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PubMed1986

Fetal heart monitoring and ultrasound in the management of placental abruption.

Three cases of placental abruption with the "pseudosinusoidal" fetal heart rate (FHR) pattern, a periodic late deceleration related to frequent uterine contractions are reported. This 'pseudosinusoidal' pattern is clearly not a true sinusoidal pattern. The fetal monitoring patterns of these patients are presented and discussed along with the use of ultrasound in the management of this condition. All infants were delivered by cesarean section with low Apgar scores at birth, but they soon recovered completely.

Abruptio Placentae↗
PubMed1990

Chorionic villus sampling and rare side-effects: will a randomised controlled trial detect them?

Controlled trials have been instigated, comparing the results and complications of chorionic villus sampling (CVS) and amniocentesis. At present most attention has focused on the miscarriage rate, which itself requires large numbers to provide studies of reasonable power. This paper describes a case of stillbirth due to massive placental abruption following CVS. The size of trial needed to provide sufficient power to detect a range of realistic postulated changes in the incidence of this or other important possible complications is calculated. It would appear that the size of sample required is very large, and that present trials will not succeed in detecting possible important differences in late obstetric, neonatal, and other long term complications of the procedure.

Abruptio Placentae↗
PubMed1987

Obstetric factors associated with cord blood gas values at birth.

Values of pH, base deficit and Pco2 in 885 unselected samples of umbilical blood collected at birth were related to pregnancy and delivery details. An increase in acidosis in both umbilical vein and artery was associated with placental abruption, maternal pethidine, pre-eclampsia, primigravidity, vaginal operative delivery for fetal distress and a long second stage of labour. Increased acidosis in arterial, but not venous, blood occurred with cord entanglement, vaginal breech delivery, postmaturity, high birthweight and a long first stage of labour. The relationship between obstetric factors and the acid-base state of the neonate suggests a possible role for cord blood gas measurements in assessing the results of obstetric practice.

Abruptio Placentae↗
PubMed1991

Prevention of perinatal consequences of pre-eclampsia with low-dose aspirin: results of the epreda trial. The Epreda Trial Study Group.

A multicentric randomized double-blind trial was realized in order to determine whether a treatment with a low-dose aspirin (150 mg/day) with or without dipyridamole (225 mg/day) was able to prevent the perinatal consequences of pre-eclampsia. This study demonstrated a significant difference in birthweight and incidence of fetal growth retardation between treatment and placebo groups. No difference was demonstrated between aspirin and aspirin + dipyridamole patients.

Abruptio Placentae↗
PubMed1992

Conservative management of placental abruption complicated by severe clotting disorders.

Placental abruption resulting in fetal death may seriously affect maternal health, especially when clotting disorders arise. The prevailing view is that the clotting system will only normalize after the uterus has been evacuated and therefore prompt delivery, often by induction of labor, is advocated. Over a 3-year period, 16 cases (0.35%) of intra-uterine fetal death due to placental abruption occurred at Leiden University Hospital. Five cases were complicated by severe clotting disorders. All women delivered vaginally. No maternal deaths occurred. In contrast to most authors, we present data showing that in four out of five cases the clotting system started to normalize before the uterus was emptied. We suggest that an expectant approach until recovery of the coagulopathy is safer than aiming at a quick delivery. After stabilization of the clotting disorder, one may then consider evacuation of the uterus, if need be by induction of labor.

Abruptio Placentae↗
PubMed1993

Postpartum hemolytic uremic syndrome following placental abruption.

Hemolytic uremic syndrome associated with pregnancy is a rare condition. Authors report a patient treated with corticosteroids for bronchial asthma who was afflicted by placental abruption at 24 weeks' gestation. The abruption was preceded by developing herpes zoster and by deteriorating respiratory symptoms. The induced labor was followed by anuria, acute renal failure, microangiopathic hemolytic anemia, thrombocytopenia then fever and hypertension. The patient was treated early with plasma infusion, transfusion and hemodialysis. She recovered completely after 7 weeks. This case seems to be unique inasmuch as the hemolytic uremic syndrome was preceded by prodromal illness during pregnancy and was associated with placental abruption.

Abruptio Placentae↗
PubMed1982

Evaluation of the soluble fibrin monomer complexes and other coagulation parameters in obstetric patients.

The soluble fibrin monomer complexes (SFMC) in 154 obstetric patients with possible disseminated intravascular coagulation (DIC) were evaluated in SDS polyacrylamide gel electrophoresis (PAGE) after precipitation with B-alanine. Other coagulation tests were performed on these patients. The patients were classified into three groups: A) patients with a clinical history of DIC (6 cases); B) patients with only the analytical alterations of DIC (35 cases); and C) patients who showed pathological obstetric diagnoses but without a clinical nor analytical history of DIC (113 cases). In the three groups, well-defined bands of less electrophoretic mobility than fibrinogen were obtained. A significant increase in the second electrophoretic band was found in group A (5.1 per cent) when compared to group C (0.5 per cent). The second electrophoretic band appeared in greater proportion in the group of patients with an unfavorable clinical evolution.

Abruptio Placentae↗
PubMed1992

Malignant placental site trophoblastic tumor associated with placental abruption, fetal distress, and elevated CA-125.

