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PubMed1992

Painless abruptio placentae associated with disseminated intravascular coagulation and syncope.

Abruptio placentae is a complication of pregnancy associated with significant morbidity and mortality for both fetus and mother. The presence of uterine pain and tenderness traditionally has been considered a useful criterion for distinguishing abruptio placentae from other causes of bleeding in pregnancy. We report the case of a 25-year-old woman who presented with painless abruptio placentae and coagulopathy during the second trimester. This case illustrates the importance of considering this diagnosis in pregnant patients with vaginal bleeding.

Abruptio Placentae↗

PubMed1985

Abruptio placentae with coagulopathy: a rational basis for management.

Abruptio placentae rarely produces severe maternal complications while the fetus is alive in utero. The advent of fetal death (grade III) indicates a severe form of abruptio placentae and a real risk that an overt coagulopathy might develop (grade IIIB). Overt coagulopathy associated with a live fetus is, however, uncommon. The advent of an overt coagulopathy should be viewed as ominous. Treatment of abruptio placentae with overt coagulopathy should be directed toward obtaining a rapid and atraumatic vaginal delivery. Once delivery has occurred, spontaneous reversal of the coagulopathy can be anticipated. In the opinion of one of the authors (G.S.), the advent of severe consumption coagulopathy and/or uterine inertia is an indication for intravenous therapy with aprotinin. It has been shown that such therapy will limit DIC, reverse fibrinolysis, reawaken uterine activity, and lead to rapid vaginal delivery within 6-8 hours. Aprotinin is not commercially available for clinical use in the United States. Prolongation of the abruption-delivery interval will worsen maternal prognosis. Accordingly, the advent of uterine inertia prior to complete cervical dilatation is an indication for immediate cesarean section in circumstances where aprotinin is not available. Following delivery, the physician should be on the lookout for postpartum hemorrhage, which may necessitate immediate transfusion, the administration of oxytocics, and/or uterine manipulation. Surgical intervention is rarely indicated in such cases. The patient should also be carefully observed over the ensuing days and weeks for the evolution and resolution of complications, such as renal failure, pulmonary insufficiency, and panhypopituitarism.

Abruptio Placentae↗

PubMed1993

Blunt abdominal trauma: are there any predictive factors for abruptio placentae or maternal-fetal distress?

OBJECTIVES: Our objectives were to determine the incidence of abruptio placentae and fetal distress in pregnant women with noncatastrophic blunt abdominal trauma and to determine the utility of historical factors, clinical presentation, coagulation profile, and fetal monitoring in predicting fetal and maternal morbidity. STUDY DESIGN: We reviewed 233 consecutive hospitalizations for noncatastrophic blunt abdominal trauma. Outcome variables included abruptio placentae, fetal distress, preterm birth, and abnormal laboratory values. RESULTS: Preterm delivery (< 34 weeks) occurred within 1 week of trauma in only two patients (< 1%). Fetal distress was diagnosed between 4 and 48 hours after observation in four women (1.7%). These four patients had frequent contractions, but none had abruptio placentae at delivery. Six patients (2.6%) had abruptio placentae. None of these had fetal distress. All had a good neonatal outcome. Coagulation studies and Kleihauer-Betke tests were not predictive of fetal or maternal morbidity. CONCLUSION: Noncatastrophic blunt abdominal trauma is associated with a low frequency of abruptio placentae, fetal distress, maternal coagulopathy, and poor neonatal outcome. Prolonged monitoring is indicated only when there is evidence of impending abruptio placentae. Kleihauer-Betke testing is necessary only for patients who are Rh negative. Coagulation profiles are not clinically helpful. Routine hospitalization beyond 4 hours is not warranted.

Abdominal Injuries↗

PubMed2001

Perinatal and maternal outcome following abruptio placentae.

