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PubMed1998

Costs of maternal conditions attributable to smoking during pregnancy.

CONTEXT: Despite known adverse health effects, many women continue to smoke during pregnancy. Public attention has now focused on the economic as well as health effects of this behavior. OBJECTIVE: To estimate health care costs associated with smoking-attributable cases of placenta previa, abruptio placenta, ectopic pregnancy, preterm premature rupture of the membrane (PPROM), pre-eclampsia, and spontaneous abortion. DESIGN: Pooled odds ratios were used with data on total cases to estimate smoking-attributable cases. Estimated average costs for cases of ectopic pregnancy and spontaneous abortion were used to estimate smoking-attributable health care costs for these conditions. Incremental costs, or costs above those for a "normal" delivery, were used to estimate smoking-attributable costs of placenta previa, abruptio placenta, PPROM, and pre-eclampsia associated with delivery. SETTING: National estimates for 1993. PARTICIPANTS: Data from the National Hospital Discharge Survey (NHDS) and claims data from a sample of large, self-insured employers across the country. RESULTS: Smoking-attributable costs ranged from $1.3 million for PPROM to $86 million for ectopic pregnancy. Smoking during pregnancy apparently protects against pre-eclampsia and saves between $36 and $49 million, depending on smoking prevalence. Over all conditions smoking-attributable costs ranged from $135 to $167 million. CONCLUSIONS: Smoking during pregnancy is a preventable cause of higher health care costs for the conditions studied. While smoking during pregnancy was found to be protective against pre-eclampsia and, hence, saves costs, the net costs were still positive and significant. Effective smoking-cessation programs can reduce health care costs but clinicians will perhaps need to manage increased cases of pre-eclampsia in a cost-effective manner.

Abortion, Spontaneous↗
PubMed2005

Pregnancy outcome following recurrent spontaneous abortions.

OBJECTIVE: The purpose of the present study was to examine the association between spontaneous consecutive recurrent abortions and pregnancy complications such as hypertensive disorders, abruptio placenta, intrauterine growth restriction and cesarean section (CS) in the subsequent pregnancy. METHODS: A population-based study comparing all singleton pregnancies in women with and without two or more consecutive recurrent abortions was conducted. Deliveries occurred during the years 1988-2002. Stratified analysis, using a multiple logistic regression model was performed to control for confounders. RESULTS: During the study period 154,294 singleton deliveries occurred, with 4.9% in patients with history of recurrent consecutive abortions. Using a multivariate analysis, with backward elimination, the following complications were significantly associated with recurrent abortions-advanced maternal age, cervical incompetence, previous CS, diabetes mellitus, hypertensive disorders, placenta previa and abruptio placenta, mal-presentations and PROM. A higher rate of CS was found among patients with previous spontaneous consecutive recurrent abortions (15.9% versus 10.9%; OR = 1.6; 95% CI, 1.5-1.7; P < 0.001). Another multivariate analysis was performed, with CS as the outcome variable, controlling for confounders such as placenta previa, abruptio placenta, diabetes mellitus, hypertensive disorders, previous CS, mal-presentations, fertility treatments and PROM. A history of recurrent abortion was found as an independent risk factor for CS (OR = 1.2; 95% CI, 1.1-1.3; P < 0.001). About 58 cases of inherited thrombophilia were found between the years 2000-2002. These cases were significantly more common in the recurrent abortion as compared to the comparison group (1.2% versus 0.1%; OR = 11.1; 95% CI, 6.5-18.9; P < 0.001). CONCLUSION: A significant association exists between consecutive recurrent abortions and pregnancy complications such as placental abruption, hypertensive disorders and CS. This association persists after controlling for variables considered to coexist with recurrent abortions. Careful surveillance is required in pregnancies following recurrent abortions, for early detection of possible complications.

Abortion, Habitual↗
PubMed2003

Anemia in the newborn.

