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PubMed1987

Preterm premature rupture of the membranes: a risk factor for the development of abruptio placentae.

A retrospective study of 298 patients with preterm premature rupture of the membranes managed expectantly during a 3-year period investigated the association between preterm premature rupture of the membranes and abruptio placentae. Expectant management was associated with the development of abruptio placentae in 19 of these 298 patients (6.3%). The prevalence of abruptio placentae in the entire population during the same 3-year period was 2.7%, whereas in patients without preterm premature rupture of the membranes it was 2%. None of the patients developed clinical or laboratory evidence of disseminated intravascular coagulation and no infection (maternal or neonatal) was noted among the patients who had abruptio placentae. Patients with preterm premature rupture of the membranes and severe oligohydramnios (largest pocket less than 1 cm) seem to be at particular risk for developing this complication. These data suggest that abruptio placentae should be considered as one of the possible risks of expectant management in preterm premature rupture of the membranes.

Abruptio Placentae↗
PubMed1989

Does prolonged preterm premature rupture of the membranes predispose to abruptio placentae?

The association between prolonged preterm premature rupture of the membranes and abruptio placentae was investigated in a case-control study. The incidence of abruptio placentae among 143 women with singleton pregnancies at less than 34 weeks' gestation who had ruptured membranes for at least 24 hours was 5.6%, significantly higher than the 1.4% observed among 143 randomly selected controls without preterm rupture of the membranes (P less than .05). Among patients with prolonged preterm premature rupture of the membranes, those who experienced vaginal bleeding before the onset of labor had a significantly higher risk for abruptio placentae than women who did not bleed (24 versus 2.5%; P less than .001). Regardless of the mechanism by which this association is produced, the clinician should be aware of this potential complication, especially in patients who have recurrent bleeding episodes during the period of expectant management.

Abruptio Placentae↗
PubMed1992

Ritodrine therapy in the presence of chronic abruptio placentae.

BACKGROUND: Betamimetic therapy is usually contraindicated for the treatment of premature labor associated with abruptio placentae. We report prolongation of a pregnancy for 7 weeks using ritodrine despite the presence of placental abruption. CASE: A 33-year-old primigravid woman presented at 25 weeks' gestation with irregular uterine contractions, vaginal bleeding, and sonographic evidence of abruptio placentae. Port wine-colored amniotic fluid was found during amniocentesis, and serial hematocrits decreased from 36 to 25%. A diagnosis of abruptio placentae was made, and because the maternal cardiovascular and fetal biophysical indices were normal, tocolytic therapy was started. Before the administration of ritodrine, the patient and her husband were given an extensive review of the risks, including blood transfusion, adult respiratory distress syndrome, disseminated intravascular coagulopathy, and maternal or fetal death. CONCLUSION: Although clinical suspicion of abruptio placentae remains a contraindication to betamimetic therapy, exceptions may be made if fetal and maternal well-being can be monitored and if a fully staffed operating room is always available for immediate cesarean delivery. The benefits of this management may outweigh the associated risks for carefully chosen, very preterm gestations.

Abruptio Placentae↗
PubMed2005

MTHFD1 R653Q polymorphism is a maternal genetic risk factor for severe abruptio placentae.

This study examined the relationship between folate/homocysteine-related genetic polymorphisms: MTHFD1 1958G --> A (R653Q), MTHFR 677C --> T (A222V), MTHFR 1298A --> C (E429A), and risk of severe abruptio placentae. We genotyped 62 women with a pregnancy history complicated by severe abruptio placentae and 184 control pregnancies. Analysis of the MTHFD1 1958G --> A (R653Q) polymorphism showed increased frequency of the 'QQ' homozygote genotype in pregnancies affected by severe abruptio placentae compared to control pregnancies (odds ratio 2.85 (1.47-5.53), P = 0.002). In contrast to previous reports, the MTHFR polymorphisms 677C --> T (A222V) and 1298A --> C (E429A) were not associated with abruptio placentae risk in our cohort, when analyzed either independently or in combination. We conclude that women who are 'QQ' homozygote for the MTHFD1 1258G --> A (R653Q) polymorphism are almost three times more likely to develop severe abruptio placentae during their pregnancy than women who are 'RQ' or 'RR.'