OBJECTIVE: To characterize the maternal and fetal presentation of abruptio placentae and associated maternal and fetal morbidity and mortality by mode of delivery and fetal status on admission. STUDY DESIGN: Perinatal data (gestational age > 24 weeks) from women with abruptio placentae at a tertiary referral center were analyzed. For the purpose of evaluating fetal morbidity and mortality, group 1 included women with hypertensive disorders of pregnancy (preeclampsia or chronic hypertension), PROM, cocaine abuse, and > 20% abruptio placentae without regard to fetal status on admission (reassuring, nonreassuring, or stillborn). In group 1, either umbilical artery pH < 7.0, Apgar < 3(5), or base excess > 12 mmol/L represented perinatal hypoxia for this evaluation. Group 2 included women with stillborn fetuses on admission without regard to etiology or size of abruptio placentae. Comparisons between groups were made with one-way analysis of variance, Kruskal-Wallis, or chi2 tests; p < 0.05 was considered significant. RESULTS: Group 1 was comprised of 342 women; 58.4% of fetuses had abnormal fetal heart rate tracings. Overall, the sensitivity of an abnormal fetal heart rate tracing to predict perinatal hypoxia was 87.2%, specificity was 33.9%, positive predictive value was 22.2%, and negative predictive value was 92.5%. Of parameters suggestive for perinatal hypoxia, 17.3% of neonates had Apgar < 3(5), 13.0% had umbilical artery pH < 7.0, and 9.9% had base excess > 12 mmol/L. Overall, neonatal survival was 84.7%; 12.0% of fetuses were stillborn. For those fetuses alive on admission, cesarean delivery was associated with a significant reduction in neonatal mortality: odds ratio of 0.10 (95% confidence interval: 0.05-0.20) and p = 0.0001. Group 2 was comprised of 61 women. Women presenting with a stillborn infant on admission were more likely to require transfusions and suffer the complications (disseminated intravascular coagulopathy, acute renal failure, and acute respiratory distress syndrome) than women presenting with a live fetus. CONCLUSION: Cesarean delivery appeared to reduce neonatal mortality. Whether emergent cesarean delivery resulted in the birth of compromised fetus cannot be evaluated from this study. Composite maternal morbidity is increased when a stillborn fetus is present on admission.

Abruptio Placentae↗

PubMed2003

Comparison of neonatal outcome including cerebral palsy between abruptio placentae and placenta previa.

OBJECTIVE: Our purpose was to evaluate the neonatal prognosis after abruptio placentae and placenta previa during pre-term gestation. STUDY DESIGN: A case-control study was performed using a logistic regression model. A poor outcome was defined as neonatal death occurring before hospital discharge or a diagnosis of cerebral palsy. RESULTS: A poor outcome was more frequent in cases of abruptio placentae (11/42, 26.2%) than in placenta previa (2/72, 2.8%) and pre-term labor (1/120, 0.8%). The difference was mainly due to the incidence of cerebral palsy. A significant association of abruptio placentae (odds ratio (OR) 61.0, 95% confidence interval (CI 3.4-1084), delivery at <31 weeks of gestation (OR 19.0, CI 2.8-128.8), and low Apgar score (<7) at 5min (OR 70.8, CI 16.5-304.9) with increased risk of poor outcome was found in the logistic regression model that controlled for confounding effects. In abruptio placentae, a low Apgar score (<7) at 5min (OR 19.8, CI 2.0-197.8) was associated with increased risk of poor outcome in the logistic regression model. CONCLUSION: From the standpoint of poor perinatal outcome including cerebral palsy, abruptio placentae was the most significant clinical entity in pre-term gestation.

Abruptio Placentae↗

PubMed1980

Abruptio placentae and placenta previa: frequency, perinatal mortality, and cigarette smoking.

Abruptio placentae and placenta previa are responsible for at least half the excessive fetal and neonatal death associated with maternal smoking during pregnancy. Data from a large prospective study were analyzed to determine if stopping smoking reduced the frequency of these disorders. Mothers who stopped smoking had a 23% lower frequency of abruptio placentae and a 33% lower frequency of placenta previa than women who continued to smoke during pregnancy. The mothers who stopped smoking had only about half as many fetal and neonatal deaths due to abruptio placentae and one third fewer losses to placenta previa than did nothers who continued to smoke. These seeming benefits of stopping smoking were greatest in mothers 30 years of age and older.

Abruptio Placentae↗

PubMed1980

Abruptio placentae--treatment with the fibrinolytic inhibitor tranexamic acid.

Abruptio placentae is known to have a bad prognosis for the fetus. Pathologic proteolysis, e.g. a pathologic activation of the coagulation mechanism and/or the fibrinolytic system is known to be a common complication in such cases. Analysis of the coagulation factors and components of the fibronlytic system in the acute stage of 14 cases confirmed the earlier finding of mainly an activation of the fibrinolytic system, which argues for the use of a specific inhibitor. 73 consecutive cases of abruptio placentae were treated with tranexamic acid in the acute stage. 67 of the patients were immediately delivered by cesarean section. The remaining six patients were in early gestational age and were treated for a prolonged period. The perinatal mortality of the entire group was only 8 per cent and the maternal mortality nil. None of the cases were complicated by hemorrhagic diathesis or thromboses. We believe that routine immediate treatment with tranexamic acid can reduce the perinatal mortality in cases of abruptio placentae.