In neonatal period anemia is a complex problem owing to the unique blood picture. The erythrocytic system undergoes serial adaptation to meet progressively changing demands of oxygen in the embryo, the fetus and neonate. This leads to rapid change in normal hematological change in post-birth period. Definition of anemia is difficult because as described earlier, several important factors influence normal blood in the newborn infants. The etiology of neonatal anemia can be classified into i) hemorrhage (ii) hemolysis (iii) failure of red cell production. Severe fetal hemorrhage may accompany various placental anomalies like placenta praevia, abruptio placenta and accidental incision of placenta during the caesarian section. It is reported that 10% of all infants born following placenta praevia and 4% of infants born following abruptio placenta present with severe anemia. The passage of fetal erythrocytes in maternal circulation occurs commonly during pregnancy. In 50% of pregnancies some fetal cells are passed in maternal circulation sometimes during gestation or during birth process. Treatment of a neonate with anemia due to blood depends on the degree of hypovolemia or anemia and whether the blood loss has been acute or chronic. Newborn with pale skin should be differentiated from an asphyxiated baby.

Anemia↗
PubMed1996

Risk factors for preterm birth in an upper middle class Chinese population.

OBJECTIVE: To examine the risk factors associated with preterm birth in an upper middle class Chinese population. STUDY DESIGN: From March 1994 to February 1995, a total of 301 cases (gestational age between 20 and 37 weeks) and 656 controls (gestational age at or greater than 37 weeks) were recruited at Mackay Memorial Hospital, Taipei, Taiwan. Using a case-control study design, logistic regression was used to examine the relative significance of various risk factors associated with preterm birth. RESULTS: Age and educational level were identified as significant risk factors for preterm birth. Multiple pregnancies, fetal congenital anomalies, placenta previa or abruptio placentae, and preeclampsia were found to be strongly associated with preterm birth (crude odds ratios between 6.37 and 25.89); vaginal bleeding during or after the first trimester, prior history of preterm delivery, and two or more previous first trimester abortions were associated with preterm birth to a lesser extent (crude odds ratios between 1.67 and 2.9). The magnitude of the increased risk associated with these variables in preterm birth did not show change to any great extent after age and educational level were adjusted for. Further stratification of these cases into groups with and without premature rupture of the membranes (PROM), showed that a multiple pregnancy was still the leading risk factor of preterm birth in both groups. Carrying an abnormal fetus was the next important risk factor for preterm birth in cases with PROM, but was less important in the group without PROM. However, placenta previa or abruptio placentae and preeclampsia were the next most important factors in the group without PROM. CONCLUSIONS: Unfavorable current obstetric conditions and a history of more than two prior abortions and preterm delivery were positively associated with preterm birth.

Abruptio Placentae↗
PubMed2001

[Bleedings during the third term: which complications?].

BACKGROUND: The aim of this research was to study the maternal and prenatal complications which may occur in the abruptio placentae and in placenta praevia. METHODS: All the patients who were hospitalized in the Obstetrics and Gynaecology Department of the Policlinico Umberto I, from January 1993 to July 2000 have been studied. Moreover, a comparative study between the onset of complications of the two pathologies considered and the ones found in a control group was carried out. We found 62 cases of placenta previa and 48 cases of abruptio placentae. The total amount of childbirths was 6861, so the incidence of abruptio placentae was 0.007%, while the incidence of placenta previa was 0.009%. RESULTS: The results show that the most frequent maternal complication, in both pathologies, was haemorrhage. We did not find any statistically meaningful difference between the percentage of haemorrhage in the two pathologies ( p=0.0608), but we noted a higher percentage of haemorrhage compared to the control group. The number of hysterectomies was higher in patients with placenta previa compared to patients with abruptio placentae. The most frequent fetal complication was premature birth, significantly more frequent than in the control population (p=0.0210). CONCLUSIONS: As a matter of fact, we can affirm that, in all its clinical manifestations abruptio placentae is a more dangerous disease than the placenta previa, except in the complications of the discharge of the afterbirth and of the postpartum, where haemorrhage and uterus atony lead to a great number of hysterectomies.