Abruptio Placentae↗
PubMed2000

Risk factors for and perinatal mortality of abruptio placentae in patients hospitalised for early onset severe pre-eclampsia - a case controlled study.

We set out to determine which patients admitted for expectant management of early onset severe pre-eclampsia develop abruptio placentae and to compare the perinatal mortality rate of patients who developed abruptio placentae with those who did not have this complication. This was a case controlled study, using gestational age at delivery to select a control group for 69 patients who developed abruptio placentae. The only significant difference on admission was the higher uric acid levels in patients who developed abruptio placentae. Mean admission to delivery intervals were 11.9 and 8.8 days for the control and abruption groups respectively (P = 0.0083). Fifty-eight per cent of the babies in the abruptio placentae group developed late decelerations, as determined by fetal heart rate monitoring compared with 32% in the control group. Lactate dehydrogenase levels before delivery were significantly higher in the abruption group, but it only became elevated shortly before delivery and in the minority of cases. There were two intrauterine and four neonatal deaths in the abruption group and two neonatal deaths in the control group. Late decelerations detected by frequent fetal heart rate monitoring in patients with early onset severe pre-eclampsia is the only early warning of abruptio placentae.

Journal Article↗
PubMed1986

Incidence and recurrence rate of abruptio placentae in Sweden.

It is desirable to identify those pregnancies that run an increased risk of abruptio placentae, as this disorder still is associated with a high perinatal mortality. Data were collected from the Swedish nationwide birth registry system on all 894,619 births in Sweden in the period 1973 to 1981. The overall incidence of abruptio placentae was 0.44%, with a perinatal mortality of 20.2% and a cesarean section frequency of 74.6%. The incidence of abruptio placentae was significantly increased in the case of twin birth, male offspring, mothers below 20 years of age, and with every delivery after the second one. A history of abruptio placentae increased the risk of a similar incident in a subsequent pregnancy by 10.2-fold. The frequency of cesarean section in subsequent parturitions remained high (32.1%) even in the absence of reabruptio placentae, thus demonstrating the need to identify further risk groups.

Abruptio Placentae↗
PubMed2005

The Glu298Asp variant of the endothelial nitric oxide synthase gene is associated with an increased risk for abruptio placentae in pre-eclampsia.

Attempts to define a pre-eclampsia susceptibility profile have been hampered by the wide clinical spectrum of the condition and the complex genetics underlying it. Genes that modulate blood pressure, fluid homeostasis and placental vascular development have been considered plausible candidates. Among these are the angiotensinogen (AGT) gene variant Met235Threo, which has been associated with pre-eclampsia and the endothelial nitric oxide synthase (eNOS) polymorphism Glu298Asp, which has been associated with both pre-eclampsia and abruptio placentae, a condition that often co-exists with pre-eclampsia. The aim of this study was to investigate a potential association between these gene variants and pre-eclampsia with and without abruptio placentae in a South African patient group. Fifty primigravidas with early onset, severe pre-eclampsia, 50 women presenting primarily with abruptio placentae (whether associated with pre-eclampsia or not) and a control panel of 50 healthy pregnant women constituted the study groups. The Met235Threo and Glu298Asp variants were characterised by polymerase chain reaction and restriction enzyme analysis. No association was demonstrated between the M235T variant of the AGT gene and pre-eclampsia or abruptio placentae. In contrast, the combined frequency of the eNOS variant genotypes (GT and TT) was significantly higher in the abruptio placentae group (49%) than the control group (21%) (p=0.006). Furthermore, in the pre-eclampsia patients who subsequently developed abruptio placentae, the eNOS GT genotype emerged as a major risk factor for the development of abruptio placentae (p<0.0001). These data suggest that the presence of a Glu298Asp eNOS variant may pre-dispose a pre-eclamptic woman to develop abruptio placentae or that it is a marker for predisposition.

