS and actual cardiovascular events remains unclear. Therapies for PCOS are varied in their effects and targets and include both nonpharmacologic as well as pharmacologic approaches. Weight loss is the primary therapy in PCOS--reduction in weight of as little as 5% can restore regular menses and improve response to ovulation- inducing and fertility medications. Metformin in premenopausal PCOS women has been associated with a reduction in features of MetS. Clamp studies using ethinyl estradiol/drosperinone combination failed to reveal evidence of an increase in either peripheral or hepatic insulin resistance. Subjects with PCOS have a 1.5-times higher baseline risk of venous thromboembolic disease and a 3.7-fold greater effect with OCP use compared with non-PCOS subjects. There is currently no genetic test to screen for or diagnose PCOS, and there is no test to assist in the choice of treatment strategies. Persistent bleeding should always be investigated for pregnancy and/or uterine pathology--including transvaginal ultrasound exam and endometrial biopsy--in women with PCOS. PCOS women can have difficulty conceiving. Those who become pregnant are at risk for gestational diabetes (which should be evaluated and managed appropriately) and the microvascular complications of diabetes. Assessment of a woman with PCOS for infertility involves evaluating for preconceptional issues that may affect response to therapy or lead to adverse pregnancy outcomes and evaluating the couple for other common infertility issues that may affect the choice of therapy, such as a semen analysis. Women with PCOS have multiple factors that may lead to an elevated risk of pregnancy, including a high prevalence of IGT--a clear risk factor for gestational diabetes--and MetS with hypertension, which increases the risk for pre-eclampsia and placental abruption. Women should be screened and treated for hypertension and diabetes prior to attempting conception. Women should be counseled about weight loss prior to attempting conception, although there are limited clinical trial data demonstrating a benefit to this recommendation. Treatment for women with PCOS and anovulatory infertility should begin with an oral agent such as clomiphene citrate or letrozole, an aromatase inhibitor.

Placental telomere length and risk of placental abruption

Objective: To investigate the associations of placental telomere length with placental abruption (PA) risk and interactions between placental telomere length and placental mitochondrial DNA (mtDNA) copy number on PA risk. Materials and methods: Relative telomere length and mtDNA copy number in placental samples collected from 105 cases and 73 controls were measured in two batches using qRT-PCR. Mean differences in relative telomere length between PA cases and controls were examined. After creating batch-specific median cutoffs for relative telomere length (84.92 and 102.53) and mtDNA copy number (2.32 and 1.42), interaction between the two variables was examined using stratified logistic regression models. Results: Adjusted mean difference in relative telomere length between PA cases and controls was −0.07 (p > 0.05). Among participants with low mtDNA copy number, participants with short relative telomere length had a 3.07-fold higher odds (95% CI: 1.13–8.38) of PA as compared with participants with long relative telomere length (the reference group). Among participants with high mtDNA copy number, participants with short relative telomere length had a 0.71-fold lower odds (95% CI: 0.28–1.83) of PA as compared with the reference group (interaction p values = 0.03). Conclusion: Findings suggest complex relationships between placental telomere length, mtDNA copy number and PA risk which warrant further larger studies.

Circadian clock-related genetic risk scores and risk of placental abruption

IntroductionThe circadian clock plays an important role in several aspects of female reproductive biology. Evidence linking circadian clock-related genes to pregnancy outcomes has been inconsistent. We sought to examine whether variations in single nucleotide polymorphisms (SNPs) of circadian clock genes are associated with PA risk. MethodsMaternal blood samples were collected from 470 PA case and 473 controls. Genotyping was performed using the Illumina Cardio-MetaboChip platform. We examined 119 SNPs in 13 candidate genes known to control circadian rhythms (e.g., CRY2, ARNTL, and RORA). Univariate and penalized logistic regression models were fit to estimate odds ratios (ORs); and the combined effect of multiple SNPs on PA risk was estimated using a weighted genetic risk score (wGRS). ResultsA common SNP in the RORA gene (rs2899663) was associated with a 21% reduced odds of PA (P < 0.05). The odds of PA increased with increasing wGRS (Ptrend < 0.001). The corresponding ORs were 1.00, 1.83, 2.81 and 5.13 across wGRS quartiles. Participants in the highest wGRS quartile had a 5.13-fold (95% confidence interval: 3.21–8.21) higher odds of PA compared to those in the lowest quartile. Although the test for interaction was not significant, the odds of PA was substantially elevated for preeclamptics with the highest wGRS quartile (OR = 14.44, 95%CI: 6.62–31.53) compared to normotensive women in the lowest wGRS quartile. DiscussionGenetic variants in circadian rhythm genes may be associated with PA risk. Larger studies are needed to corroborate these findings and to further elucidate the pathogenesis of this important obstetrical complication.

