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PubMed1975

Maternal and fetal outcome associated with hemoglobin E trait and hemoglobin E disease.

A study of 20 patients with hemoglobin E trait abnormality and 8 patients with hemoglobin E disease in pregnancy is presented. The hematologic abnormality in HbE hemoglobinopathy is mild though hemoglobin values are significantly lower than in HbA patients. Fetal wastage is no increased and the salvage rate is high (live births over 95 per cent). The mean birthweight of the baby in HbE patients is significantly lower than in HbA patients, but the incidence of prematurity is not significantly increased in HbE patients. Blood loss at delivery is not markedly affected by hemoglobin type. The incidences of postpartum hemorrhage, preeclampsia, and malaria are not significantly increased in HbE patients; the reason for the significant increase in incidence of abruptio placentae in HbE is not known. No maternal deaths or congenital fetal abnormalities were recorded. It is concluded that the course of pregnancy in HbE trait abnormality and HbE disease is relatively benign.

Abortion, Spontaneous↗

PubMed1992

Antepartum haemorrhage at the Port Moresby General Hospital: a retrospective study of 130 consecutive cases.

In a retrospective study of 130 out of 141 consecutive cases of antepartum haemorrhage admitted to the Obstetrics Unit of the Port Moresby General Hospital in the three years 1987 to 1989, 33% had abruptio placentae, 48% had placenta praevia and in 19% the cause of the APH could not be determined. Delivery was by caesarean section in 56% of cases compared to a caesarean section rate of 3% for the total obstetric population. Stillbirth rates per 1000 total births were 223 for all the 130 cases, 81 for the praevia group, 488 for the abruptio group and 120 for the indeterminate group. The stillbirth rate for all deliveries in the hospital in the year 1989 was 21.5/1000.

Abruptio Placentae↗

PubMed1998

[Morphologic findings in fetuses and placentas of late abortion in the 2nd trimester].

To investigate possible causes of abortion (and intrauterine foetal death) we reviewed clinical and morphological data of foetuses and placentas morphologically from 830 spontaneous abortions seen during a 12 years period (1978-1989) at the Institute of Pathology, University of Leipzig, and the Pathological Institute of Hoyerswerda. Our review showed that definite and possible causes of foetal death and abortion could be classified as placental, foetal maternal, and clinical. Placental changes, which included infection of the foetal membranes, disturbances of the uteroplacental circulation (abruptio placentae with bleeding) and placental dysmaturity, were the most important causes and accounted for 73.8% of the cases. Foetal causes mainly comprised multiple twin pregnancies and foetal malformations. In 20 cases (2.4%) we found malformations as a cause of foetal death and consecutive abortion. Overall, malformations were found in 7.5% of the cases examined. Maternal and obstetric complications of pregnancy were less frequent. In 16.5% of our cases, the cause of the abortion or intrauterine death remained obscure. However, since 1989, genetic analysis and prenatal diagnostic procedures have improved, bringing a greater knowledge on the spectrum and aetiology of possible developmental disorders in the foetus. This should reduce the number of unexplained abortions.

Abortion, Spontaneous↗

PubMed1995

Lymphocyte subsets and autoantibodies in pregnancies complicated by placental disorders.

PROBLEM: The survival of the fetoplacental unit might partly depend on down-regulation of rejection reactions. Pathological maternal cellular immune response mechanisms could therefore be of pathogenic importance in pregnancies complicated by placental disorders. METHOD: A flow-cytometric analysis of T-cell subsets and B-cell, as well as serological tests for anticardiolipin antibodies (aCL), antinuclear antibodies (ANA), and rheumatoid factor (RF) were done on 90 women with complicated pregnancies. The results were compared with that of nonpregnant women (n = 5), and normal pregnant women (n = 5) in the third trimester. RESULTS: Two women, suffering from severe preeclampsia and eclampsia respectively, had aCL on 12 and 13 units, respectively. ANA occurred in 11 patients with moderate and severe preeclampsia and intrauterine growth retardation. All women had negative RF tests. Within the CD4 T-helper subpopulations, the proportion of suppressor/inducer T-cell population (CD4+CD45RA+) significantly increased, while the memory and helper/inducer T-cells (CD4+CD45RO+ and CD4+CD29+) significantly decreased during normal pregnancy compared to nonpregnant controls. This deviation of CD4 subpopulations was not found, or was less pronounced, in complicated pregnancies. The proportion of cytotoxic T cells (CD8+S6F1+) was significantly reduced during normal pregnancy. This reduction was less pronounced in complicated pregnancies. CONCLUSION: Systemic immunological deviations toward suppression or decreased activity of the immunological response as seen in normal pregnancies, was not observed in preeclampsia, intrauterine growth retardation, intrauterine fetal death, and abruptio placentae. This lack of suppression or increased T-cell activity may have a primary pathogenic role in some women with a complicated pregnancy, or it may be secondary to the placental disorders.

