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PubMed1992

[Total uterine rupture of a cesarean section scar during attempted vaginal delivery under epidural analgesia].

A case of complete uterine rupture and abruptio placentae during an attempt of vaginal delivery under epidural analgesia in a woman with previous caesarean section is described and discussed. When using epidural analgesia for such a patient during vaginal delivery it is imperative that newly developed pain should be ascribed to the uterine scar and the diagnosis of threatening uterine rupture be made immediately.

Abruptio Placentae↗

PubMed1975

Defibrination in obstetrics. Modern concepts.

Coagulation profiles of serum fibrinogen, factors V and VIII and haemoglobin in normal pregnancies during labour, delivery and the early puerperium are presented. These factors were also studied in patients with abruptio placentae, in intra-uterine death, and in patients whose pregnancies were terminated with intra-amniotic saline and prostaglandin F2alpha. An assessment of fibrinolytic activity in these patients was made using qualitative (euglobulin lysis time) and quantitative (FR-antigen) tests. The coagulation findings presented form a basis for the rational management of defibrination in obstetrics.

Abortion, Induced↗

PubMed2003

Postpartum hemolytic uremic syndrome in a 17-year-old Filipina primigravid.

A 17-year-old Filipina primigravid developed acute renal failure secondary to hemolytic uremic syndrome (HUS) after undergoing emergency cesarean section for severe pre-eclampsia and abruptio placenta. She underwent hemodialysis with concurrent infusions of fresh-frozen plasma and packed red cells for 5 weeks. Renal biopsy revealed findings consistent with HUS with glomerular crescents. She received three doses of pulse methylprednisolone followed by oral prednisone. Renal function improved 5 weeks after the onset of HUS. The pathogenesis, differential diagnosis, and treatment options of postpartum HUS are discussed.

Abruptio Placentae↗

PubMed1999

Risk factors for urinary tract infection in the postpartum period.

OBJECTIVE: We sought to examine risk factors for urinary tract infection in postpartum women. STUDY DESIGN: Subjects (n = 931) with maternal urinary tract infections and control subjects (n = 1862) were identified by using a linked Washington State birth certificate and Birth Events Records Database for the years 1987-1993; stratified analysis was performed by using Mantel-Haenszel procedures. RESULTS: Increased risk for postpartum urinary tract infection was associated with black, Native American, or Hispanic race-ethnicity (odds ratio, 1.30; 95% confidence interval, 1.03-1.64) and unmarried status (odds ratio, 1.33; 95% confidence interval, 1.11-1.58). Cesarean delivery (odds ratio, 2.70; 95% confidence interval, 2.27-3.20) and tocolysis (odds ratio, 3.30; 95% confidence interval, 2.15-5.06) also contributed to maternal risk of acquiring a urinary tract infection. Maternal risk factors included renal disease (adjusted odds ratio, 3.89; 95% confidence interval, 1.80-8.41) and preeclampsia-eclampsia (adjusted odds ratio, 3.21; 95% confidence interval, 2.36-4.38). Among women undergoing vaginal delivery, renal disease (odds ratio, 5.47; 95% confidence interval, 2.04-14.64) and abruptio placentae (odds ratio, 5.02; 95% confidence interval, 1.84-13.64) were risk factors. Length of hospital stay was significantly associated with urinary tract infection. CONCLUSION: Maternal medical conditions and procedures that predispose to urinary tract infections are those that also are associated with urethral catheterization. In addition, maternal urinary tract infections may contribute significantly to duration of postpartum hospital stay.

Abruptio Placentae↗

PubMedDate not supplied

[Neonatal ultrasonographic cerebral findings: association with risk factor for cerebral palsy].