Abruptio Placentae↗
PubMed1979

Abruptio placenta: sonographic and pathologic correlation.

In cases of abruptio placenta, the ultrasound examination may be negative if external bleeding occurs without a large enouth accumulation of blood to be sonographically visible. A positive sonogram may demonstrate either a retroplacental hematoma or a hematoma that has dissected beneath the chorionic membranes. Six cases of abruptio placenta are presented with sonographic and pathologic findings.

Abruptio Placentae↗
PubMed2001

Combined heterozygosity for methylenetetrahydrofolate reductase (MTHFR) mutations C677T and A1298C is associated with abruptio placentae but not with intrauterine growth restriction.

OBJECTIVE: This study was undertaken to investigate the involvement of MTHFR gene mutations C677T and A1298C implicated in vascular disease, in patients with abruptio placentae and intrauterine growth restriction (IUGR). STUDY DESIGN: DNA was extracted from blood samples of 54 patients with placental vasculopathy (18 patients with abruptio placentae and 36 with IUGR) and 114 control patients and amplified by the polymerase chain reaction (PCR). The resulting fragments were subjected to restriction enzyme analysis and resolved by gel electrophoresis. RESULTS: A significant association could be demonstrated between mutation A1298C and both abruptio placentae and IUGR. Combined heterozygosity for mutations C677T and A1298C was detected in 22.2% of abruptio placentae cases. CONCLUSIONS: Combined heterozygosity for MTHFR mutations C677T and A1298C may represent a genetic marker for abruptio placentae.

Abruptio Placentae↗
PubMed1985

Raised uterine resting tone in patients with abruptio placentae.

Uterine contractions were studied in 21 patients with abruptio placentae and intrauterine death. Contractions were examined in four 10-minute windows taken immediately prior to delivery, 30 and 60 minutes before delivery and at the beginning of the recording. Mean resting tone values for the 4 periods fluctuated between 23 and 25 mmHg. The mean contraction frequency for all the windows was 8 per 10 minutes. It is postulated that the high resting tone and frequent uterine contractions contribute to the high perinatal mortality associated with abruptio placentae.

Abruptio Placentae↗
PubMed1987

Abruptio placentae--risk factors and outcome of the newborn.

A total of 180 (0.21%) out of 85.177 deliveries were complicated by abruptio placentae (AP) during the period 1962-1981. Of these the obstetric records of 130 deliveries were retrospectively studied in order to elucidate risk factors for the occurrence of abruptio placentae as well as to find out factors influencing the outcome of the newborn. The control group consisted of 120 randomly chosen contemporary parturients. Preterm contractions during pregnancy seemed to be most significantly associated with the occurrence of abruptio placentae. Also mothers with gestational hypertension or pre-eclampsia, smokers and unmarried mothers seemed to run a more than two-fold risk of premature separation of the placenta, while twin pregnancy and high parity seemed to increase the risk only slightly. However, a history of abruptio placentae revealed an 11-fold risk of premature separation of placentae in subsequent pregnancy. The factors most significantly associated with favourable prognosis of the newborn were: duration of gestation, birth weight and the degree of separation of the placenta. However, degree of cervical dilatation, presentation, mode of delivery or the time interval between diagnosis of AP and delivery seemed to have only weak discriminative power between newborns who survived and those who were lost.

Abruptio Placentae↗
PubMed1985

Uterine contraction patterns in abruptio placentae.

Tocographic monitoring of 21 patients with grade III abruptio placentae revealed the following: the tocographic pattern can be of diagnostic aid; the tocograph is of no value in measuring progress, because there is no significant change in uterine tone and contraction frequency and amplitude from the time the membranes are ruptured until the delivery of the fetus; and the tocographic patterns in abruptio placentae are probably of diagnostic value as regards the coagulation defect, but further proof of this is necessary.

Abruptio Placentae↗
PubMed1985

Abruptio placentae following snake bite.

