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PubMed1982

[Alterations in coagulation and fibrinolytic system in abruptio placentae (author's transl)].

Abruptio placentae tends to be accompanied by abnormal coagulation and fibrinolysis, and is known as high risk pregnancy allowing both mother and fetal lives to endanger. Blood coagulation and fibrinolytic system in abruptio placentae, in particular, sequential changes around its onset have been remained unclarified despite the progress in hematology. This permits an irregular therapeutical process for its acute clinical manifestation. In this study, observation was made of the changes of coagulation and fibrinolytic system mainly in relation to delivery, and hemorrhagic diathesis in abruptio placentae was studied. The results obtained are as follows. The studied patients were 14 cases classified into 8 multipara, 10 toxemia of pregnancy, 6 cesarean section, 11 intrauterine fetal death, and 8 complicated disseminated intravascular coagulation respectively. A moderate type demonstrating an increased serum FDP with retarded ESR and lowering in fibrinogen level were observed, but those abnormalities recovered to normal by 3 days after delivery. In serious case, observations also were made of marked decrease of fibrinogen, prolonged PT and PTT, high concentrations of serum and urinary FDP, lowering in levels of coagulation factors, attenuated platelet counts, retarded ESR, and inhibition of platelet aggregation along with thrombelastgram that showed thrombocytopenic type. All of those anomalies tended to be improved following delivery.

Abruptio Placentae↗
PubMed2004

Severe vasovagal attack: an unusual cause of abruptio placentae.

CASE REPORT: Abruptio placentae occurred in a 29 years old woman following a vasovagal episode. Her medical history was free from all the commonly accepted risk factors for abruption. DISCUSSION: We speculate that the restoration of placental blood flow caused a sudden increase in uteroplacental blood pressure, and induces rupture of some vessels, causing a progressively growing retroplacental hematoma and placental detachment.

Abruptio Placentae↗
PubMed1974

Heparin treatment in abruptio placentae.

Two cases of abruptio placentae with disseminated intravascular coagulation (DIC) were treated with heparin, and coagulation was monitored by thromboelastography as well as the usual hematology tests. The cases demonstrated the vagaries of DIC and both showed decreased overt hemorrhage after heparin treatment was started. Heparin may be indicated for the management of abruptio placentae where delivery is not imminent, where significant disseminated intravascular coagulation exists, and when adequate serial coagulation studies are available.

Abruptio Placentae↗
PubMed1991

On reducing the frequency of severe abruptio placentae.

At Parkland Memorial Hospital the frequency of abruptio placentae so severe as to kill the fetus has decreased from 1 in 420 deliveries during 1956 through 1969 to 1 in 830 during 1974 through 1989. Major factors in this reduction were elimination of very high parity and a marked increase in the percentage of Latin American women, in whom the risk was 1 in 1473 deliveries compared with 1 in 595 for black women and 1 in 876 for white women. Abdominal trauma was encountered rarely, as was fetoplacental-to-maternal hemorrhage sufficient to impair fetal perfusion seriously. Abnormal development of Müllerian ducts and uterine myomas were encountered rarely. Neither red blood cell macrocytosis characteristic of folate deficiency nor iron deficiency could be implicated in the genesis of severe abruptio placentae. Abruptio placentae recurred in 12% of subsequent pregnancies and proved fatal to the fetus in 7%, unchanged from our earlier experience.

Abruptio Placentae↗
PubMed2000

Mathematic modeling to predict abruptio placentae.

OBJECTIVE: This study was undertaken to identify correlates of abruptio placentae and to develop a mathematic model for the prediction of abruptio placentae. STUDY DESIGN: A total of 170,258 singleton birth records from 1991 to 1996 contained in the Schleswig-Holstein perinatal database were analyzed. Fifty-two recognized obstetric risk factors were subjected to univariate analysis. Correlates of abruptio placentae then underwent stepwise forward binary logistic regression. A constant value B(0), coefficients B(1) through B(p), an odds ratio, and a 95% confidence interval were calculated for individual correlates. RESULTS: Abruptio placentae occurred in 874 of 170,258 singleton gestations (0.5%). Of the 52 risk factors 31 proved to be correlates of abruptio placentae, with 16 among primiparous women and 25 among multiparous women. Ten correlates for primiparous, women and 13 for multiparous women emerged from the linear regression, with 7 correlates being shared by both primiparous and multiparous women. CONCLUSION: The probability that abruptio placentae will occur (p) can be calculated according to the following expression: p = e (z)/(1 + e (z)), where z = B(0) + B(1), em leaderB(p). For example, for a primiparous woman who smokes with bleeding at >28 weeks' gestation and a male fetus in the breech position, the following calculation would yield the chance of abruptio placentae:z = -2.25 + 2.51 + 0.41 + 0.24 + 0.60 = 1.51; p = e (1.51)/ (1 + e (1.51)) = 4. 53/5.53 = 0.82, or 82%.