BACKGROUND: Is it possible to identify patients with cerebral palsy (CP) with postnatal ultrasound scan? Which risk factors are associated with an increased risk of CP?. PATIENTS AND METHODS: The data of 37 children with CP, who were sonographically investigated during the first 24 hours of life were analyzed retrospectively. The data of 21 preterm infants with gestational age </= 32 wk were compared with the data of 59 without CP. RESULTS: A tetraparesis was found in 15/21 of preterm babies </= 32 wk, a hemiparesis in 4/8 of premature infants >/= 33 wk and in 5/8 of the mature babies. The mature babies had prenatal brain atrophy or hypoxic-ischaemic cerebral lesions. Cytomegaly and encephalitis were detected in two babies. Immature babies >/= 33 wk showed prenatal porencephaly or encephalomalacia after asphyxia. Premature babies </= 32 wk had cystic periventricular leucomalacia (n=12) or cerebral haemorrhage (n=3); 3 babies had meningitis. Only two prematures </= 32 wk with mild CP had inconspicuous ultrasound scans. Factors associated with cerebral palsy were: cystic periventricular leucomalacia (OR 24,89; 95 % CI: 5,85 - 105,87), cerebral atrophy (OR 4,84; 95 % CI: 1,61 - 14,51), fetal hypoxia (CTG) - (OR 4,78; 95 % CI: 1,31 - 17,45), abruptio placentae (OR 4,32; 95 % CI: 1,16 - 16,13), anemia after birth (OR 18,13; 95 % CI: 1,97 - 166,43), abnormal neurological behavior at term (OR 14,00; 95 % CI: 3,29 - 59,55). CONCLUSION: Cerebral ultrasound scan after birth is a useful method detect for cerebral lesions in patients with CP-risks.

Abruptio Placentae↗

PubMed1986

Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia.

During an 8-year period, 112 severe preeclamptic-eclamptic patients with the above syndrome were studied. The incidence of this syndrome was significantly higher in white patients, in patients with delayed diagnosis of preeclampsia and/or delayed delivery, and in multiparous patients. Twenty-six patients had amniocentesis and 16 received epidural anesthetics. There was one maternal bleeding episode associated with epidural anesthetics. The use of steroids in 17 patients did not improve maternal platelet count. The overall perinatal mortality was 367 per 1000 and neonatal morbidity was significant. There were two maternal deaths and two patients with ruptured liver hematoma, and nine had acute renal failure. Thirty-eight percent had intravascular coagulopathy and 20% had abruptio placentae. On follow-up, 44 patients used oral contraceptives without maternal morbidity and 38 patients had 49 subsequent pregnancies. Only one patient had recurrence of the syndrome in subsequent pregnancies. The presence of a "true" syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) in preeclampsia is associated with poor maternal-perinatal outcome.

Abruptio Placentae↗

PubMed1991

Cocaine use during pregnancy: perinatal outcomes.

The relation between maternal cocaine use and perinatal outcomes was investigated among 17,466 non-Asian singleton deliveries in 1988 from the University of Illinois Perinatal Network data base in the metropolitan Chicago area. Elevated adjusted relative risks (RR) of low birth weight (RR = 2.8, 95% confidence interval (CI) 2.2-3.7), prematurity (RR = 2.4, 95% CI 1.9-3.1), abruptio placentae (RR = 4.5, 95% CI 2.4-8.5), and perinatal death (RR = 2.1, 95% CI 1.1-4.0) were observed for "any" cocaine users (n = 408) compared with women who did not use cocaine or any other drugs or alcohol (n = 17,058). There was an increased (although unstable) risk of intrapartum placenta previa not previously reported (RR = 2.3, 95% CI 1.0-5.1). The relative risk of small-for-gestational-age births for cocaine users who did not smoke (RR = 3.4, 95% CI 1.8-6.5) was greater than that for cocaine users who did (RR = 2.1, 95% CI 1.1-4.1). Irrespective of smoking status, cocaine use during pregnancy increased the risk of small-for-gestational-age births.

Abruptio Placentae↗

PubMed1995

[Acute complications in full term neonates with severe neonatal asphyxia].

