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PubMed1980

Trasylol in the management of abruptio placentae with consumption coagulopathy and uterine inertia.

A study was conducted on 40 patients with abruptio placentae complicated by intrauterine death of the fetus, consumption coagulopathy and uterine inertia. All patients had severe hyperfibrinolysis (FDP > 300 microgram/ml). Following correction of shock, amniotomy was performed, intrauterine pressure catheters were placed, and oxytocin infusions were begun in all cases. The diagnosis of uterine inertia was made when the cervix failed to dilate following six hours of this treatment. After diagnosing uterine inertia, 18 patients (group B) did not. All but one patient in group A showed a marked improvement in the associated consumption coagulopathy and a rapid reawakening of uterine activity with progress to spontaneous vaginal delivery. Thirteen patients in group B did not show prepartum improvement in consumption coagulopathy or a resumption of uterine activity. These patients required cesarean section. There were two maternal deaths in group B; the overall complication rate in this group was greater than in group A.

Abruptio Placentae↗
PubMed1991

Risk factors for abruptio placentae.

The authors studied the relation of sociodemographic, medical, and life-style factors and abruptio placentae in a large cross-sectional data base. The 143 cases of abruption identified in the Delivery Interview Program, conducted in Boston from 1977 to 1980, were compared with 1,257 randomly selected controls. The authors used multiple logistic regression techniques to derive maximum likelihood estimates of the adjusted odds ratios and 95% confidence intervals as measures of the association between exposure factors and abruption. A history of chronic hypertension was associated with a threefold increase in risk (odds ratio (OR) = 3.1, 95% confidence interval (Cl) 1.1-8.4), but pregnancy-induced hypertension was not associated with abruption. Excess risk was associated with advanced maternal age (OR = 2.3, 95% Cl 1.3-3.9), low prepregnancy body mass index (OR = 2.3, 95% Cl 1.3-4.1), a history of prior stillbirth (OR = 3.5, 95% Cl 1.8-7.0), and at least weekly use of marijuana during pregnancy (OR = 2.8, 95% Cl 1.2-6.6). Overall, the association with cigarette smoking during pregnancy was of only borderline significance (OR = 1.5, 95% Cl 1.0-2.2), although there appeared to be a dose-response relation between the number of cigarettes smoked and risk of abruption.

Abruptio Placentae↗
PubMed1986

Chronic Ureaplasma urealyticum amnionitis associated with abruptio placentae.

Ureaplasma urealyticum is a common inhabitant of the lower genital tract of women. It is unclear whether or not the microorganism plays a role in provoking spontaneous abortion. Reported is a U urealyticum infection of placenta and amniotic fluid in an immunologically competent host resulting in abruptio placentae and spontaneous abortion during the second trimester of pregnancy. U urealyticum was isolated from peripheral maternal blood twice. Immunologic alterations, namely a transiently reversed OKT4/OKT8 rate and a decrease in immunoglobulin G levels, were detected in the patient. U urealyticum must be considered as a pathogen able to interfere with normal fetal development.

Abortion, Spontaneous↗
PubMed1983

The use of ultrasound in the expectant management of abruptio placentae.

The use of real-time ultrasound and antepartum nonstress testing in the management of abruptio placentae is discussed. In one patient, fetal distress developed when the retroplacental clot volume reached 480 ml. Two cases in which retroplacental clot was less than 480 ml were managed expectantly with the use of ultrasound and antepartum fetal testing, with excellent results.

Abruptio Placentae↗
PubMed1989

[Abruptio placentae in the data from the obstetrical clinics in Varna, Tolbukhin and Shumen during 1984-1987].

Abruptio placentae was established in 202 pregnancies out of 43,678 pregnancies (0.48%). Pre-eclampsia was diagnosed in 76 women as well (37.6%). Caesarean section was performed in 109 women as vital maternal indications were found in 43 of them. 139 children were born alive (67.8%), but the perinatal mortality was 43.9% (90 children). The maternal mortality was 1.98% (4 women). Caesarean section should be made only in women with alive infant, but obligatory in all cases with severe separation, if preconditions for quick management of delivery by vaginal way lack. Vaginal delivery is recommended in all milder cases and dead fetus, but the duration of delivery should not surpass 6 hours. Total hysterectomy and tamponade of the operative field and vagina should be performed in women with persistent bleedings, but in grave cases a ligature of the hypogastric arteries as well. All interventions should be done after application of intensive infusion, transfusion and other reanimation. The authors propose a scheme for medicamentous treatment.

Abruptio Placentae↗
PubMed1985

Abruptio placentae and disseminated intravascular coagulation.

Several parameters of hemostasis have been studied in 19 patients suffering from abruptio placentae. In 10 of them severe hemostatic alterations were detected and in 5, disseminated intravascular coagulation was observed. The patients were divided into four groups according to the severity of their clinical picture. The degree of placental separation was related to the severity and course of the clinical history and to the alterations in hemostasis detected at the most critical clinical moment. The analytical parameters were evaluated after extraction of the thromboplastic material. A good correlation was observed between the severity of the clinical picture and the degree of placental separation and the greatest analytical alteration, especially with cross-linked soluble fibrin monomer complexes (SFMC). In 9 of the 19 patients who showed analytical and/or clinical alterations, an improvement was detected in these alterations after evacuation of the uterus.

Abruptio Placentae↗
PubMed1990

The use of a cephalic perforator for delivery of the dead fetus in cases of severe abruptio placentae.