Abruptio Placentae↗
PubMed1996

Long-term effects of cesarean sections: ectopic pregnancies and placental problems.

OBJECTIVE: Few studies on the long-term effects of cesarean sections exist. The purpose of this study was to investigate the occurrence of three long-term effects, ectopic pregnancy, placenta previa, and abruptio placentae, in the subsequent pregnancy. STUDY DESIGN: This retrospective cohort study was based on two nationwide registers in Finland: the birth register and the hospital inpatient register. Women (n = 16,938) having had a cesarean section (exposed women) and a matched control group were identified from the birth register. The occurrence and outcome of the first subsequent pregnancy was determined from the 1987 to 1993 hospital inpatient register and the first subsequent birth from the 1987 to 1993 birth register. RESULTS: During the follow-up time in the hospital inpatient register, fewer exposed women had a completed pregnancy. Ectopic pregnancy was more common among the exposed women than among the controls (risk ratio 1.28). In the first subsequent birth abruptio placentae was more common among primiparous (at index the birth, risk ratios of 3.22 in hospital inpatient register and 2.41 in birth register) and multiparous women (4.52 in hospital inpatient register and 3.89 in birth register). Placenta previa was more common among primiparous exposed women than among control women (risk ratio 5.34 in hospital inpatient register and 3.78 in birth register). CONCLUSIONS: Cesarean section is a modest risk factor for ectopic pregnancy and an important risk factor for placental problems.

Abruptio Placentae↗
PubMed2004

[Effect of smoking during pregnancy on maternal condition and birth outcome--overview of epidemiologic studies].

The association between maternal smoking and retarded fetal grow was first time described in 1957, and now is well know. In addition smoking during pregnancy increases risk of spontaneous abortion, placenta previa, abruptio placenta, preterm premature rupture of membranes, stillbirth, preterm delivery and congenital malformations. The risk for most of these conditions has been found to increase with the number of cigarettes smoked and on the other hand women who stopped smoking during pregnancy are at the lower risk for most of those pathologies.

Abruptio Placentae↗
PubMed2000

Perinatal complications associated with maternal tobacco use.

The use of tobacco products by pregnant women is associated with placenta previa, abruptio placentae, premature rupture of the membranes, preterm birth, intrauterine growth restriction and sudden infant death syndrome. Approximately 15-20% of women smoke during pregnancy. It has been suggested that smoking is responsible for 15% of all preterm births, 20-30% of all infants of low birthweight, and a 150% increase in overall perinatal mortality. Cigarette smoking is one of the most important and modifiable risk factors associated with adverse perinatal outcomes.

Abruptio Placentae↗
PubMed1984

Marijuana and alcohol use in pregnancy.

The literature is sparse on the adverse effects of moderate alcohol consumption and marijuana use during pregnancy. Recent studies have evaluated the association of these drugs of abuse with pregnancy outcome, each using interview and medical record data of over 12 000 women. Children of marijuana users were more likely to have one or more major malformations, lower birthweight, and shorter gestation than children of nonusers. However, when logistic regression was used to control for other variables, these relationships were not statistically significant. The odds ratio for major malformations does, however, remain suggestive for marijuana. The use of similar logistic regression techniques revealed that the only statistical association between alcohol intake of 14 or more drinks per week was placenta abruptio. With the exception of placenta abruptio, alcohol intake of fewer than 14 drinks weekly was not associated with an increased risk of any adverse outcome. There was no association between alcohol use at any level and the rate of congenital malformations. Recommendations based on these data are presented.

Abnormalities, Drug-Induced↗
PubMed2000

A comprehensive program to improve safety for pregnant women and fetuses in motor vehicle crashes: a preliminary report.