The acute systemic complications of perinatal asphyxia, defined as an umbilical artery pH at birth of 7.10 or less, were evaluated in fifty full-term newborn infants. We also investigated the prenatal complications that lead to asphyxia, and the relationship between Apgar score and cord pH. Asphyxia or fetal distress was not identified in 56% of the cases. The most common condition associated with asphyxia was prolonged labor followed by abruptio placentae. About half of the babies studied, suffered some degree of renal and brain dysfunction; 24% had severe respiratory disease. Myocardial failure was present in 24%. Regarding metabolic complications, the most frequent was hypocalcemia, present in 44%. On the other hand, there was no correlation between Apgar score and cord pH. Mortality was 22%. The main cause of death was Persistent Pulmonary Hypertension.

Abruptio Placentae↗

PubMed2002

Mild gestational hypertension: differences in ethnicity are associated with altered outcomes in women who undergo outpatient treatment.

OBJECTIVE: The purpose of this study was to evaluate the impact of ethnicity on outcome in women with mild gestational hypertension that is remote from term. STUDY DESIGN: Nulliparous women with mild gestational hypertension who participated in an outpatient monitoring program between January 1995 and December 1999 were candidates. Patients had a singleton pregnancy at <37 weeks of gestation and were followed up for a minimum of 2 days as an outpatient. Maternal and perinatal outcomes were compared between groups by the Student t test, Mann-Whitney U test, and Pearson chi2 analyses. RESULTS: One thousand one hundred eight-two women were included in the analysis. No clinically remarkable differences in gestational age or incidence of proteinuria at the start of observation were noted. Newborn infants of Hispanic and African American women had significantly smaller birth weights compared with those of white women. African American women had a higher incidence of abruptio placentae (n = 5), stillbirths (n = 3), and neonatal deaths (n = 2) versus the other groups (n = 0 for all). The frequency of progression to thrombocytopenia/HELLP (hemolysis, elevated liver enzymes, and low platelet count syndrome) and cesarean delivery rates were similar between groups. CONCLUSION: Differences in outcomes are observed between ethnic groups even when the women undergo the same intensive outpatient monitoring for mild gestational hypertension.

Abruptio Placentae↗

PubMed2004

Perinatal outcome in women with severe pregnancy complications and multiple thrombophilias.

Hypercoagulability leading to placental thrombosis has been implicated in severe pregnancy complications. We compared the perinatal outcome in women with severe preeclampsia, intrauterine growth retardation (IUGR) and severe abruptio placentae and multiple acquired and inherited thrombophilias (study group, n=22) to matched women with similar complications and single thrombophilia (control group, n=22). Gestational age at delivery and birth weight were significantly lower in the study group compared to the control group (p<0.01) and among the study women with severe preeclampsia and IUGR. Severe pregnancy complications may occur earlier during pregnancy and more seriously affect perinatal outcome in women with multiple thrombophilias.

Abruptio Placentae↗

PubMed1979

Coagulation problems in human pregnancy.

Coagulation problems in pregnancy are primarily associated with overactivity of the intrinsic clotting system. This accounts for the increased incidence of thrombo-embolism during pregnancy. Where specific obstetric complications cause clotting problems the common underlying feature is usually placental pathology as in abruptio placentae, pre-eclampsia or hydatidiform mole. Abnormal activation of the clotting system is an early, and occasionally the first detectable feature of pre-eclampsia, but there is no evidence that this is a primary change. Therefore the role of anticoagulant treatment in the management of pre-eclampsia remains questionable. A new test for estimating factor VIII consumption is proving to be a sensitive index of early activation of the clotting system and can be used for the diagnosis of early pre-eclampsia.

Abruptio Placentae↗

PubMed1975

Fibrin monomer as a test for intravascular coagulation.

Soluble fibrin monomer complexes have been determined in approximately 500 obstetric patients by protamine sulfate precipitation, as a test for intravascular coagulation. The incidence of positive fibrin monomer was less than 1% in 139 samples drawn during normal pregnancy. In confirmed abruptio placentae, 84% of samples were positive, but other sources of antepartum bleeding were negative. Positive results were obtained in 24% of samples from patients between 3 and 48 hours after injection of hypertonic saline for second trimester abortion, 33% were positive by only 3% were positive after administration of prostaglandins. The test for intravascular coagulation is simple and rapidly carried out. The results correlated well with the clinical condition of patients with disseminated intravascular coagulation. However, the test is usually negative in patients with thromboembolic phenomena.