Abruptio Placentae↗
PubMedDate not supplied

Abruptio placentae and its complications at Ayub Teaching Hospital Abbottabad.

BACKGROUND: Abruptio placentae remains a major cause of perinatal morbidity and mortality globally, though of most serious concern in the developing world. As most known causes of abruptio placentae are either preventable or treatable, an increased frequency of the condition remains a source of medical concern. METHODS: The present study was undertaken at the Department of Obstetrics and Gynaecology, Unit B, of the Ayub Teaching Hospital, Abbottabad, Pakistan, from July 2003 to June 2004. Patients of abruptio placentae were selected from all cases of 28 weeks or greater gestation, presenting with ante partum haemorrhage during the study period. Patients underwent a complete obstetrical clinical workup including history, general physical examination, abdominal and pelvic examination. Relevant investigations such as laboratory tests and imaging were performed. Patients were managed according to maternal and fetal condition. Any maternal and/or fetal complications were noted and recorded. All data were collected on predesigned proformas and analyzed by computer. RESULTS: A total of 53 cases of abruptio placentae were recorded out of 1194 cases (4.4%) admitted for delivery during the study period, giving a rate of 44 cases of abruptio placentae per 1000 deliveries. Induction of labour was required in 27 (50.9%) cases, while caesarean section was performed in 16 (30.2%) cases. Major complications were intra uterine fetal demise (31/53, 58.5%), fetal distress (8/22 live births, 36.4%) and post partum haemorrhage, which occurred in 10 (18.9%) cases. CONCLUSIONS: A higher than expected frequency of abruptio placentae exists in our setting and the consequences of abruptio placentae for neonatal mortality outcome are alarmingly high. The majority of patients presented with intra uterine death so that any management protocol directed at abruptio placentae or its consequences is of little help in preventing perinatal mortality.

Abruptio Placentae↗
PubMed1993

[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%.

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PubMed1979

Perinatal death due to abruptio placentae in an African city.

Abruptio placentae was a common cause of perinatal death in Addis Ababa, Ethiopia in 1974-1975 with a frequency of 5.5/1000 births. This disorder had its peak frequency at term. No abnormalities were found in the placentas to explain the placental abruptions but there were other clues to their genesis. There was a strong association of the fatal abruptions with severe poverty in the mothers. These poor mothers were both undernourished and malnourished during pregnancy. Their fetuses and neonates who died had multiple evidences of undernutrition including a relative undergrowth of adrenals, spleens and livers and a relative acceleration of lung maturation. These findings support observations in more prosperous nations that poor nutrition of the gravida may have an important role in the genesis of abruptio placentae.

Abruptio Placentae↗
PubMed1987

Ultrasound diagnosis of abruptio placentae with fetomaternal hemorrhage.

Fetomaternal hemorrhage and abruptio placentae may occur concurrently. A prospective study was done to determine the incidence of fetomaternal hemorrhage in noncatastrophic cases of abruptio placentae consistent with sonographic findings. Significant fetomaternal hemorrhage was found in 75% of noncatastrophic cases. Implications of conservative management of abruptio placentae with fetomaternal hemorrhage are discussed.

Abruptio Placentae↗
PubMed1979

The aetiology and outcome of abruptio placentae.

A series of 193 cases of abruptio placentae in a hospital population of 35,217 is described. This is an incidence of 0.55%. In the series both age and parity, but not pre-eclampsia or anaemia, are significant associated factors. The recurrence rate of abruptio placentae was 5.6%. There were no maternal deaths and the perinatal mortality was 35%. Epidural analgesia does not abolish the pain of the abruptio placentae in spite of abolishing the pain of labour.

Abruptio Placentae↗
PubMed1990

[Abruptio placentae].

