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PubMed1991

[Clinical evaluation of pseudosinusoidal fetal heart rate pattern associated with abruption placentae].

From retrospective studies of fetal heart rate records on abruption placentae, six cases with the pseudosinusoidal FHR pattern (pseudosinusoidal pattern) are reported. The pseudosinusoidal pattern has the following characteristics: 1) oscillation frequency synchronized with the frequency of uterine contractions, 2) an amplitude of 19bpm or more, which is positively correlated with the area of placental separation, 3) uniform frequency and amplitude, 4) a frequency of 1.3 cycles/min or less, which is clearly different from the true sinusoidal pattern. It seems that this characteristic pseudosinusoidal pattern appeared with decreased fetoplacental blood flow, which was initiated by abruption placentae and superimposed by uterine contractions. Since this pattern indicates progressive fetal jeopardy, an emergency delivery should be performed for intact survival.

Abruptio Placentae↗
PubMed2007

Placental shelf - a common, typically transient and benign finding on early second-trimester sonography.

OBJECTIVE: Placental shelves are believed to represent circumvallate placentae. It is thought that circumvallate placenta may be associated with adverse perinatal outcome when present at delivery. The objective of this study was to determine the prevalence, persistence and significance of placental shelves detected in the early second trimester. METHODS: In 152 consecutive anomaly scans performed between 13 and 16 weeks of gestation, special attention was directed to placental structure and the presence of a placental shelf. When present, a mid-gestation scan was performed to verify if the finding persisted. If so, a third-trimester scan was performed. Delivery charts were reviewed for all cases initially diagnosed with a placental shelf, recording any placenta-related complications. RESULTS: In 17 of 152 (11.2%) early second-trimester scans a placental shelf was detected. In three of these 17 cases the shelf persisted to the 20-22-week scan. In the two cases that presented for the third-trimester scan the shelf was no longer present. In all 17 cases the perinatal outcome was good. CONCLUSIONS: In our study group early second-trimester placental shelves rarely persisted to mid-gestation and never to the third trimester. There were no placenta-related perinatal problems. Early second-trimester placental shelf appears to be a common, benign and transient sonographic finding.

Abruptio Placentae↗
PubMed1990

Unexplained elevations of maternal serum alpha-fetoprotein.

Alpha-fetoprotein (AFP) is a commonly used prenatal screening test for congenital anomalies. However, when anomalies are excluded after high resolution ultrasound and/or amniocentesis, an elevated maternal serum AFP (MSAFP) has been found to be associated with a 2- to 4-fold increase in low birthweight resulting from both preterm delivery and intrauterine growth retardation. Unexplained MSAFP elevations are also associated with up to 10-fold increase of placental abruption and a 10-fold increase in perinatal mortality. Results from studies of over 225,000 screened pregnancies indicate that 20 and 38 per cent of women with an unexplained MSAFP elevation may have an adverse pregnancy outcome. Twin gestations with MSAFP elevations greater than four multiples of the median are associated with similar constellations of pregnancy complications. Maternal serum AFP elevations in women with pregnancy complications are most likely the result of a leak of AFP across the placenta. Optimum management of women with unexplained elevations has not yet been established; however, evaluation of fetal growth throughout gestation is important in these patients.

Abruptio Placentae↗
PubMed2000

Obstetric history and the risk of placenta previa.

OBJECTIVE: To evaluate secular trends in the occurrence of placenta previa and whether placenta previa is associated with the outcome of previous pregnancies, cesarean section, and sociodemographic factors. DESIGN: A cohort study based on the Medical Birth Registry of Norway. Placenta previa in the second pregnancy was investigated for associations with outcomes in the first pregnancy and sociodemographic factors. RESULTS: In birth orders 1 and 2 the occurrence of placenta previa was 1.2 and 2.2 per 1,000, respectively, with no secular trend. The occurrence increased with maternal age and was lowest in women aged 20-29 years. The recurrence rate was 23 per 1,000 (adjusted odds ratio (OR) of recurrence=9.7). In women with prior delivery at < or =25 gestational weeks the risk of placenta previa was 6.7 per 1,000 (adjusted OR=3.0). In women with prior placental abruption the risk was 5.8 per 1,000 (OR=2.6). In women with prior perinatal death the risk was 4.4 per 1,000 (adjusted OR= 1.8). No independent relationship emerged with socio-economic factors, previous birthweight, and a history of pregnancy induced hypertension. Cesarean section was associated with subsequent development of placenta previa (adjusted OR= 1.3). CONCLUSIONS: We found no secular trends in the occurrence of placenta previa. Placenta previa is associated with previously described risk factors for placental abruption. The increased risk of placenta previa subsequent to placental abruption supports the theory of a shared etiologic factor. However, placenta previa and placental abruption do not share a common etiology in relation to a history of pregnancy induced hypertension, fetal growth retardation, and socio-economic factors.