OBJECTIVE: A program was developed to study the mechanisms of abruptio placentae and pregnancy loss caused by motor vehicle crashes. The results were intended to be used to develop strategies to improve protection of the fetus in this setting. STUDY DESIGN: Four integrated projects were conducted: (1) seated anthropometric measurements and belt fit determination during pregnancy, (2) development of new models of traumatic abruptio placentae, (3) investigations of crashes involving pregnant women, and (4) the development of the second-generation pregnant crash dummy from these data and others. RESULTS: Twenty-two different pregnant subjects in five different height groups underwent serial measurements of abdominal surface contours, seat belt fit, and distances between the subjects and various landmarks in the automobile interior with a laboratory-designed "automobile seat" (seating buck). The abdomen was significantly closer to the steering wheel in the shorter stature group than among the taller women. Beginning at approximately 20 weeks' gestation the fundus of the uterus was above the lower rim of the steering wheel. Lap belts fit properly over the anterior superior iliac spine throughout gestation, but the lap belt overlapped the uterus in the midsagittal plane. Two separate mechanisms for traumatic abruptio placentae were tested: shear failure and tensile failure. In the shear failure model large circumferential strains in the uterine wall induce a shear strain across the uteroplacental interface, and the model predicts placental separation at a mean circumferential strain of -58% +/- 8%. By means of finite-element modeling, it was demonstrated that tensile failure might also be a mechanism that causes abruptio placentae during rapid deceleration of the uterus. Crash investigations were performed in 43 cases involving pregnant women beyond 20 weeks' gestation. There were a total of 8 fetal losses and 8 major complications (fetal survival with abruptio placentae, direct fetal injury, or preterm delivery before 34 weeks' as a result of the accident). The best predictors of fetal loss or adverse outcome were impact severity and proper seat belt use. With these newly acquired data a second-generation crash dummy, known as the Maternal Anthropomorphic Measurement Apparatus version 2b (MAMA-2b), is being developed. It incorporates strain gauges in the fundal region of the fluid-filled uterus plus pressure transducers in both the anterior and posterior uterus. Criteria are being developed to associate the likelihood of abruptio placentae with measurements from these instruments that correspond to the two major hypothesized mechanisms of abruptio placentae. CONCLUSION: An improved understanding of the elements of automobile crashes that cause fetal loss and other major pregnancy complications has been gained through this series of investigations.

Abdomen↗
PubMed1999

Causes of stillbirth: an analysis of 77 cases.

OBJECTIVE: To devise preventive measures for stillbirths, which account for more than 70% of perinatal deaths in Japan. METHODS: We retrospectively reviewed the medical records of 77 women with singleton pregnancies who gave birth to stillborn infants at > or = 30 weeks between 1979 and 1996 at our hospital. RESULTS: Major malformations were present in 21 (27%) of 77 infants, including 11 infants with anencephaly. Two infants (2.6%) were severely hydropic. Preeclampsia preceded the stillbirth and might have been an indirect cause of stillbirth in 21 (39%) of 54 women whose infants had normal formations. The cause of stillbirth in 33 non-preeclamptic women was unclear in 15 (28%), abruptio placentae in 9, fetal growth retardation in 3, the HELLP syndrome in 3, chorioamnionitis in 2, and cord accident in 1. Abruptio placentae also occurred in 9 of 21 preeclamptic patients. Thus, abruptio placentae was responsible for 18 (33%) of 54 stillborn infants with a grossly normal appearance. An autopsy was performed on only 13 (24%) of 54 infants with grossly normal appearance and did not provide new information relating to deaths. CONCLUSIONS: The causes of stillbirth were many and varied, with a large proportion having no obvious cause, although autopsies were underused. Increased monitoring for women with preeclampsia and early diagnosis and prompt delivery for women with abruptio placentae might be helpful in reducing the number of stillbirths.

Abruptio Placentae↗
PubMed2004

Hyperhomocysteinemia, pregnancy complications, and the timing of investigation.