Gestational weight gain and risks for adverse perinatal outcomes: A retrospective cohort study based on the 2009 Institute of Medicine guidelines

ObjectiveTo investigate perinatal outcomes according to the 2009 Institute of Medicine (IOM) gestational weight gain (GWG) guidelines. Materials and methodsA retrospective cohort study was conducted among all term, singleton, live births to women who delivered at the Taipei Chang Gung Memorial Hospital, Taipei, Taiwan between 2009 and 2014. Women were categorized into three groups based on prepregnancy body mass index and GWG relative to the IOM guidelines. Multivariable logistic regression analysis was used to assess the associations between GWG outside the IOM guidelines and adverse perinatal outcomes. Women with GWG within the guidelines served as the reference group. ResultsOf 9301 pregnancies, 2574 (27.7%), 4189 (45.0%), and 2538 (27.3%) women had GWG below, within, and above the IOM guidelines. Women with GWG above the IOM guidelines were at risk for preeclampsia [adjusted odds ratio (OR) 3.0, 95% confidence interval (CI) 1.9–4.7], primary cesarean delivery (adjusted OR 1.4, 95% CI 1.2–1.6) due to dysfunctional labor and cephalopelvic disproportion, large-for-gestational age (adjusted OR 1.8, 95% CI 1.5–2.1), and macrosomic neonates (adjusted OR 2.2, 95% CI 1.6–3.1). Women with GWG below the IOM guidelines were more likely to be diagnosed with gestational diabetes mellitus (adjusted OR 1.5, 95% CI 1.3–1.8) and were at higher risk for placental abruption (adjusted OR 1.7, 95% CI 1.1–2.5), small-for-gestational age (adjusted OR 1.6, 95% CI 1.4–1.9), and low birth weight neonates (adjusted OR 1.9, 95% CI 1.4–2.4). ConclusionWomen with GWG outside the 2009 IOM guidelines were at risk for adverse maternal and neonatal outcomes.

Incidence and recurrence rate of placental abruption: a longitudinal linked national cohort study in the Netherlands

Women who have experienced a placental abruption have a risk of recurrence, but exact information to quantify this risk is currently not available. We studied the incidence and recurrence rate of placental abruption in a subsequent pregnancy and the influence of hypertensive disorders. We conducted a retrospective national cohort study of all singleton pregnancies that ended from 1999-2007 in the Netherlands. A longitudinal linked national cohort of these women with information on a subsequent singleton delivery was used. We calculated and compared incidence and recurrence rates of placental abruption for women in total, stratified by gestational age of first placental abruption and by the presence of a hypertensive disorder in their first pregnancy. We studied 1,570,635 women of which 3496 (0.22%) experienced a placental abruption. Information was available on a subsequent singleton delivery for 264,424 deliveries. Of these, 521 women (0.20%) had a placental abruption in the first pregnancy vs 214 women (0.08%) in the second pregnancy. The risk of placental abruption in a subsequent pregnancy was significantly higher in women with a previous placental abruption compared with women without (5.8% vs 0.06%; adjusted odds ratio [aOR], 93; 95% confidence interval [CI], 62-139). Women with a placental abruption that occurred at term in their first pregnancy were more at risk for recurrence (aOR, 188; 95% CI, 116-306) than women with a preterm (aOR, 52; 95% CI, 25-111) or early preterm (<32 weeks of gestation) placental abruption in their first pregnancy (aOR, 39; 95% CI, 13-116). Placental abruption was more frequent among women with a hypertensive disorder compared with normotensive women (0.44% vs 0.16%; odds ratio, 2.7; 95% CI, 2.3-3.3). Women with a hypertensive disorder were less at risk for recurrence than were normotensive women (aOR, 0.68; 95% CI, 0.27-1.6). No interaction between a hypertensive disorder in the first pregnancy and the recurrence risk was found. Women with a placental abruption in their first pregnancy have a greatly increased risk of placental abruption in a subsequent pregnancy. Hypertensive disorders increase the risk of placental abruption but do not increase the recurrence rate in a subsequent pregnancy. We suggest elective induction from 37 weeks of gestation for women with a history of placental abruption at term in a previous pregnancy.