Abruptio Placentae↗
PubMed2003

[Obstetrical hysterectomy].

OBJECTIVE: Obstetrical hysterectomy still remains life saving operation. The aim of study was to determinate the frequency, indications and complications after the operation in the hospital in Zielona Góra, Poland. MATERIALS AND METHODS: A retrospective review based on hospital data of 36 patients undergoing obstetrical hysterectomy over the period of 11 years was undertaken. RESULTS: The incidence of obstetrical hysterectomy during 1990-2001 et the Department of Obstetrics and Gynaecology in the district hospital in Zielona Góra was 1: 593 deliveries. Post partum hysterectomy occurred in 0.021% of normal deliveries and 1.03% of cesarean sections. The most common indications were placenta increta and placenta accreta /61.1%/, followed by uterine atony /13.8%/ and rupture of the uterus /11.1%. The most frequent complications were shock and lesion of the urinary bladder/both 5.6%/. The maternal mortality was 2.8%. CONCLUSIONS: 1. The most common indications for the obstetrical hysterectomy are: placenta's pathologies; uterine atony and rupture of the uterus. 2. Obstetrical hysterectomy is connected with high risk of complications and maternal mortality.

Abruptio Placentae↗
PubMed1996

Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy.

The authors carried out an epidemiologic study to evaluate the role of maternal cigarette smoking as a potential risk factor for placental abruption, placenta previa, and uterine bleeding of unknown etiology in pregnancy. Data for this prospective cohort study were obtained from women seeking prenatal care at any of the two tertiary, seven regional, or 17 community hospitals in the province of Nova Scotia, Canada, between January 1, 1986, and December 31, 1993. A total of 87,184 pregnancies (among 61,667 women) were registered in the database. Women who smoked during pregnancy (33%) were compared with nonsmokers, and all women were followed until the termination of pregnancy. Placental abruption was indicated in 9.9 per 1,000 pregnancies, while placenta previa and uterine bleeding of unknown etiology were indicated in 3.6 and 58.9 per 1,000 pregnancies, respectively. Women who smoked had a twofold increase in the risk of abruption (relative risk = 2.05, 95% confidence interval (CI) 1.75-2.40) in comparison with nonsmokers, while the relative risk for placenta previa was 1.36 (95% CI 1.04-1.79). However, cigarette smoking was not found to be associated with uterine bleeding of unknown etiology (relative risk = 1.01, 95% CI 0.94-1.08). There was no evidence for an increased risk of uteroplacental bleeding disorders with increasing numbers of cigarettes smoked. All analyses were adjusted for potentially confounding factors through logistic regression models based on the method of generalized estimating equations. The study confirms a positive association between cigarette smoking and placental abruption and a weak association with placenta previa but not with other uterine bleeding. The distinct pattern of results for placental abruption, placenta previa, and uterine bleeding of unknown origin suggests that these three uteroplacental bleeding disorders do not have a common etiology in relation to cigarette smoking.

Abruptio Placentae↗
PubMed1990

Acute leukemia during pregnancy. Association with immune-mediated thrombocytopenia in mother and infant.

A 29-year-old female in the 20th week of pregnancy was admitted because of a change in the ABO blood group and bleeding tendency. Acute myelogenous leukemia was diagnosed with a weak reaction of red blood cells with anti-A antibody and a decreased level of A-transferase activity. Though the patient tolerated intensive chemotherapy and achieved complete remission, thrombocytopenia persisted after consolidation chemotherapy. Since platelet-associated IgG was elevated, thrombocytopenia was considered to be immune-mediated. In the third trimester, premature separation of the normally implanted placenta developed and cesarean section was performed. The male baby was also thrombocytopenic, but successfully treated with gamma-globulin.

Abruptio Placentae↗
PubMed1991

Peripartum cocaine use: estimating risk of adverse pregnancy outcome.