A case in which, besides the clinical complications that commonly follow snake biting, abruptio placentae occurred is reported here. None of the factors that are frequently associated with abruptio placentae were present. The laboratory tests performed showed that renal function was impaired and that a dramatic hypercoagulability was present. The relationship of the latter to the abruptio placentae is discussed.

Abruptio Placentae↗
PubMed2003

[Abruptio placentae: epidemiological, clinical and prognostic aspects with respect to a 177 case series].

OBJECTIVE: A retrospective study based on 177 cases of abruptio placentae, and describing the epidemiological, clinical and prognosis aspects. PATIENTS AND METHODS: A hundred and seventy-seven cases, corresponding to 185 children, were registered over a five-year period in the department of gynecology and obstetrics of the CHNYO of Ouagadougou. RESULTS: Abruptio placentae occurrence rate was about 9.6 per 1000 deliveries. In our study, this type of accident was most frequent with 30 to 34-year-old women (31.1%), with multiparous ones (56.5%), and with those suffering from arterial hypertension linked to pregnancy (31.1%). The clinical picture was most often complete, 83.1% of patients having reached grade 3 of abruptio placentae with complete symptomatology and foetal death. Vaginal delivery was preferred to cesarean section in 64.4% of the cases. Maternal death rate was about 3.9% and mainly caused by severe anemia (61.6%) and puerperal infections (7.9%). Foetal prognosis was dominated by the high rate of mortinatality (85.9%). DISCUSSION AND CONCLUSION: To reduce maternal mortality as well as morbidity due to abruptio placentae, correct prenatal follow-up, early diagnosis and prompt evacuation of the womb are required.

Abruptio Placentae↗
PubMed1999

[Protein C, protein S and antithrombin III at normal delivery and during abruptio placentae].

Protein C, Protein S and Antithrombin III were screened in one hundred patients admitted for abruptio placentae and one hundred women who delivered normally in Dakar university hospital. We found a reduction of Protein S at normal delivery which is linked to hypercoagulation activity during this process. PC and PS were significantly decreased during abruptio placentae in relation with the disseminated intravascular coagulation which was found in our study. We recommend to include these tests to explore aetiologies of abruptio placentae and to confirm their congenital deficit two months after delivery.

Abruptio Placentae↗
PubMed1989

Severe abruptio placentae--still unpreventable.

The management of abruptio placentae remains a problem, despite advances in medical science. This study analyses severity of abruption, resultant morbidity, and maternal and fetal mortality in 105 cases. Among the contributory factors, hypertension (44%) and grand multiparity (24%) were common. There was no maternal death among these cases, mainly because of liberal use of blood transfusion, prompt delivery, and careful fetal monitoring, but perinatal mortality remained high (73%). Factors responsible for this high perinatal mortality and its prevention are discussed.

Abruptio Placentae↗
PubMed1980

Uterine contraction patterns in patients with severe abruptio placentae.

Uterine contractions were monitored in 54 patients in whom severe abruptio placentae had caused intra-uterine death of the fetus. The frequency at the beginning of monitoring ranged from 2 to 14 contractions in 10 minutes, with a mean of 8,4. Only 4 patients had 4 or fewer contractions in the first 10 minutes of monitoring. No change in contraction frequency was observed during the course of labour. A high frequency of contractions before or during labour is highly suggestive of severe abruptio placentae.

Abruptio Placentae↗
PubMed1989

[Clinical and morphological aspects of abruptio placentae with hemorrhagic shock].

Seven histories of deliveries, complicated with abruptio placentae with hemorrhagic shock, and fetal autopsy protocols were examined, while the placentas and the uteri, removed at surgery were studied morphologically. Pregnancy had been complicated by gestosis in all patients. Placental abruption developed by 35-37 weeks of pregnancy in 5 patients, and near term in 2. All patients underwent urgent cesarean section followed by supravaginal amputation and extirpation of the uterus. Uterine, placental and fetal morphologic changes were qualified as shock-related. It is concluded that progressive abruptio placentae is an indication for abdominal delivery.

Abruptio Placentae↗