Hématome rétroplacentaire : terrain et facteurs pronostiques revisités à propos d’une série de 171 cas en Guyane francaise

To describe the epidemiological, clinical and prognostic factors of placental abruption and fetal death in utero and to investigate possible risk factors for their occurrence. Observational retrospective study including the women having presented a placental abruption between January 2001 and January 2012, in a IIB maternity. Women's sociodemographic characteristics, clinical symptoms and the method used to detect placental abruption were collected. Patient data of those whose pregnancy resulted in fetal death were compared to those with more favorable outcomes. There were 171 cases of placental abruption among 21,913 patients having delivered, which represents a 0.78% incidence. Diagnosis was rarely based on clinical data (30%). The rate of fetal death in utero represented 25% of the pregnancy's outcomes. A history of fetal death in utero increased the risk of placental abruption (P<0.001). This complication was more frequent for patients who did not have pregnancy monitoring (P=0.054) and before 37 weeks of amenorrhoea (P=0.005). Placental abruption is an important cause of perinatal mortality and maternal morbidity. Among the observed risk factors, only regular pregnancy monitoring can be an easy way to prevent these complications.

Change in paternity, risk of placental abruption and confounding by birth interval: a population-based prospective cohort study in Norway, 1967–2009

ObjectivesWe examined abruption risk in relation to change in paternity, and evaluated if birth interval confounds this association.SettingPopulation-based study of singleton births in Norway between 1967 and 2009.ParticipantsWomen who had...

Deleterious Consequences of Diamond Blackfan Anemia on Reproductive Health and Pregnancy Outcomes: A Report from the Diamond Blackfan Anemia Registry (DBAR)

Background: Diamond Blackfan anemia (DBA) is a rare, congenital bone marrow failure syndrome characterized by red cell aplasia, birth anomalies, and a predisposition to cancer. Due to a primarily autosomal dominant mode of inheritance, DBA affects males and females at a ratio of 1:1. Treatment consists of corticosteroid administration and chronic red cell transfusion therapy and in some cases hematopoietic stem cell transplantation. Current clinical observations suggest that women with DBA may experience delayed puberty, irregular menstrual cycles, and decreased fertility. Women who do become pregnant may sustain a higher than average risk of pregnancy complications, including miscarriage, placental abruption, and stillbirth, and others of vascular-placental origin (Faivre et al. Haematologica, 2006). Anecdotal reports suggest that DBA women experience changes to treatment response and remission status during periods characterized by hormonal fluctuations; namely, puberty and pregnancy. The etiology of these complications is unclear.Methods: Questionnaires were sent to females greater than 15 years of age (n=224) participating in the Diamond Blackfan Anemia Registry of North America (DBAR), a comprehensive database of 720 patients who are enrolled after obtaining informed consent. The questionnaires ask about menstrual and gynecologic health and pregnancies, focusing on complications, treatment requirements, and outcomes. We grouped patients by steroid and/or transfusion dependence status and/or remission before age 12 to analyze the effects of treatment on menarche. The patients were regrouped based on the majority of their treatment to evaluate for gynecologic health and pregnancy complications. The Fisher’s exact test was used to examine associations between variables. When compared to the general population, normal values were obtained from a variety of sources including the American Academy of Pediatrics, the National Institutes of Aging and the March of Dimes.Results and Conclusions: We reviewed results from 84 women aged 15 to 62 years (median age 28.6 years). Menarche was delayed in both steroid dependent and transfusion dependent girls, with 39.5% and 77.8%, respectively experiencing menarche at age 15 or later (vs 2% normal). Transfusion dependent girls were significantly more likely to have delayed menarche compared to the steroid dependent and remission groups (p<.005). Additionally, transfusion dependent females were significantly more likely to experience premature ovarian failure, compared to those who were either steroid dependent or in remission (32.1% vs 8.6%; p<.025). Of those who report entering menopause, 75% stopped by age 40 or younger (vs average, 51 years). Women who are transfusion dependent were more likely to report having taken medication to regulate their menstrual cycle, as compared to steroid dependent and remission groups (48.1% vs 22.9%; p<.06). Of the 50 pregnancies reported in 23 women, 30 resulted in live births (60%). Of the total live births, 43.3% were preterm (vs 11.5% normal). Interestingly, steroid dependent women as well as those in remission had the highest percentage of preterm deliveries at 66.7% and 63.6%, respectively. 26% of the pregnancies resulted in miscarriage, and 4.3% resulted in stillbirth (vs normal, 15% and 0.6%, respectively) and 4.3% of pregnancies were complicated by placental abruption (vs normal, <1%). During pregnancy, 52.2% of women reported requiring transfusions; specifically, 100% of the women who were steroid dependent at conception required transfusions during pregnancy. 7.4% of women in the study had a hysterectomy, half of whom were under age 40. We also noted an increased incidence of endocrinopathies: transfusion dependent women reported a significantly higher prevalence of thyroid disorders compared to the steroid dependent group (42.9% vs 11.1%; p<.03). Additionally, there was a higher prevalence of diabetes in the transfusion group as compared to the steroid dependent group (14.3% vs 0%, p=NS). These findings suggest an important role of iron overload in menstrual abnormalities, reproductive issues and endocrinopathies in DBA women. Pregnancy complications are in excess of those seen in the normal population. Future analyses will determine whether there is a correlation between menstrual abnormalities and/or pregnancy complications and specific DBA genotypes. DisclosuresNo relevant conflicts of interest to declare.

