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Am J Perinatol 2002; 19(8): 451-460
DOI: 10.1055/s-2002-36868
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Reproductive Risk Factors, Doppler Findings, and Outcome of Affected Births in Placental Abruption: A Population-Based Analysis

Sari Toivonen1 , Seppo Heinonen1 , Maarit Anttila1 , Veli-Matti Kosma2 , Seppo Saarikoski1
  • 1Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
  • 2Department of Pathology and Forensic Medicine, Kuopio University Hospital, Kuopio, Finland
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Publication History

Publication Date:
22 January 2003 (online)

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ABSTRACT

Placental abruption complicates about 1% of all singleton pregnancies and the aim of this study is to assess the reproductive maternal risk factors associated with placental abruption, and the outcome of affected births. We analyze 170 women with singleton pregnancies complicated by placental abruption who gave birth at Kuopio University Hospital from March 1989 to December 1999. The general obstetric population (n = 22,905) was selected as the reference group and logistic regression analysis was used to identify independent reproductive risk factors. Furthermore, Doppler ultrasonographic results and pregnancy outcome measures in the two groups were also recorded. The incidence of placental abruption was 0.57% in the referral area. Preeclampsia, grand multiparity, velamentous umbilical cord insertion, cigarette smoking, prior fetal demise, advanced maternal age (>35 years), and previous miscarriage were independent risk factors of placental abruption, with adjusted relative risks of 4.39, 3.60, 2.53, 2.46, 2.02, 1.62, and 1.55, respectively. Most cases of placental abruption occur before the onset of labor in low-risk pregnancies and are not predictable with regard to maternal reproductive risk factors. Current antepartum methods of detecting uteroplacental problems, including Doppler ultrasonography, are not effective in prenatal prediction of placental abruption. The outcome of affected births is still poor.