Abruptio Placentae↗

PubMed1999

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

OBJECTIVE: Our purpose was to characterize the clinical presentation or laboratory variables predictive of either abruptio placentae or eclampsia in women with severe preeclampsia. STUDY DESIGN: Prospective collection of perinatal data from 445 consecutively managed women with severe preeclampsia and eclampsia. Univariate analysis was used to determine which of the independent variables were significantly different between the groups (abruptio placentae vs no abruptio placentae; eclampsia vs no eclampsia). Those with significant differences were then entered into multiple logistic regression analysis to determine those characteristics that were independently related to the outcome variable (abruptio placentae or eclampsia). Before multivariate analysis, the independent variables with an interval scale of measurement were converted to a dichotomous scale, with the receiver-operator characteristic curve used to determine a cutoff level. RESULTS: Univariate analysis revealed statistical significance for the following variables associated with eclampsia: uric acid concentration, > 8.1 mg/dL; proteinuria (>3+); headache; visual symptoms; deep tendon reflexes >3+; serum albumin concentration, <3 mg/dL; and serum creatinine concentration, >1.3 mg/dL. However, with subsequent multivariate analysis, only headache and deep tendon reflexes >3+ remained significant. Univariate analysis for variables associated with abruptio placentae revealed an association between bleeding and platelet count <60,000/mm3. There was no association between abruptio placentae and eclampsia and systolic, diastolic, or mean arterial pressure, quantitative proteinuria, epigastric pain, bleeding, gestational age at delivery, history of preeclampsia, or chronic hypertension. CONCLUSION: Quantitative proteinuria and degree of blood pressure elevation were not predictive of either abruptio placentae or eclampsia, as has previously been suggested. The greatest morbidity associated with eclampsia occurred in women with preterm gestations not receiving medical attention.

Abruptio Placentae↗

PubMed2000

Abruptio placentae after auto accidents. A case-control study.

OBJECTIVE: To compare accident and injury characteristics in pregnant women with and without abruptio placentae involved in auto accidents (AAs). STUDY DESIGN: A retrospective, case-control study involving 12 pregnant women (16-39 weeks) with a diagnosis of abruptio placentae after AAs and 12 control subjects matched for gestational age (+/- 2 weeks) involved in AAs without abruptio placentae from 1988 through 1997. Numerous variables were compared, including restraint system use, estimated speed of the collision, injury severity score (ISS), clinical findings and patient position in the vehicle. Patient complaints and physical examination on admission were also recorded, and obstetric and neonatal outcomes were compared. Statistical analysis was performed using the independent sample t, Mann-Whitney and Fisher's exact tests, when appropriate. RESULTS: There was no significant difference in the frequency of unrestrained subjects or position in the vehicle between cases and controls. Estimated speed of the vehicle at the time of collision was significantly higher in the abruptio placentae group (> 30 mph, 92% vs. 50%, P = .03), as was the mean ISS code (20 [SD 12.71] vs. 4 [SD 5.13], P < .001). Abdominal pain and vaginal bleeding were seen more frequently in women with abruptio placentae as compared to controls (58% vs. 25% and 33% vs. 0, respectively). Patients with abruptio placentae had a higher incidence of preterm delivery (mean gestational age at delivery = 29 weeks [SD 7.99] vs. 36 weeks [SD 7.21], P = .008) and stillbirth (57% vs. 0%, P = .002) and lower mean birth weight (1,924 g [SD 931] vs. 3,069 g [SD 450], P = .003). There was no significant difference in cesarean section rates between the groups (58% vs. 30%, P = .23). There was no difference in the two groups in placental location on ultrasonography. CONCLUSION: Pregnant women who were involved in severe accidents (i.e., higher speed or ISS) were more likely to suffer abruptio placentae. In severe accidents, proper restraints were frequently not used. Because of the severity of these accidents, current restraint systems may not be sufficient to prevent abruptio placentae even with proper restraint use. Efforts toward designing new restraint systems for pregnant women should be encouraged.

Abruptio Placentae↗

PubMed2006

Risk factors of abruptio placentae among Peruvian women.