A technique of cephalic perforation and fetal bone screw application is described in 9 cases of severe abruptio placentae complicated by intra-uterine fetal death and uterine inertia. Eight of the patients were delivered per vaginam within 6 hours of the procedure. Besides rapid progress to vaginal delivery, fetal mutilation was minimal and no maternal injuries occurred.

Abruptio Placentae↗
PubMed1997

Etiologic determinants of abruptio placentae.

OBJECTIVE: To quantify the roles of suspected sociodemographic, anthropometric, behavioral, and pathologic determinants in the etiology of abruptio placentae. METHODS: We performed a hospital-based cohort study of 36,875 nonreferred births between January 1978 and March 1989. Gestational age was based on menstrual dates confirmed (within 7 days) by early ultrasound. RESULTS: Parity, maternal education, pre-pregnancy weight, and the rate of net gestational weight gain did not have significant independent associations with abruption. Significant determinants included the following: severe small for gestational-age (SGA) birth (odds ratio [OR] 3.99; 95% confidence interval [CI] 2.75, 5.77), chorioamnionitis (OR 2.50; 95% CI 1.58, 3.98), prolonged rupture of membranes (OR 2.38; 95% CI 1.55, 3.65), preeclampsia (OR 2.05; 95% CI 1.39, 3.04), pregnancy-induced hypertension without albuminuria (OR 1.57; 95% CI 1.00, 2.46), pre-pregnancy hypertension (OR 1.77; 95% CI 1.05, 2.99), maternal age at least 35 years (OR 1.50; 95% CI 1.14, 2.01), unmarried status (OR 1.50; 95% CI 1.13, 1.98), cigarette smoking (OR 1.40; 95% CI 1.00, 1.97 for ten to 19 cigarettes per day and OR 1.13; 95% CI 0.81, 1.59 for at least 20 cigarettes per day), and male fetal gender (OR 1.38; 95% CI 1.12, 1.70). Removal of SGA from the regression model resulted in little change in the magnitude of the other associations. CONCLUSIONS: Severe fetal growth restriction, prolonged rupture of membranes, chorioamnionitis, hypertension (before pregnancy and pregnancy-induced), cigarette smoking, advanced maternal age, unmarried status, and male fetal gender are significant etiologic determinants of placental abruption. Non-SGA determinants appear to operate largely independently of their effects on fetal growth.

Abruptio Placentae↗
PubMed1977

Infant survival following uterine rupture and complete abruptio placentae.

This report concerns a case of spontaneous rupture of the uterus through a previous cesarean scar with resulting complete abruptio placentae and extrusion of the fetus inside the intact membranes and the placenta into the peritoneal cavity. That the infant survived this dual insult is worthy of reporting.

Abruptio Placentae↗
PubMed1989

Abruptio placentae at the University of Nigeria Teaching Hospital, Enugu: a 3-year study.

A total of 81 cases of abruptio placentae treated in a 3-year period at the University of Nigeria Teaching Hospital, Enugu is reported. The incidence of 0.44% found in the study is low when compared to reports from Europe. The outstanding clinical features were high parity, low incidence of renal failure, hypertension and proteinuria. The perinatal mortality of 58% is quite high while 2 mothers who were referred to the Teaching Hospital in poor condition died. Management was by rapid and adequate resuscitation by blood transfusion and delivery as soon as the diagnosis was made. The absence of maternal mortality amongst mothers who received antenatal care at the University Teaching Hospital emphasizes the need for adequate antenatal and intrapartum care in order to eliminate the complications of this obstetrical enigma.

Abruptio Placentae↗
PubMed1986

Amniotic fluid infection syndrome and abruptio placentae.

The incidence of amniotic fluid infection syndrome, as assessed by the presence of an acute inflammatory infiltrate of the placenta, umbilical cord, and membranes at birth, was 23.3% in pregnancies complicated by severe abruptio placentae. This was not significantly higher than that noted in uncomplicated pregnancies. These data therefore fail to support the proposal that amniotic fluid infection predisposes to placental abruption.

Abruptio Placentae↗
PubMed1989

DIC and acute renal failure as a complication of abruptio placentae.

Disseminated intravascular coagulopathy (DIC) is not a new concept. Almost 90 years ago De Lee reported a case of fetal coagulation disorder with abruptio placentae and described it as "temporary hemophilia." Disseminated intravascular clotting is the result of a widespread exposure of the circulating blood to procoagulant activity capable of activating fibrinolytic enzyme system converting fibrinogen into the fibrin. Fibrin may in turn cause small blood vessel occlusion resulting in tissue necrosis, and as the phenomenon occurs more often in the glomerular capillaries acute renal failure may ensue.

Abruptio Placentae↗
PubMed1984

Changes of the clinical presentation of abruptio placentae.

There is an increase of the diagnosis "a.p." during the last years, especially stage 0 + 1. Qualified US monitoring seems to be responsible for this fact. Abruptio placentae is reversible in some cases. Conservative management can be done under intensive care conditions if antenatal treatment is indicated.

Abruptio Placentae↗
PubMed1981

Racial differences in the etiology of abruptio placentae.

Of 13,500 deliveries in a 6-year period, 326 cases of antepartum hemorrhage (2.4%) were encountered. Fifty-six (0.42%) of these patients had abruptio placentae while 130 (0.96%) had placenta previa. An inverse ratio of placenta previa and abruption placentae was observed in this study, which may be due to a racial difference--probably a result of the late onset of preeclampsia among Nigerians. A high perinatal mortality of 643/1000, influenced mainly by the high prematurity rate, was observed; cesarean section resulted in the lowest perinatal mortality (154/1000). There was one maternal death, giving a maternal mortality rate of 18/1000.

Abruptio Placentae↗