Abruptio Placentae↗

PubMed2004

First pregnancy characteristics and subsequent breast cancer risk among young women.

There is growing evidence that perinatal factors associated with altered gestational hormones may influence subsequent breast cancer risk in the mother. Events occurring during the first pregnancy may be particularly important. In this matched case-control study, we investigated the relation between characteristics of a woman's first pregnancy and her later breast cancer risk using linked records from the New York State birth and tumor registries. Cases were 2,522 women aged 22 to 55 diagnosed with breast cancer between 1978 and 1995 and who had also completed a first pregnancy in New York State (NY) at least 1 year prior to diagnosis. Controls were 10,052 primiparous women not diagnosed with breast or endometrial cancer in NY and matched to cases on county of residence and date of delivery. Information on factors characterizing the woman's first pregnancy was obtained from the pregnancy record of each subject. The association of these factors to breast cancer risk was assessed using conditional logistic regression. Extreme prematurity (< 32 weeks gestational age) was associated with elevated maternal breast cancer risk [adjusted odds ratio (OR)=2.1, 95% confidence interval (CI) 1.2,3.9], as were abruptio placentae (OR = 1.8, CI 1.1,3.0) and multifetal gestation (OR=1.8, CI 1.1,3.0). Preeclampsia was associated with a marked reduction in breast cancer risk among women who bore their first child after age 30 (OR=0.3, CI 0.2,0.7) and in the first 3 years after delivery (OR=0.2 (0.1-0.9). These findings suggest that certain perinatal factors influence maternal breast cancer risk and offer indirect support for a role of gestational hormones, and particularly gestational estrogens, in the etiology of breast cancer.

Abruptio Placentae↗

PubMed1993

Evaluation of pregnant women after blunt injury.

A retrospective review of 125 pregnant women with blunt injuries admitted to a level I trauma center over a 35-month period was performed. The usefulness of three diagnostic tests, fetal ultrasound (US), external fetal monitoring (EFM), and Kleihauer-Betke (KB) tests in detecting fetal or pregnancy-associated complications was evaluated. The majority of women (77.6%) were involved in motor vehicle crashes and the mean injury Severity Score was low (4.7). The most common complications were premature uterine contractions (67%) and abruptio placentae (11%). When used together, EFM and US identified all complications. Moreover, all complications were manifest within 6 hours of admission. The KB tests had a sensitivity of 56%, a specificity of 71%, and an accuracy of 27%. We conclude that EFM and US are more useful in detecting fetal or pregnancy-associated complications after blunt injury. Monitoring can be limited to 6 hours if previous monitoring is normal. The KB test is of little use in the setting of acute trauma.

Abruptio Placentae↗

PubMed2006

Thrombophilia and adverse maternal-perinatal outcome.

A recent review of the literature on thrombophilia and adverse pregnancy outcome (APO) reveals contradictory findings. We have limited our review of literature mostly to the most recent decade. On the basis of our review, screening for thrombophilias with a history of APO (preeclampsia, abruptio placenta, intrauterine growth restriction, and fetal loss) is not clear. There are retrospective and prospective studies that recommend testing for genetic and acquired markers of thrombophilia for those with the enumerated APO. The rationale for such recommendation is to use heparin prophylaxis in subsequent pregnancies. However, this recommendation is not based on randomized trials. Hence, a randomized double-blinded controlled trial is urgently needed to evaluate the benefit of heparin during pregnancy in women with a history of APO in association with thrombophilia.

Abortion, Spontaneous↗

PubMed1999

Severe uterine diastolic notch as a prognostic factor in preeclamptic women.