OBJECTIVE: To assess associations between vitamin-dependent homocysteine metabolism and vascular-related pregnancy complications by considering interval between delivery and postpartum investigation and maternal age. METHODS: Case-control study performed at the University Medical Center Nijmegen in the Netherlands. Patients had experienced pregnancy-induced hypertension (n = 37), preeclampsia (n = 144), hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome (n = 104), recurrent early pregnancy loss (n = 544), abruptio placentae (n = 135), intrauterine growth restriction (n = 144), or intrauterine fetal death (n = 104). Controls comprised 176 women with uncomplicated obstetric histories. Oral methionine loading tests and fasting vitamin profiles were performed more than 6 weeks after delivery. Odds ratios and 95% confidence intervals were calculated after logistic regression analysis. RESULTS: Hyperhomocysteinemia was associated with an approximately 2-fold to 3-fold increased risk for pregnancy-induced hypertension, abruptio placentae, and intrauterine growth restriction. Cobalamin deficiency was associated with HELLP syndrome, abruptio placentae, intrauterine growth restriction, and intrauterine fetal death. Pyridoxal 5-phosphate deficiency increased the risk for pregnancy-induced hypertension 4-fold. These associations lost their significance after adjustment for time interval and maternal age. High red cell folate was associated with a decreased risk for abruptio placentae and intrauterine growth restriction. An increased creatinine concentration was associated with pregnancy-induced hypertension, preeclampsia, HELLP syndrome, and abruptio placentae. CONCLUSION: Hyperhomocysteinemia and vitamin deficiencies are largely determined by the interval between delivery and postpartum investigation and by maternal age. Time interval and maternal age should be considered in the risk estimation for vascular-related pregnancy complications.

Adult↗
PubMed2000

Risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome.

OBJECTIVE: This study was undertake to determine risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. STUDY DESIGN: Maternal medical records of pregnancies complicated by HELLP syndrome managed between July 1, 1992, and April 30, 1999, were reviewed. Risk factors evaluated included maternal age, parity, race, previous preeclampsia, chronic hypertension, gestational age at diagnosis, mean arterial blood pressure, nadir blood platelet count (<50,000 cells/microL vs > or =50,000 cells/microL), and peak serum levels of aspartate aminotransferase and lactate dehydrogenase. Maternal outcome variables analyzed included eclampsia, abruptio placentae, disseminated intravascular coagulopathy, pulmonary edema, pleural effusion, ascites, acute renal failure, liver hematoma, need for transfusion of blood products, cesarean delivery, and death. Statistical analysis was performed with the Student t test, the chi(2) test, and logistic regression analysis. RESULTS: A total of 183 women with HELLP syndrome were studied. Eclampsia was present in 6%, abruptio placentae was present in 10%, and disseminated intravascular coagulopathy was present in 8%. Forty-one women (22%) required transfusion of blood products. Incidence of eclampsia significantly decreased with increasing gestational age, from 16% at < or =28 weeks' gestation to 3% at >32 weeks' gestation (P <.05) and was higher among African American patients than among white patients (12% vs 3%; P <.05). Logistic regression analysis showed an independent relationship between eclampsia and race (P <.05). Incidence of abruptio placentae was higher among women with previous preeclampsia than among women without this clinical history (26% vs 5%; P <.05). Disseminated intravascular coagulopathy was significantly associated with abruptio placentae (P <.0001) and acute renal failure (P <.0001). A nadir platelet count of <50, 000/microL, a peak serum aspartate aminotransferase level of >150 U/L, and a peak serum lactate dehydrogenase level of >1400 U/L were not independent risk factors for adverse outcome. CONCLUSIONS: Among women with HELLP syndrome, African American race is a risk factor for eclampsia. Both acute renal failure and abruptio placentae are associated with disseminated intravascular coagulopathy. Laboratory parameters of HELLP syndrome are not independent risk factors for adverse maternal outcome.

Abruptio Placentae↗
PubMed2005

Outcome of adolescent pregnancy at a university hospital in Jordan.