Pregnancy outcome of 83 patients with a positive urine toxicology screen for cocaine in the third trimester were reviewed. The outcomes of pregnancies complicated by cocaine abuse were compared to those of matched controls selected from our general obstetric population. We observed a statistically significant increase in the incidence of premature separation of the placenta, low birthweight infants, preterm deliveries, and the incidence of fetal distress requiring cesarean section. On admission, 55% of patients denied recent cocaine use. These observations have implications for planning perinatal services.

Abruptio Placentae↗
PubMed1987

Sonographic spectrum of placental abruption.

Fifty-seven cases of placental abruption detected by sonography were retrospectively reviewed. The location of hemorrhage was subchorionic in 46 cases (81%), retroplacental in nine cases (16%), and preplacental in two cases (4%). Subchorionic hematomas were more frequently shown in the 33 patients presenting before 20 menstrual weeks (91%) than in the 24 patients presenting after 20 weeks (67%). The echogenicity of hemorrhage depended on the time the sonogram was performed relative to the onset of symptoms: Acute hemorrhage was hyperechoic to isoechoic compared with the placenta, while resolving hematomas became hypoechoic within 1 week and sonolucent within 2 weeks. Acute hemorrhage was occasionally difficult to distinguish from the adjacent placenta. This occurred in five retroplacental hematomas that showed only an abnormally thick and heterogeneous placenta. Nine cases of placental abruption were initially confused with other mass lesions. Placental abruption causes a wide spectrum of sonographic findings that may be overlooked or misdiagnosed.

Abruptio Placentae↗
PubMed1995

Circumvallate placenta: sonographic diagnosis.

We prospectively identified 12 patients who had a shelf at the margin of the placenta consistent with the diagnosis of circumvallate placenta. Ten patients were followed to delivery and three placentas were sent for pathologic analysis. Circumvallate placenta was diagnosed by gross inspection in all three but was confirmed by microscopic analysis in only two. One of these patients had placental abruption and cesarean delivery for fetal distress at 27 weeks. Circumvallate placenta is another cause of uterine band, sheet, or shelf. The finding can be associated with a normal obstetric outcome but may predispose to placental complications.

Abruptio Placentae↗
PubMed1980

Cord entanglement causing premature placental separation and amniotic fluid embolism. Case report.

A woman died undelivered of amniotic fluid embolism. Postmortem examination showed that cord entanglement had caused premature placental separation with a marginal tear of the membranes and so opened a route of entry for amniotic fluid into the subplacental maternal venous sinuses. It is suggested that premature separation of the normally implanted placenta, associated with macro- or microscopic tears of or damage to the fetal membranes, provides a route of entry for amniotic fluid through the placental site in approximately one half of the fatal cases of amniotic fluid embolism.

Abruptio Placentae↗
PubMed1964

PERINATAL DEATH. A CLINICOPATHOLOGICAL ANALYSIS OF 99 CASES.

The findings at autopsy in 99 cases of perinatal deaths in a ten-year period and on pathologic examination of the accompanying placentas in 39 cases were analyzed clinicopathologically. Also reviewed were the pathologic diagnoses of 225 placentas that were examined for causes other than neonatal death. Cardiovascular and pulmonary problems, particularly hyaline membrane disease, atelectasis and cardiac anomalies were most common. Asphyxia, heart failure and premature placental separation were the most frequent causes of death. In slightly more than half of the cases a reasonable final diagnosis was established by autopsy, and if the placenta was examined, nearly two-thirds could be properly classified. In the remaining 37 per cent, as previously reported in larger series, neither the autopsy nor placental examinations disclosed a satisfactory explanation of the perinatal death.

Abruptio Placentae↗
PubMed1980

The anechoic retroplacental area: a pitfall in diagnosis of placental--endometrial abnormalities during pregnancy.

A total of 116 consecutive obstetric ultrasound examinations were reviewed. An anechoic area was observed at the placental-endometrial junctionin all 54 fundal placentas, 51 of the 52 posterior placentas, and 9 of the 36 anterior placentas. Detail was enhanced by use of a focused transducer with digital gray-scale equipment, and visualization of anterior placentas was improved by placing a water bath between the transducer and the skin surface. The anechoic area was seen beginning in the twelfth week of gestation and corresponds best to the dilated vessels of the decidua basalis.

Abruptio Placentae↗
PubMed2003

Value of ultrasonography in the diagnosis of placental abruption.