OBJECTIVE: To investigate the usefulness of grade II uterine diastolic notch to predict maternal or perinatal outcome during conservative management of preeclampsia. STUDY DESIGN: We reviewed medical charts of 35 pregnant women admitted for hypertension and > or =1+ urine dipstick protein determination and who had a uterine Doppler examination at admission. Grade I notch was defined as a 'nadir' in early diastole higher than half of peak diastolic notch velocity. Grade II diastolic notch was defined as a 'nadir' in early diastole lower than half of peak diastolic notch velocity. RESULTS: Thirty-one preeclamptic women were admitted at 30.1+/-3 weeks. Of them, 23 had a grade I notch (group I) and eight a grade II notch (group II). Rates of abruptio placenta, eclampsia, thrombocytopenia, stillbirth, birth weight < or = 3rd centile, fetal distress before delivery and neonatal death were similar in the two groups. Rates of delivery before 32 weeks and newborn spending more than 48 h in neonatal intensive care unit were significantly higher in group II. Admission-to-delivery interval was significantly lower in group II (2.6+/-1.5 vs. 9.4+/-8.7 days, P<0.05). CONCLUSION: Grade II notch seems to identify in preeclamptic women those with a higher risk of early pregnancy termination.

Abruptio Placentae↗

PubMed2001

Review of unexplained infertility and obstetric outcome: a 10 year review.

BACKGROUND: Increased maternal and fetal risks have been reported in pregnancies following unexplained infertility. Our aims were to examine the obstetric and perinatal outcome of singleton pregnancies in couples with unexplained infertility and explore the impact of fertility treatment. METHODS: Women with unexplained infertility were identified from the Aberdeen Fertility Clinic Database. Their unit numbers were matched against the Aberdeen Maternity and Neonatal Databank (AMND) in order to extract obstetric records of those women with subsequent pregnancy outcomes. The general obstetric population served as a control group. RESULTS: Women with unexplained infertility were older [30.8 versus 27.9 years, 95% confidence interval (CI) for difference = +2.4 to +3.4] and more likely to be primiparous (59 versus 40%, 95% CI = +1.3 to +1.9). After adjusting for age and parity they had a higher incidence of pre-eclampsia, abruptio placentae, preterm labour, emergency Caesarean section and induction of labour in comparison with the general population (P < 0.05). Perinatal outcome did not differ between women with unexplained infertility and those of the general population. The multiple pregnancy rate was 5.4% higher following fertility treatment than in women who conceived spontaneously (95% CI = +2.8 to +9.7). CONCLUSIONS: Women with unexplained infertility are at higher risk of obstetric complications which persist even after adjusting for age, parity and fertility treatment. The reasons are however unclear and merit further study.

Abruptio Placentae↗

PubMed1994

Unexplained elevated maternal serum alpha-fetoprotein levels and perinatal outcome in an urban clinic population.

OBJECTIVE: Our purpose was to determine whether obstetric patients with unexplained elevated maternal serum alpha-fetoprotein levels from an indigent clinic population are at increased risk for adverse perinatal outcome compared with similar patients with normal values. STUDY DESIGN: Perinatal outcomes from inner-city obstetric patients with unexplained elevated maternal serum alpha-fetoprotein levels (> 2.0 multiples of the median) were compared with patients from the same clinic with normal values. The frequency of adverse outcomes in the two groups was subjected to chi 2 analysis. RESULTS: Adverse perinatal outcomes occurred in 33 of 57 (58%) of the subjects with unexplained elevated maternal serum alpha-fetoprotein levels compared with 163 of 719 (23%) patients with normal values (p < 0.001). Statistically significant differences were observed for abruptio placentae (p < 0.025), intrauterine growth retardation (p < 0.025), stillbirth at > 20 weeks (p < 0.001), and pregnancy-induced hypertension (p < 0.01). Differences in the frequencies of preterm premature rupture of membranes, preterm delivery, pregnancy loss < 20 weeks, and congenital malformations were not statistically significant. CONCLUSION: In contrast to a previous report, we found that unexplained elevated maternal serum alpha-fetoprotein levels confer an increased risk of adverse perinatal outcome in an urban clinic population over and above the already increased risk related to socioeconomic status.

Abruptio Placentae↗