KEYWORD

Abruption placentae - risk factors

REFERENCES

  • 1 Huisjes H J, Touwen B CL, van Doorm M J. Perinatal mortality and late sequelae in children born after abruptio placentae.  Eur J Obstet Gynecol Reprod Biol . 1979;  1 45-49
    PubMedGoogle Scholar
  • 2 Ananth C V, Berkowitz G S, Savitz D A, Lapinski R H. Placental abruption and adverse perinatal outcomes.  JAMA . 1999;  282 1646-1651
    CrossrefPubMedGoogle Scholar
  • 3 Raymond E G, Mills J L. Placental abruption: maternal risk factors and associated fetal conditions.  Acta Obstet Gynecol Scand . 1993;  72 633-639
    PubMedGoogle Scholar
  • 4 Rasmussen S, Irgens L M, Bergsjoe P, Dalaker K. The occurrence of placental ablations in Norway 1967-1991.  Acta Obstet Gynecol Scand . 1996;  75 222-228
    CrossrefPubMedGoogle Scholar
  • 5 Walles B, Tydén T, Herbst A. Maternal health care program and markers for late fetal death.  Acta Obstet Gynecol Scand . 1994;  73 773-778
    PubMedGoogle Scholar
  • 6 Kramer M S, Usher R H, Pollack R. Etiologic determinants of abruptio placentae.  Obstet Gynecol . 1997;  89 221-226
    CrossrefPubMedGoogle Scholar
  • 7 Ananth C V, Savitz D A, Bowes Jr A W, Luther E R. Influence of hypertensive disorders and cigarette smoking on placental abruption and uterine bleeding during pregnancy.  Br J Obstet Gynaecol . 1997;  104 572-578
    PubMedGoogle Scholar
  • 8 Ananth C V, Wilcox A J, Savitz D A. Effect of maternal age and parity on the risk of uteroplacental bleeding disorders in pregnancy.  Obstet Gynecol . 1996;  88 511-516
    CrossrefPubMedGoogle Scholar
  • 9 Babinszki A, Kerenyi T, Torok O. Perinatal outcome in great-grand multiparity: effects of parity on obstetric risk factors.  Am J Obstet Gynecol . 1999;  181 669-674
    PubMedGoogle Scholar
  • 10 Mooney E E, Boggess K A, Herbert W NP, Layfield L J. Placental pathology in patients using cocaine: an observational study.  Obstet Gynecol . 1998;  91 925-929
    CrossrefPubMedGoogle Scholar
  • 11 Ray J G, Laskin C A. Folic acid and Homocyst(e)ine metabolic defects and the risk of placental abruption, pre-eclampsia and spontaneous pregnancy loss: a systematic review.  Placenta . 1999;  20 519-529
    CrossrefPubMedGoogle Scholar
  • 12 de Vries I J, Dekker G A, Huijgens P C. Hyperhomocysteinaemia and protein S deficiency in complicated pregnancies.  Br J Obstet Gynaecol . 1997;  104 1248-1254
    CrossrefPubMedGoogle Scholar
  • 13 Wiener-Megnagi Z, Ben-Sholomo I, Goldberg Y, Shalev E. Resistance to activated protein C and the Leiden mutation: high prevalence in patients with abruptio placentae.  Am J Obstet Gynecol . 1998;  179 1565-1567
    CrossrefPubMedGoogle Scholar
  • 14 Saftlas A F, Olson D R, Atrash H K. National trends in the incidence of abruptio placentae, 1979-1987.  Obstet Gynecol . 1991;  78 1081-1086
    PubMedGoogle Scholar
  • 15 Major C A, De Veciana M, Lewis D F, Morgan M A. Preterm premature rupture of membranes and abruptio placentae: is there an association between these pregnancy complications?.  Am J Obstet Gynecol . 1995;  172 672-676
    CrossrefPubMedGoogle Scholar
  • 16 Rafla N M. The use of Doppler umbilical artery waveforms in placental abruption: a report of two cases.  Eur J Obstet Gynecol Reprod Biol . 1991;  38 167-168
    CrossrefPubMedGoogle Scholar
  • 17 Heinonen S, Ryynänen M, Kirkinen P. Prenatal screening for congenital nephrosis in East Finland: results and impact on the birth prevalence of the disease.  Prenatal Diagn . 1996;  16 207-213
    PubMedGoogle Scholar
  • 18 Van Rijn M, Van der Schouw T Y, Hagenaars A M, Visser G HA, Christiaens G C. Adverse obstetric outcome in low- and high-risk pregnancies: predictive value of maternal serum screening.  Obstet Gynecol . 1999;  94 929-934
    CrossrefPubMedGoogle Scholar
  • 19 Huerta-Enochian G, Katz V, Erfurth S. The assosiation of abnormal α-fetoprotein and adverse pregnancy outcome: does increased fetal surveillance affect pregnancy outcome?.  Am J Obstet Gynecol . 2001;  184 1549-1555
    CrossrefPubMedGoogle Scholar
  • 20 Jaakkola K, Jokimaa V, Kallajoki M. Pre-eclampsia does not change the adhesion molecule status in the placental bed.  Placenta . 2000;  21 133-141
    CrossrefPubMedGoogle Scholar
  • 21 Salafia C M, Pezzullo J C, Ghidini A. Clinical correlations of placental pathology in preterm pre-eclampsia.  Placenta . 1998;  19 67-72
    CrossrefPubMedGoogle Scholar
  • 22 Bush P G, Mayhew T M, Abramovich D R. Maternal cigarette smoking and oxygen diffusion across the placenta.  Placenta . 2000;  21 824-833
    CrossrefPubMedGoogle Scholar
  • 23 Ananth C V, Smulian J C, Vinzileos A M. Incidence of placental abruption in relation to cigarette smoking and hypertensive disorders during pregnancy: a meta-analysis of observational studies.  Obstet Gynecol . 1999;  93 622-628
    CrossrefPubMedGoogle Scholar
  • 24 Rasmussen S, Irgens L M, Bergsjoe P, Dalaker K. Perinatal mortality and case fatality after placental abruption in Norway 1967-1991.  Acta Obstet Gynecol Scand . 1996;  75 229-234
    CrossrefPubMedGoogle Scholar
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