Abruptio Placentae↗

PubMed2000

Primary aldosteronism in pregnancy.

Aldosteronism is a rare complication of pregnancy. We report a case of a 26-year-old woman who became pregnant soon after a diagnosis of primary aldosteronism due to left adrenal adenoma was made. Only oral potassium supplementation was required in addition to routine prenatal care until 36 weeks' gestation. Subsequently, antihypertensive medication was needed to control elevated blood pressure. A healthy male infant was delivered by cesarean section because of abruptio placentae. The postoperative course was uneventful. Left adrenalectomy was conducted eight months after delivery under laparoscopic visualization. In this case report, we discuss management of aldosteronism in pregnancy and review the literature.

Abruptio Placentae↗

PubMed2003

Chronic hypertension in pregnancy.

Hypertension is the most common medical disorder during pregnancy. Chronic hypertension is a serious medical complication in pregnancy with increased maternal and perinatal morbidity and mortality. Those who develop uncontrolled severe hypertension, those with target organ damage, and those who are poorly compliant with prenatal visits are at high risk for poor perinatal outcome. Maternal complications include abruptio placenta, stroke, and superimposed pre-eclampsia. Fetal complications include prematurity, low birth weight, and perinatal death. Careful antepartum, intrapartum and postpartum management of women with high-risk chronic hypertension in pregnancies may reduce morbidity and mortality.

Abruptio Placentae↗

PubMed1988

Pregnancy and liver transplantation.

A pregnancy after an orthotopic liver transplantation was associated with abruptio placentae and preterm delivery at 27.5 weeks. The mother's immediate postpartum period was complicated by a midgut volvulus through a mesenteric defect in the Roux-en-Y loop. Both mother and infant survived after prolonged hospitalization.

Abruptio Placentae↗

PubMed1994

Early morbidity and neurodevelopmental outcome in low-birthweight infants born after third trimester bleeding.

Neonatal mortality, morbidity, and neurodevelopmental sequelae were compared between a consecutive series of 77 liveborn, low-birthweight (less than 2500 g) infants delivered after third trimester bleeding and 154 appropriate control infants of similar gestational age. Infants born after abruptio placentae had lower Apgar scores at 1 minute and higher rates of acidosis in comparison with control infants. In multivariate analysis, the infants in this group had higher risks of severe intraventricular hemorrhage and poor outcome (neonatal death or cerebral palsy) in comparison with control infants. In placenta previa, the infants had a higher prevalence of respiratory distress syndrome, whereas unclassified antepartum bleeding was associated with a high rate of neonatal hypoglycemia. After adjustment, by logistic regression analysis, for the effect of confounding factors (gestational age, birthweight, social class, and education of the mother), the risk of minor infant neurodevelopmental abnormalities at 2-year follow-up was increased in infants delivered after total or partial placenta previa or after unclassified antepartum bleeding. Third trimester bleeding should be considered a strong risk factor for both short-term neonatal morbidity and subsequent infant neurodevelopmental impairment in the low-birthweight infant population.

Abruptio Placentae↗

PubMed1998

Chronic abruption-oligohydramnios sequence.

OBJECTIVE: To determine outcome in patients with chronic abruption. STUDY DESIGN: A retrospective review was performed of all patients delivering at a tertiary medical center during a 54-month period. All patients with a diagnosis of placental abruption with oligohydramnios or ruptured membranes were included. Chronic abruption-oligohydramnios sequence (CAOS) was defined by the following criteria: (1) clinically significant vaginal bleeding in the absence of placenta previa or other identifiable source of bleeding, (2) amniotic fluid volume initially documented as normal, and (3) oligohydramnios (amniotic fluid index < or = 5) eventually developing without concurrent evidence of ruptured membranes. RESULTS: Twenty-four patients with CAOS were identified. Fourteen had first evidence of abruption at < 20 weeks' gestational age. A clot was identified between the chorion and uterus in 18/24. The mean gestational age at the first bleeding episode was 19.4 +/- 5.5 (SD) weeks, with the mean gestational age at delivery 28.1 +/- 4.5 weeks. Preterm premature membrane rupture occurred in 15/24. In these 15 there was a mean of 11.5 +/- days between the diagnosis of oligohydramnios and of ruptured membranes. Patients whose first blood occurred at < 20 weeks' gestation delivered at a gestational age of 26.1 +/- 3.9 weeks versus 33.0 +/- 5.3 weeks for the control group. CONCLUSION: CAOS can occur in pregnancies complicated by abruptio placentae. If it develops, the mean gestational age at delivery is 28 weeks.