OBJECTIVE: To determine whether adolescent pregnancies are associated with increased risk of adverse obstetrical outcome. MATERIALS AND METHODS: This is a retrospective study comparing the obstetric outcome of 267 adolescent pregnancies to 500 adult women pregnancies during the same period at a university hospital. RESULTS: Medical and obstetric complications including pregnancy-induced hypertension, diabetes mellitus, anemia, placenta praevia, abruptio placenta and multiple pregnancy were not different in both groups, where there was a significant increase of preterm labor in adolescent pregnancies compared to adult pregnancies (14.6 and 8%, respectively). Moreover, adolescent pregnancies when compared to adult pregnancies, were associated with a significantly higher incidence of forceps delivery (4.5 and 1.4%, respectively), neonatal intensive care unit admission (22.7 and 13.5%, respectively) and a lower incidence of caesarean section (7.1 and 16.8%, respectively). CONCLUSION: Adolescent pregnancies are associated with a favorable obstetric outcome apart from the higher incidence of preterm labor.

Adolescent↗
PubMed1991

Birth weights of infants of black and white mothers without pregnancy complications.

An analysis of 10,159 normal spontaneous vaginal deliveries was performed to examine racial differences in mean birth weight of infants whose mothers were without antepartum or intrapartum medical complications of pregnancy. The study was limited to black and white infants of low-income mothers who were inborn, singleton, and weighed greater than or equal to 500 gm at birth. High-risk maternal transfer patients and patients with hypertension, toxemia, bacteriuria, pyelonephritis, renal failure, diabetes, anemia, polyhydramnios, oligohydramnios, prolapsed cord, vaginal bleeding, placenta previa, abruptio placentae, prolonged rupture of membranes, maternal fever on admission, amnionitis, sexually transmitted diseases, or fewer than five prenatal care visits were excluded. When statistically significant differences in demographic characteristics were controlled, black infants had an average birth weight 181 gm less than that of white infants.

Birth Weight↗
PubMed1992

The predictive value of fetal heart rate monitoring: a retrospective analysis of 2165 high-risk pregnancies.

The predictive value of fetal heart-rate monitoring on fetal well-being was studied in 2165 high-risk pregnancies. 1883 reactive nonstress test (NST) patterns and 278 nonreactive NST patterns and 4 cases of sinusoidal pattern were obtained. Oxytocin challenge test (OCT) was applied to 263 nonreactive cases. OCT was not applied to 15 cases out of 278 nonreactive NST cases, because of placenta previa, abruptio placenta and previous cesarean section. There were 155 cases with negative OCT, 84 cases with positive OCT and 24 cases with equivocal, prolonged or severe variable decelerations. Sensitivity and specificity were for NST 50 and 88% and for OCT 60 and 67%. The positive and negative predictive values were 11 and 98% for NST and 18 and 93% for OCT. It is concluded that the reactive nonstress test is a reliable test for good outcome but a positive oxytocin challenge test is not a reliable test for poor outcome. Additional procedures are necessary such as assessment of fetal growth, doppler velocity waveforms and fetal biophysical profile to avoid unnecessary obstetric interventions and to reach good fetal outcome.

Adolescent↗
PubMed1995

The grand multipara.

Grandmultiparity (GMP) has long been considered an obstetric complication for both mother and fetus, although recent studies indicate that, with proper perinatal care, women with high-parity rates are no longer at high risk. The current study examines the outcome of delivery in 1700 women in their fifth or more delivery, as compared with two control groups: 622 primiparas and 735 multiparas (two to three previous deliveries). Excellent prenatal care was available free of charge to all parturients. Our objectives were to evaluate the management of GMP in contemporary obstetrics and to assess whether grand multiparas are still high-risk patients. The age of the grandmultiparas was significantly higher compared with with the control groups, which may explain the higher incidence among them of antenatal medical disorders, such as diabetes mellitus and hypertensive disease. No significant differences were found among the three groups for preterm or post-term births, small-for-gestational-age infants, polyhydramnios, oligohydramnios, perinatal death, fetal distress, multiple births, placenta previa, abruptio placentae or cord prolapse. Macrosomia was markedly higher in the grandmultiparas and multiparas than in nulliparas. Thus, our results indicate that good perinatal care can ensure better results in grandmultiparas, and that grandmultiparity no longer needs to be considered a high-risk obstetric category in our population.

Adult↗