Neither the frequency nor the clinical pattern of abruptio placentae have changed significantly in the past years. In a retrospective study (1979-1988) we found a frequency of 0.55%, that means one abruptio placentae in every 182 births. Important and significant factors which could be correlated with the abruptio placentae were: premature labour, vaginal bleeding and gestosis. The case histories show a high rate of abortions and interruptions (24.3%) of pregnancy, as well as premature rupture of membranes (15.4%) and multiple pregnancies. Ultrasound furnished valuable diagnostic criteria in only 7.7% of the cases. A high rate of breech presentation (1/5 of all cases) is seen in combination with premature birth (37% less than or equal to 33 weeks of gestation). Half of the patients showed disturbances of coagulation. The high rate of perinatal mortality (12%) is related to the prematurity on the one hand and too late diagnosis of abruptio placentae.

Abruptio Placentae↗
PubMed1993

Maternal serum CA 125 levels in the diagnosis of abruptio placentae.

OBJECTIVE: To evaluate measurements of maternal serum CA 125 for the diagnosis of abruptio placentae. METHODS: This investigation was conducted at Swedish Medical Center/Seattle from December 1991 through April 1992. During the study period, we identified 21 consecutive patients with a clinical diagnosis of abruptio placentae. In addition, we enrolled two groups of patients whose pregnancies were not complicated by placental abruption (28 preterm controls and 53 term controls). RESULTS: Mean maternal serum levels of CA 125 were significantly higher among women with abruptio placentae (40.6 +/- 29.6 U/mL) than among preterm controls (26.6 +/- 17.2 U/mL) or term controls (22.0 +/- 11.4 U/mL). Using a positive threshold of 35 U/mL, the sensitivity and specificity of maternal serum CA 125 for abruptio placentae were 42.9% (95% confidence interval [CI] 21.7-64.1) and 92.5% (95% CI 85.4-99.6), respectively. CONCLUSIONS: These findings support an earlier report documenting higher mean maternal serum levels of CA 125 among women with pregnancies complicated by abruptio placentae than in control subjects. However, measurement of maternal serum CA 125 does not appear to be a useful marker for the diagnosis of abruptio placentae. At present, clinical diagnosis of abruptio placentae, with the aid of ultrasonography to rule out other causes of late gestational hemorrhage, should be considered the most sensitive and specific method of detecting this pregnancy complication.

Abruptio Placentae↗
PubMed1986

Association of prolonged, preterm premature rupture of the membranes and abruptio placentae.

Nine patients with prolonged, preterm premature rupture of the membranes (PROM) had associated abruptio placentae confirmed at delivery. Antepartum vaginal bleeding during the course of expectant management was the most common feature in the clinical course of the patients who developed abruptio placentae. Other clinical and laboratory findings suggesting the diagnosis were not present consistently. Retrospective analysis of all patients with prolonged, preterm PROM led to an estimated risk of 4% for the development of abruptio placentae during the course of expectant management of such patients. This risk estimate is three to eight times greater than that for the development of abruptio placentae in pregnancy generally. A high index of suspicion for abruptio placentae is appropriate when patients with prolonged, preterm PROM develop vaginal bleeding or any other suggestive clinical signs or symptoms of abruptio placentae during the course of expectant management.

Abruptio Placentae↗
PubMed1994

Abruptio placentae: perinatal outcome in normotensive and hypertensive patients.

OBJECTIVE: The objective of this study was to compare perinatal outcomes of hypertensive and normotensive women experiencing abruptio placentae. Our hypothesis is that hypertensive women have a less favorable perinatal outcome than do normotensive women. STUDY DESIGN: Women with the diagnosis of abruptio placentae delivered between July 1, 1988, and May 31, 1992, composed the study group (n = 226) in this case-control study. The incidence of abruptio placentae was 0.7% during this time. Those women with either multifetal gestations (n = 4) or delivery before 20 weeks' gestation (n = 2) were excluded from data analysis. The remaining 220 patients were divided according to their hypertensive (n = 29) or normotensive (n = 191) status. Maternal and neonatal medical records were reviewed and abstracted for demographic variables, antepartum complications, delivery route, abruptio placentae grade, neonatal gender, birth weight, Apgar score, cord pH, and perinatal mortality. These perinatal outcome variables were compared between the hypertensive and normotensive patient groups. RESULTS: Black women with abruptio placentae were significantly more likely to be hypertensive (p = 0.0078). Hypertensive women with abruptio placentae had the antepartum complication diabetes mellitus significantly more often than did normotensive women (p = 0.032). However, they were similar to normotensive women with regard to the frequency of positive urine drug screen and trauma. Hypertensive women were no more likely to be delivered before 32 or 37 weeks' gestation, have neonates weighing < 1500 or 2500 gm, or to be delivered by cesarean section. Abruptio placentae grades 2 and 3 occurred more often in hypertensive women (p = 0.053), as did significantly lower umbilical cord artery (p = 0.005) and venous (p = 0.003) pH values. Neonates from hypertensive women were no more likely to have low 5-minute Apgar scores or to die than those from normotensive women. CONCLUSION: Although hypertensive women experiencing abruptio placentae are more likely to have higher-grade abruptio placentae and lower umbilical cord pH values, the overall perinatal outcome was not significantly different from that of normotensive women experiencing abruptio placentae.