Abruptio Placentae↗

PubMed1981

Decrease prostacyclin production: a characteristic of chronic placental insufficiency syndromes.

Prostacyclin production in neonates born at various gestational ages (28 weeks to term) was compared with that in neonates born of pregnancies complicated by various acute and chronic placental insufficiency states. Prostacyclin levels were reflected by the amount of conversion of 14C arachidonic acid to 6-keto-PGF1 alpha (the stable end-product of prostacyclin) by umbilical arteries. The uptake of 14C arachidonic acid by the umbilical arteries was also determined, and since this was similar for all groups it was not the cause of the differences noted in prostacyclin production. Neonates born of normal pregnancies had similar levels of prostacyclin production regardless of gestational age. Prostacyclin production was very low in neonates born of pregnancies complicated by chronic placental insufficiency (intrauterine growth retardation, essential hypertension, and pre-eclampsia), but normal with acute placental insufficiency (abruptio placentae). Hence the decrease in fetal prostacyclin production in pre-eclampsia is not related to gestational age; furthermore, it is also seen in other chronic placental insufficiency states.

6-Ketoprostaglandin F1 alpha↗

PubMed1977

Clinical experience with the contraction stress test.

During a period of 16 months, 1 170 contraction stress tests (CST) were performed on 767 women who were at high risk of losing their babies. The tests were positive in 42 patients, of whom 29 were subsequently delivered by caesarean section. Fetal distress, which necessitated caesarean section, occurred in 5 of 6 cases of intra-uterine growth retardation in which labour was induced. Abruptio placentae caused the intra-uterine death of 4 fetuses, 3 of which died within 7 days of a negative CST. The low perinatal mortality rate of 13 demonstrates the reliability of the CST in the evaluation of placental function in obstetric patients who are at high risk.

Abruptio Placentae↗

PubMed1992

[Obstetric complications associated with DIC. Importance of D-dimer in the diagnosis and treatment. A clinical case].

The case of a 32-year old woman with 36-week pregnancy presented at hospital because of spontaneous vaginal bleeding, anemia and mild hypotension is reported. Fetal mors in utero, abruptio placentae and diffuse intravascular coagulation were diagnosed. The patient subsequently underwent cesarean section and large retroplacental hematoma was removed and obviously fetum. The DIC was easily controlled by means of recently introduced method of determination of fibrin D-dimer.

Abruptio Placentae↗

PubMed1977

Placental infarction leading to fetal or neonatal death. A prospective study.

The pathogenesis of perinatal death due to placental infarction was analyzed in a large prospective study that included more than 1000 medical, demographic, hereditary, and postmortem variables. The disorder was the fifth most frequent cause of death in the study with a perinatal mortality of 2.26/1000 births. Its frequency was directly correlated with the gravidas' blood pressures, an effect augmented by albuminuria and work during pregnancy. Fatal infarcts were increased 20-fold with glomerulonephritis, fivefold with abruptio placentae, and twofold when the gravidas' hemoglobins were over 12 g/100 ml. Maternal weight gains were suboptimal and the involved neonates had a pattern of growth retardation characteristic of undernutrition. The disorder was more frequent when the gravida had made few prenatal visits for medical care and had had prior unsuccessful pregnancies.

Abruptio Placentae↗

PubMed1992

Liver rupture in pregnancy: a typical case?

We report a patient who presented with abruptio placenta and hepatic rupture at 30 weeks gestation. The latter is a recognised but rare complication of pre-eclampsia and eclampsia. The typical features of this entity as described in the literature and as seen in this patient are emphasized as increased awareness can lead to early diagnosis and better prognosis.

Abruptio Placentae↗

PubMed2003

The frequency and severity of placental findings in women with preeclampsia are gestational age dependent.