Placental abruption is a serious cause of fetal mortality. We retrospectively reviewed 24 patients with placental abruption who underwent cesarean section to evaluate ultrasonographic images with reference to the clinical findings and fetal and maternal prognosis. Fourteen of these patients presenting with placental edge separation and persistent hematoma showed a significantly smaller area of abruption, a smaller amount of intraoperative bleeding, a smaller incidence of disseminated intravascular coagulation, and a higher Apgar score as compared to the 10 patients with a thickened placenta. The patients with thickened placenta tended to have a typical clinical presentation, whereas those with placental edge separation and hematoma appeared to have an atypical and mild clinical manifestation. It was concluded that ultrasonography is useful in the diagnosis of mild and atypical placental abruption.

Abruptio Placentae↗
PubMed2003

Maternal complications following amniocentesis and chorionic villus sampling for prenatal karyotyping.

OBJECTIVE: To investigate whether amniocentesis and chorionic villus sampling increase the risk of bleeding, placental abruption, complications related to amniotic cavity and membranes, abnormal labour, operative deliveries and to investigate the impact of gestational length at the time of the procedure. DESIGN: A population-based cohort study. SETTING: Sweden, 1991-1996. POPULATION: All women, 35 to 49 years old, with single births (N = 71,586). The women were classified as exposed to amniocentesis (N = 21,748) or chorionic villus sampling (N = 1984) or not exposed (N = 47,854). METHODS: Maternal outcomes were collected from the Swedish Medical Birth Register and the Swedish Hospital Discharge Register. With Logistic regression analyses odds ratios were calculated. MAIN OUTCOME MEASURES: Crude and adjusted odds ratios of bleeding, complications related to amniotic cavity and membranes, abnormal labour and operative deliveries. Women exposed to amniocentesis or chorionic villus sampling were compared with women non-exposed. RESULTS: Neither amniocentesis nor chorionic villus sampling was associated with severe pregnancy complications such as placental abruption or placenta praevia. Women in the amniocentesis group had a lower chance of normal delivery (OR = 0.93, 95% CI 0.90-0.97), an increased risk of complications related to amniotic cavity and membranes (OR = 1.15, 95% CI 1.06-1.24) and hypotonic uterine dysfunction (OR = 1.12, 95% CI 1.06-1.18). The risks were higher for amniocentesis before 15 weeks of gestation. Women in the amniocentesis group were more often delivered by forceps or vacuum extractions (OR = 1.11, 95% CI 1.03-1.19) and elective caesarean sections (OR = 1.09, 95% CI 1.02-1.16). For the chorionic villus sampling group, no significant associations were found. CONCLUSIONS: Among women aged 35-49 years, amniocentesis is not associated with important adverse outcomes such as abruption or placenta praevia. Minor associations were found for other maternal complications when amniocentesis was performed before 15 weeks of gestation. Improved methods to identify women with increased risk of chromosomally abnormal pregnancies might minimise the number of women exposed to invasive procedures.

Abruptio Placentae↗
PubMed1992

Perinatal placental pathology.

Examination of the placenta may be viewed as a diary of the pregnancy. Apart from its immediate diagnostic value, it can also broadly serve two purposes: 1) it provides a method of auditing antenatal clinical judgment by clinicopathologic correlation, and 2) it makes an important contribution in the context of unsolved clinical problems. The placenta's strategic location at the fetomaternal interphase mirrors disorders of both mother and fetus; however, "merged images" still cause some confusion, eg, villitis. This review summarizes recent areas of clinicopathologic correlation that have enhanced our understanding of placental function and the fetoplacental unit.

Abruptio Placentae↗
PubMed1985

Peripheral placental separation: a possible relationship to premature labor.

This investigation was undertaken to determine the relationship, if any, between peripheral placental separation and idiopathic premature labor. Ninety placentas from prematurely delivered patients (who had had no antepartum bleeding) were examined grossly and microscopically. Criteria for antepartum peripheral placental separation included adherent clot, with fibrin deposition and lamination, as well as polymorphonuclear infiltration and marginal decidual necrosis. Forty-nine placentas showed unequivocal evidence of previous peripheral separation. Another three placentas showed presumptive evidence of previous peripheral separation. It is suggested that this separation is of venous origin, and that it may play a role in the process of premature labor. This is not necessarily a cause and effect relationship.

Abruptio Placentae↗