Prenatal drinking-water exposure to tetrachloroethylene and ischemic placental disease: a retrospective cohort study.

BackgroundPrenatal drinking water exposure to tetrachloroethylene (PCE) has been previously related to intrauterine growth restriction and stillbirth. Pathophysiologic and epidemiologic evidence linking these outcomes to certain other pregnancy complications, including placental abruption, preeclampsia, and small-for-gestational-age (SGA) (i.e., ischemic placental diseases), suggests that PCE exposure may also be associated with these events. We examined whether prenatal exposure to PCE-contaminated drinking water was associated with overall or individual ischemic placental diseases.MethodsUsing a retrospective cohort design, we compared 1,091 PCE-exposed and 1,019 unexposed pregnancies from 1,766 Cape Cod, Massachusetts women. Exposure between 1969 and 1990 was estimated using water distribution system modeling software. Data on birth weight and gestational age were obtained from birth certificates; mothers self-reported pregnancy complications.ResultsOf 2,110 eligible pregnancies, 9% (N = 196) were complicated by ≥1 ischemic placental disease. PCE exposure was not associated with overall ischemic placental disease (for PCE ≥ sample median vs. no exposure, risk ratio (RR): 0.90; 95% confidence interval (CI): 0.65, 1.24), preeclampsia (RR: 0.36; 95% CI: 0.12-1.07), or SGA (RR: 0.98; 95% CI: 0.66-1.45). However, pregnancies with PCE exposure ≥ the sample median had 2.38-times the risk of stillbirth ≥27 weeks gestation (95% CI: 1.01, 5.59), and 1.35-times of the risk of placental abruption (95% CI: 0.68, 2.67) relative to unexposed pregnancies.ConclusionsPrenatal PCE exposure was not associated with overall ischemic placental disease, but may increase risk of stillbirth.Electronic supplementary materialThe online version of this article (doi:10.1186/1476-069X-13-72) contains supplementary material, which is available to authorized users.