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

Abruptio Placentae↗

PubMed1995

[Abruptio placentae--a clinical diagnosis?].

The diagnosis of abruptio placentae is based on clinical symptoms and the classical presentation seldom causes diagnostic doubt. There is no significant correlation between the presenting symptoms and degree of placental abruption. Additional diagnostic parameters would be useful in cases with few symptoms. The survey describes the clinical presentation and diagnosis. The use of paraclinical tests in diagnosing, monitoring and estimating prognosis in cases with suspicion of abruptio placentae is reviewed.

Abruptio Placentae↗

PubMed1977

Abruptio placentae and perinatal death: a prospective study.

Abruptio placentae caused 3.96 perinatal deaths per 1,000 births in a large prospective study. Intrapartum but not prepartum maternal hypertension was observed in the fatal cases. Decidual necrosis at the placental margin and large placental infarcts were the most characteristic placental abnormalities. The decidual necrosis was correlated with maternal cigarette smoking and low pregnancy weight gains in the abruption placentae cases. The fetuses and neonates who died had a pattern of growth retardation characteristic of antenatal undernutrition, indicating that poor maternal nutrition during pregnancy may have contributed to the genesis of the abruptio placentae.

Abruptio Placentae↗

PubMed1998

Abruptio placentae: risk factors and perinatal outcome.

OBJECTIVE: It is a case control study, conducted in order to determine the risk factors, and to find out the perinatal outcome of abruptio placentae in women delivered at the Princess Badeea Teaching Hospital in North Jordan. METHODS: We reviewed all cases of placental abruption delivered between 15th April 1994 till 26 November 1995 and to compare that with pregnancies and deliveries not complicated by abruptio placentae. RESULTS: During the study period there were 108 cases of abruptio placentae and 108 cases of the control group. The total number of women delivered were 18,256, so the incidence of abruptio placentae was 5.9 per 1000 births. When compared to the control group, abruptio placentae occurred more in parous women (para > or = 5) (p < 0.0005), more preterm deliveries (p < 0.0001) with more birth weight < 2,500 g (p < 0.0001). Preeclampsia and pregnancy induced hypertension, intrauterine growth retardation, caesarean delivery, and intrauterine fetal death occurred more in patients with abruptio placentae. CONCLUSION: High parity, preeclampsia and hypertension are significant etiological determinants of abruptio placentae.

Abruptio Placentae↗

PubMed1990

Pregnancy, abruptio placentae and cocaine.

Widespread cocaine use has caused concern about possible harmful effects during pregnancy. Several studies have suggested an increased incidence of abruptio placentae and stillbirths with cocaine use during pregnancy. This study examined what percentage of pregnant women in a lower socioeconomic population use cocaine, as well as positive urine cocaine screens in those with abruptio placentae and intrauterine fetal death (IUFD). Thirty patients were enrolled in the control group, eight in the abruptio placentae group and five in the IUFD group. One of 30 controls, one of eight in the abruptio placentae group and none of the IUFD group urines were positive for cocaine. A higher percentage of those in the abruptio placentae group had a history of abruptio placentae or fetal death, suggesting possible prior drug use. This group also had little, if any, prenatal care. Cocaine abusers may show signs of abuse in their obstetrical histories.

Abruptio Placentae↗

PubMed1993

A rapid test for abruptio placentae: evaluation of a D-dimer latex agglutination slide test.

OBJECTIVE: Our purpose was to evaluate a rapid latex agglutination slide test for D-dimer, a byproduct of clot lysis, in the prediction of abruptio placentae. STUDY DESIGN: Four groups were studied: (1) 15 patients with normal pregnancies at 40 weeks' gestation, (2) 17 participants with preeclamptic pregnancies, (3) 14 patients with preterm labor, and (4) 15 patients with confirmed abruptio placentae. The latex agglutination slide test was performed with positive and negative reference solutions and plasma dilutions of 1:1, 1:2, 1:4, and 1:8. A test was considered positive if, at 2 minutes, agglutination was present at dilutions of > or = 1:2 (> or = 1.0 micrograms/ml fibrin equivalent units). Test results were compared in patient groups with and without abruptio placentae by means of the chi 2 test. RESULTS: The likelihood of a positive D-dimer test result was not significantly different among patients in the non-abruptio placentae groups (p = 0.454). Patients in the abruptio placentae group were significantly more likely to have a positive D-dimer slide test result than those in the non-abruptio placentae groups (p = 0.0001). The D-dimer test conferred sensitivity, specificity, positive predictive value, and negative predictive value of 67%, 93%, 91%, and 48%, respectively. In contrast, other laboratory measures of coagulation (e.g., platelet count, prothrombin time, partial thromboplastin time, and fibrinogen levels) yielded no better than a 20% sensitivity for abruptio placentae. CONCLUSIONS: The D-dimer slide test may be a superior rapid method to improve early diagnosis of abruptio placentae.