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PubMed1994

Factors associated with abruptio placentae in preterm deliveries.

OBJECTIVE: To evaluate risk factors associated with occurrence of abruptio placentae in preterm deliveries. METHODS: Risk factors were evaluated in 55 consecutive index cases of abruptio placentae and 726 control patients delivered between 24-36 weeks' gestation. RESULTS: In logistic regression analysis abruptio placentae was associated with a low number of antenatal visits, smoking in pregnancy, hypertension, intravenous drug abuse and a history of recent abdominal trauma. Among hypertensive disorders of pregnancy, preeclampsia superimposed on chronic hypertension was associated with the highest risk of premature placental separation. Finally, there was a significant trend relating duration of premature rupture of membranes with abruptio placentae (chi-square for trend = 3.93, p = 0.047). CONCLUSIONS: Several risk factors seem strongly associated with abruptio placentae in preterm deliveries; the presence of these risk factors should dictate intensive surveillance.

Abruptio Placentae↗
PubMed1987

Abruptio placentae following nipple stimulation.

A case of severe abruptio placentae evolved during the course of prepartum electronic fetal heart rate (FHR) monitoring which was associated with nipple stimulation. The fetal monitor tracing and clinical course are discussed. The unpredictability of abruptio placentae is underscored by the normal appearance of the FHR tracing immediately preceding the event. The association of nipple stimulation with abruptio placentae in this case raises concerns about the potential dangers of this surveillance technique.

Abruptio Placentae↗
PubMed1995

Preterm premature rupture of membranes and abruptio placentae: is there an association between these pregnancy complications?

OBJECTIVE: Our purpose was to determine whether the incidence of abruptio placentae is increased in pregnancies with preterm premature rupture of membranes and to assess whether certain clinical risk factors in this group predispose them to have abruptio placentae. STUDY DESIGN: A retrospective cohort study over a 2.5-year period was performed. The study group consisted of 756 singleton pregnancies between 20 and 36 weeks' gestation complicated by preterm premature rupture of membranes and managed expectantly. The control group consisted of 11,240 pregnancies not complicated by preterm premature rupture of membranes and delivered during the same time period. The incidence of abruptio placentae was compared between the two groups. The study group of patients with preterm premature rupture of membranes was further subdivided into cases with (n = 38) and without abruptio placentae (n = 718) and compared. Clinical factors such as admission amniotic fluid index, history of bleeding before or after rupture of membranes, incidence of intrapartum fetal distress, and low 5-minute Apgar scores (< 6), latency-to-delivery interval, gestational age and weight at delivery, and incidence of amnionitis and endometritis were compared. RESULTS: The incidence of abruptio placentae in the study group (38/756, 5%) was significantly higher than that in the control group (97/11, 240, 0.9%) (p < 0.001, odds ratio = confidence interval). Comparison of cases with preterm premature rupture of membranes with and without abruptio placentae demonstrated both groups to have a similar gestational age at delivery, birth weight, latency-to-delivery interval, amniotic fluid index, and infectious morbidity. The group with abruptio placentae had a significantly higher incidence of bleeding before rupture of membranes (six of 38, 15% vs eight of 718, 1%; p < 0.005) and of intrapartum fetal distress (18/38, 46% vs 49/718, 7%; p < 0.0009). CONCLUSIONS: Pregnancies complicated by preterm premature rupture of membranes that are managed expectantly are at significant risk for abruptio placentae. Preterm premature rupture of membranes in such cases is more often preceded by bleeding. These abruptions may predispose the patient to intrapartum fetal distress.

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