Influence of threatened miscarriage on pregnancy and early postpartum period: a case–control report

Objective: To evaluate the influence of threatened miscarriage on obstetric complications during pregnancy and early postpartum period.Methods: In this case–control study, hospital records of 12 050 first-trimester patients between January 2011 and December 2012 at the Research and Educational Hospital in Ankara, Turkey, were used. Of the 12 050 patients, 481 threatened miscarriage patients were evaluated. The control group was formed by age- and body mass index-matched cases without first trimester bleeding. Abortion, intrauterine foetal demise, preterm birth, preeclampsia, antenatal haematoma, uterine atony placental abruption and low birth-weights were compared between the study and the control group.Results: When compared with the control group, the risk of having a preterm birth (p = 0.014; OR: 1.95; 95% CI: 1.15–3.24), low-birth-weight infant (p = 0.001; OR: 2.33; 95% CI: 1.45–3.83) and abortion (p = 0.00; OR: 2.55; 95% CI: 1.62–3.91) increased in cases of threatened miscarriage. However, the risk of uterine atony was decreased (p = 0.006; OR: 0.09; 95% CI: 0.12–0.7) in the threatened miscarriage group when compared with the control group. Threatened miscarriage did not increase the risk of placenta praevia, placental abruption or intrauterine foetal demise.Conclusion: Increased complications after threatened miscarriage is probably due to the persistence of a triggering mechanism. As preterm birth and abortion rate increased, whilst uterine atony rate decreased, one of the mechanisms causing threatened miscarriage might be increased uterine contractility.

The risk of placental abruption and placenta previa in pregnant women with chronic hepatitis B viral infection: A systematic review and meta-analysis

IntroductionSeveral epidemiological studies have found a positive association between chronic hepatitis B virus (CHB) infection and the risk of placental abruption and placenta previa, but various studies have reported conflicting findings. The objective was to systematically review the literature to determine a possible association between CHB infection and these two placental complications. MethodsWe conducted a computerized search in electronic database through March 1, 2014, supplemented with a manual search of reference lists, to identify original published research on placental abruption and placenta previa rates in women with CHB infection. Data were independently extracted, and relative risks were calculated. The meta-analysis was performed using Stata version 10.0 software. ResultsFive studies involving 9088 placenta previa cases were identified. No significant association between CHB infection and placenta previa was identified (OR = 0.98, 95% CI = 0.60–1.62). Five studies involving 15571 placental abruption cases were identified. No significant association between CHB infection and placental abruption was identified (OR = 1.42, 95% CI, 0.93–2.15). DiscussionThe immune response against the virus represents a key factor in determining infection outcomes. No observation of significant increased risk of the placental complications could be partially explained by the complex immune response during CHB infection. ConclusionsOur meta-analysis found no evidence of significant associations between CHB infection and increased risk of placental abruption as well as placenta previa. Further well-designed studies were warranted to assess any potential association between CHB infection and increased risk of placental abruption as well as placenta previa.

Maternal Arrhythmia and Perinatal Outcomes

INTRODUCTION: Maternal cardiac diseases can be severely compromised in the setting of arrhythmias. We compared perinatal outcomes among women with a cardiac arrhythmia with women with other types of cardiac disease. METHODS: This is a retrospective cohort study of pregnant women with cardiac disease who delivered from 2008 to 2013. Perinatal outcomes among women with an arrhythmia were compared with those with other types of maternal cardiac disease (congenital, structural, or cardiomyopathy). RESULTS: A cohort of 143 women was identified; 37 (26%) had a diagnosis of an arrhythmia. Compared with women without arrhythmias, those with an arrhythmia were more likely to have a spontaneous vaginal delivery (62% compared with 43%, P<.05) and required fewer operative vaginal births (11% compared with 26%, P=.05). Pregnancies were more likely to be complicated by intrauterine growth restriction (IUGR) (16% compared with 5%, P<.05) and placental abruption (5% compared with 0%, P<.05). The risk of IUGR remained increased in multivariable model controlling for confounding (adjusted odds ratio 6.9, 95% confidence interval 1.6–30.4, P=.01). There were no differences in rates of other maternal complications including gestational diabetes, postpartum hemorrhage, chorioamnionitis, or intensive care unit admission. Neonatal outcomes including gestational age at delivery, birth weight, 5-minute Apgar, umbilical artery pH less than 7, and neonatal intensive care unit admission were not different. CONCLUSIONS: Patients with arrhythmias were more likely to have a successful vaginal delivery compared with those other maternal cardiac diseases. However, the pregnancy had an increased risk for IUGR and placental abruption. The rates of adverse neonatal outcomes were similar between the groups.