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We report a case of idiopathic arterial calcification in a stillborn of 22 weeks gestational age. The pregnancy was complicated by abruptio placentae and the postmortem examination showed widespread arterial calcification in the placenta, as well as in the pulmonary, renal, cerebellar, and brain arteries.
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In a prospective investigation on 9,169 pregnant women which showed a substantial increase in stillbirths among smokers, a large proportion of this increase is due to abruptio placentae. The percentage of smokers in this category rises to 46% while it is only 12% in the group of livebirths. Smoking appears to be an important risk factor in this occurence, the etiology of which is little known. The effect of parity and its possible interaction with smoking are discussed.
The so-called antiphospholipid syndrome may be responsible for repeated spontaneous abortion and fetal loss. We examined the plasma of 61 women with either reproductive failure or abruptio placentae for the presence of lupus anticoagulant and anticardiolipin antibodies in an attempt to assess the prevalence of this condition. No patient had haematological abnormalities consistent with the presence of lupus anticoagulant. However, 6 women had anticardiolipin antibodies with normal coagulation tests. The clinical profile together with this laboratory finding allows us to diagnose the antiphospholipid syndrome in these patients. Our incidence is considerably lower than that reported in many other studies but does suggest a place for screening for this condition in patients with recurrent complications of pregnancy.
The use of umbilical cord sampling is becoming more widespread. The full risk of the procedure, however, is not completely known. Reported here is a case of abruptio placentae immediately after percutaneous umbilical cord sampling.
A population-based case-control study was conducted to examine the relationship between maternal smoking and the occurrence of abruptio placentae and to assess the joint relationship of smoking and small for gestational age (SGA) status with abruption. Cases (N = 1089) reported on Washington state birth certificates from 1984-1986 were compared with randomly selected births (N = 2323) from the same period. The occurrence of placental abruption was associated with both smoking (relative risk = 1.6; 95% confidence interval 1.3-1.8) and SGA status (relative risk = 2.6; 95% confidence interval 2.0-3.3). The association with SGA status was identical for smokers and non-smokers. Thus, the increase of SGA infants in women whose pregnancies are complicated by abruption is not explained by maternal smoking, and in some cases may result from placental dysfunction induced by the process of placental separation.
The short term neonatal morbidity and 2-year neurodevelopmental outcome were evaluated in 40 low birthweight (< 2500 g) liveborn infants delivered after abruptio placentae and in 80 control infants of similar gestational age. Apgar scores at 1' and 5' were lower in infants born to mothers with severe abruption. The prevalence of intraventricular hemorrhage (Grades I-IV) was 17.5% (7/40) in the cases and 5% (4/80) in the controls (P = 0.035). Cystic periventricular leukomalacia was diagnosed in two cases (5%) and in none of the controls (P = 0.1). At 2-year follow-up, among surviving infants, cerebral palsy (spastic diplegia, hemiplegia or tetraplegia with or without mental retardation) was diagnosed in 11.1% (4/36) of the cases and in none of the 76 controls (P = 0.011). After adjustment by logistic regression analysis for the effect of confounders (gestational age, birthweight, social class and duration of mother's education) the odds ratio of a poor outcome defined as neonatal death or cerebral palsy was 4.4 (95% confidence interval, 1.2-17.0) in index cases as a whole and 8.0 (95% confidence interval, 1.5 to 43.0) in the subgroup of infants born after severe abruption. Mild abruption did not affect the 2-year infant outcome in both univariate and multivariate analysis.
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This is a case study of a 28-year old woman, gravida 1 para 0, presented at 37+4 weeks gestation due to purpura and fetal death. A 3700 gram dead male fetus without gross malformation was delivered by forceps. Post delivery abruptio placentae, diffuse intravascular coagulation, fulminant preeclampsia and acute renal failure followed. Skin biopsy revealed pruritic urticarial papules and plaques of pregnancy. The patient fully recovered one week postpartum. This case report discusses a possible association between pruritic urticarial papules, plaques of pregnancy and severe preeclampsia with fetal death.
An emergency cesarean section was performed in the 38th week of pregnancy in a patient with acute abdominal pain in the left upper quadrant. The ultrasound picture was interpreted as a retroplacentar hematoma. Cardiotocography demonstrated fetal tachycardia which was interpreted as asphyxia. A diagnosis of abruptio placentae was made, but was finally ruled out when the cesarean section was performed. The intraabdominal exploration revealed a large hematoma of the rectus sheath with about 800 ml of blood. After evacuation and drainage the postoperative recovery was uneventful. Sudden rupture of a deep epigastric vessel with formation of an abdominal wall hematoma also mimics intraabdominal conditions such as appendicitis, diverticulitis, cholecystitis, tumours and visceral injuries.
A 30 year old white woman presented at term with vaginal bleeding, dizziness and blurred vision due to bilateral serous retinal detachments. Extensive areas of choroidal occlusion with focal leakage of dye from the posterior retinal pigment epithelium and choroid were demonstrated by fluorescein angiography. With the diagnosis of abruptio placentae, a dead fetus and disseminated intravascular coagulation (DIC) the patient underwent removal of the uterine contents by cesarean section. DIC and retinal detachments resolved with improvement of vision, DIC, frequently observed in obstetric complications, has a tendency to occlude the posterior choroidal vessels, which often results in serous retinal detachments. In the setting of pregnancy, especially complicated late pregnancy, the occurrence of serous retinal detachments may be an early ocular sign of DIC.
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