OBJECTIVE: The purpose of this study was to evaluate placental lesions found in women with preeclampsia compared with normotensive control subjects and to determine whether the presence of these lesions are related to gestational age at delivery. STUDY DESIGN: Placental disease of women with preeclampsia at 24 to 42 weeks of gestation was compared with the placental disease of normotensive gestational age-matched control subjects. The placental lesions that were studied specifically included decidual arteriolopathy, thrombi in the fetal circulation, central infarction, intervillous thrombi, and hypermaturity of villi. Data analysis involved the chi(2) test, the Student t test, and logistic regression; odds ratios and CIs were estimated. RESULTS: Placentas from women with preeclampsia (n=158) and normotensive control subjects (n=156) were evaluated. Among women with preeclampsia, 67% had severe disease. Placental lesions were studied according to gestational age at delivery: <28, 28 to 32, 33 to 36, and >or=37 weeks of gestation. Of the placental lesions that were studied, decidual arteriolopathy (odds ratio, 23.8, 95% CI 10.0-57.0), hypermaturity of villi (odds ratio, 12.4; 95% CI 5.3-29.2), intervillous thrombi (odds ratio, 1.95;95% CI 1.0-3.7), central infarction (odds ratio, 5.9; 95% CI 3.1-11.1), and thrombi in the fetal circulation (odds ratio, 2.8; 95% CI 1.2-6.6) were found to have significantly higher rates in the preeclamptic group. In contrast, the rate of chorioamnionitis was significantly lower in the preeclamptic group (odds ratio, 0.2; 95% CI 0.1-0.4). The rates of abruptio placentae and meconium staining were not different between the two groups. Within the preeclamptic group, the rates of decidual arteriolopathy (P<.0001), central infarction (P=.0001), and hypermaturity of villi (P<.0001) were higher the earlier the gestational age at delivery. CONCLUSION: Placentas in women with preeclampsia have increased amounts of disease. The rate is increased with lower gestational ages at the time of delivery for women with preeclampsia.

Abruptio Placentae↗

PubMed1963

Congenital hypofibrinogenemia in five members of a family.

The bleeding tendency in five members of one family with fibrinogen levels ranging from 58 mg. % to 158 mg. % was mild and chiefly related to dental extractions. Abruptio placentae in one patient produced severe bleeding. Reports of menstrual bleeding patterns in patients with defects of hemostatic mechanisms suggest that normal platelets, vascular function and extrinsic and possibly intrinsic coagulation systems, except for fibrinogen, control menstrual blood loss. An autosomal dominant gene with variable penetrance may determine fibrinogen levels.

Abruptio Placentae↗

PubMed2000

Intrauterine infection, magnesium sulfate exposure and cerebral palsy in infants born between 26 and 30 weeks of gestation.

OBJECTIVE: To identify prenatal events associated with cerebral palsy (CP) in infants born between 26 and 30 weeks of gestation. STUDY DESIGN: Case (n=22)-control (n=170) study was performed using a logistic regression model. RESULTS: Significant association of intrauterine infection with increased risk of CP was found in a logistic regression model that controlled for abnormal FHR patterns, placental infection, fetal acidosis at birth (umbilical artery pH<7. 1), and low Apgar score (<7) (odds ratio (OR) 5.47, 95% confidence interval (CI) 1.46-20.4). Magnesium sulfate exposure was associated with decreased risk (OR 0.13, CI 0.03-0.66) after exclusion of premature rupture of the membranes and abruptio placentae. In the magnesium exposure group, cases were infants born less than 28 weeks of gestation (3/21 vs. 0/61, P=0.015). CONCLUSION: In this case-control study, both intrauterine infection and magnesium sulfate exposure were significant factors related to the occurrence of cerebral palsy.

Abruptio Placentae↗

PubMed1991

The use of Doppler umbilical artery waveforms in placental abruption; a report of two cases.

In a prospective study, the predictive value of Doppler umbilical arterial velocimetry waveforms in detecting the fetus at risk was examined in ten patients with abruptio placenta. One patient suffered intra-uterine fetal death within 8 h of obtaining a normal reactive cardiotocograph and normal umibilical artery waveforms. In another patient with severe placental abruption, following 2500 ml of blood loss, the umbilical artery waveforms were normal. In this study, umbilical artery waveforms failed to predict fetal outcome in cases of placental abruption.

Abruptio Placentae↗