Abruptio Placentae↗

PubMed1995

Low-dose aspirin: lack of association with an increase in abruptio placentae or perinatal mortality.

OBJECTIVE: To perform a meta-analysis determining the association of low-dose aspirin treatment with subsequent abruptio placentae or perinatal mortality. DATA SOURCES: Studies were identified and selected using the MEDLINE bibliographic data base of entries from January 1985 through April 1994. In addition, a manual search was performed using the references from all retrieved reports, review articles, and chapters from textbooks. METHODS OF STUDY SELECTION: Three criteria were used to select studies for inclusion: 1) Studies were designed as randomized or double-blind clinical trials; 2) aspirin was administered in doses of less than 200 mg/day; and 3) outcome data included the incidence of abruptio placentae and perinatal mortality. Three studies did not report the occurrence of abruptio placentae, but the authors of those papers answered written requests for such data. A total of 11 studies met our inclusion criteria. DATA EXTRACTION AND SYNTHESIS: We independently evaluated the study methods for each trial and abstracted quantitative outcome data. For each outcome, relative risk, risk differences, and 95% confidence intervals were calculated. The diagnosis of abruptio placentae was taken as self-reported in each trial. No trial of low-dose aspirin in pregnancy had predefined criteria for the diagnosis of abruptio placentae, and abruption was not a primary outcome in any of the 11 trials. We combined data from all studies and compared the data from the randomized trials to those from the double-blind studies. CONCLUSION: We found no increased risk for abruptio placentae or increased perinatal mortality in women taking low-dose aspirin.

Abruptio Placentae↗

PubMed1978

Abruptio placentae. An assessment of the time and method of delivery.

Abruptio placentae occurs once per 120 deliveries, but accounts for 15--25% of all perinatal mortality. Several series in the literature suggest that an abnormal fetal-maternal relationship exists in patients with abruptio placentae weeks prior to the actual placental separation and that the separation is only the terminal event. A review of the literature and an analysis of 388 cases of abruptio placentae from the US Navy Coding System were undertaken. It was found that approximately 75% of fetal deaths occurred more than 90 minutes after admission to the hospital and almost 70% of all perinatal mortality occurred in infants who were delivered more than 2 hours from the time of diagnosis. Delivery by cesarean section improved survival in those infants weighing 1500 g or greater and reduced perinatal mortality as much as fourfold in some reports. A prospective study is proposed which would compare two methods of management of this condition.

Abruptio Placentae↗

PubMed2005

Risk factors for severe abruptio placenta in Mulago Hospital, Kampala, Uganda.

OBJECTIVE: To determine the risk factors for severe abruptio placenta in Mulago hospital, Kampala, Uganda. DESIGN: A case control study. SETTING: Mulago hospital labour wards Study population: Women who delivered in Mulago hospital. PARTICIPANTS: Forty five women with severe abruptio placenta (cases) were recruited between 15(th) November 2001 and 30(th) November 2002. They were followed up and compared to five hundred women (controls) who had normal deliveries. OUTCOME VARIABLES: Socio-demographic characteristics, familial history, medical history, gynaecological and obstetric history. RESULTS: The risk factors for severe abruptio placenta were low socio economic status (OR 10.5,95% CI 3.8 to 29.2), co existing hypertension (OR 56.8, 95% CI 9.0 to 358.5), previous history of stillbirth (OR 3.1,95% CI 1.1 to 9.1), delivery by caesarean section in previous pregnancy (OR 7.3, 95% CI 1.8 to 29.7), non attendance of antenatal care(OR 6.5, 95% CI 2.0 to 21.2), recurrent vaginal bleeding(OR 26.7, 95% CI 8.6 to 85.4) and delivery of male babies(OR 2.2, 95% CI: 1.2 to 4.9). CONCLUSION: The risk factors for abruptio placenta were chronic hypertension, recurrent vaginal bleeding, previous delivery with caesarean section and low socio economic status. These factors can be identified during prenatal period and used to prevent maternal morbidity and mortality.

Abruptio Placentae↗