The second pregnancy of 27-year-old woman, gravida 2, para 2 was complicated by a low alpha-fetoprotein and symptoms of chronic placental abruption. She delivered by cesarean section at 35 weeks for fetal distress at which time a biopsy of the uterus revealed a placental site trophoblastic tumor (PSTT). She rapidly developed intraabdominal spread of the neoplasm which did not respond to chemotherapy and she died 10 weeks later. Her CA-125 was elevated to 5360 mu/ml and this decreased after hysterectomy. This patient is reported to highlight a very malignant course of PSTT that was associated with a live-born male infant.

Abruptio Placentae↗
PubMed1984

Disseminated intravascular coagulation and facial injury.

A severe case of disseminated intravascular coagulation secondary to a road traffic accident in a pregnant woman is presented. The nature of this recognised complication of pregnancy is noted, and the problems encountered when it occurs together with facial trauma, are described. The importance of awareness and recognition of this condition is emphasised.

Abruptio Placentae↗
PubMed1996

Hyperhomocysteinemia: a risk factor for placental abruption or infarction.

OBJECTIVE: To establish the prevalence of hyperhomocysteinemia in women with placental abruption or infarction. DESIGN: Forty-six women with normal pregnancy outcome (controls) and 84 women with placental abruption or infarction (study group) were selected, and studied in the non-pregnant state. Homocysteine metabolism was investigated by a standardized oral methionine loading test. Hyperhomocysteinemia was defined as a concentration of fasting and/or postmethionine plasma homocysteine exceeding the estimated 97.5 percentile level of the controls. In the fasting state, the vitamin status was investigated by the measurement of serum and red cell folate, serum vitamin B12, and whole blood pyridoxal-5'-phosphate (PLP, an active form of vitamin B6). RESULTS: Hyperhomocysteinemia was diagnosed in four controls (9%) and 26 women of the study group (31%, P < 0.05). The median concentrations of the vitamins studied were significantly lower in women of the study group as compared to the controls, except for red cell folate, where the median concentration was comparable in both groups. The median concentration of fasting plasma homocysteine, unlike post-methionine plasma homocysteine, was significantly higher in women who experienced placental abruption or infarction in their first pregnancy than in women who had the same event after one or more uncomplicated pregnancies. CONCLUSION: Hyperhomocysteinemia is associated with placental abruption or infarction.

Abortion, Habitual↗
PubMedDate not supplied

Magnetic resonance evaluation of brainstem dysfunction in eclampsia and the HELLP syndrome.

An unusual case of a 40-year-old woman with eclampsia and the HELLP syndrome associated with brainstem dysfunction is presented. The patient made a progressive neurological recovery. A follow-up magnetic resonance image (MRI) demonstrated complete resolution of the multiple foci. The MRI of the brainstem was found to correlate far more closely with neurological findings than with computed tomography (CT scan).

Abruptio Placentae↗
PubMed1988

Translaryngeal guided intubation solved a critical airway problem.

Airway obstruction during the induction of general anesthesia remains a persistent problem in modern anesthesia practice, particularly in obstetric patients. Generally, a careful preoperative airway evaluation uncovers most abnormalities that might make intubation difficult. The planning and preparation for additional intubation equipment facilitate an anticipated difficult intubation. However, situations may arise in which unanticipated airway obstruction occurs requiring prompt management. Although every anesthesia provider is trained to manage such acute airway problems, the provision of a patent airway is not always possible, particularly when repeated attempts at endoscopic or blind intubation have failed, leaving a bloody field that prevents optimal visualization, or when time does not allow to wake up the patient. In this article a difficult airway problem is reported in which translaryngeal guided intubation was lifesaving.

Abruptio Placentae↗
PubMed2004

Threatened abortion: A risk factor for poor pregnancy outcome, a population-based screening study.

OBJECTIVE: The purpose of this study was to determine whether patients with first-trimester threatened abortion are at increased risk for poor pregnancy outcome. STUDY DESIGN: A large prospective multicenter database was studied. Subjects were divided into three groups: (1) no bleeding, (2) light bleeding, and (3) heavy bleeding. Univariate and multivariable logistic regression analyses were used. RESULTS: The study comprised 16,506 patients: 14,160 patients without bleeding, 2094 patients with light bleeding, and 252 patients with heavy bleeding. Patients with vaginal bleeding, light or heavy, were more likely to experience a spontaneous loss before 24 weeks of gestation (odds ratio, 2.5 and 4.2, respectively) and cesarean delivery (odds ratio, 1.1 and 1.4, respectively). Light bleeding subjects were more likely to have preeclampsia (odds ratio, 1.5), preterm delivery (odds ratio, 1.3), and placental abruption (odds ratio, 1.6). Heavy vaginal bleeding subjects were more likely to have intrauterine growth restriction (odds ratio, 2.6), preterm delivery (odds ratio, 3.0), preterm premature rupture of membranes (odds ratio, 3.2), and placental abruption (odds ratio, 3.6). CONCLUSION: First-trimester vaginal bleeding is an independent risk factor for adverse obstetric outcome that is directly proportional to the amount of bleeding.

Abortion, Spontaneous↗
PubMed2005

Placental abruption in the United States, 1979 through 2001: temporal trends and potential determinants.

OBJECTIVE: The purpose of this study was to evaluate temporal trends in abruption risk and to assess how much underlying changes in the clinical determinants may have affected these trends. STUDY DESIGN: We used the National Hospital Discharge Summary data (1979-2001), an annual survey of sampled non-federal, short stay, general, and specialty hospitals in the United States. Trends in abruption were assessed for the periods 1979 through 1981 and 1999 through 2001. Clinical determinants of abruption that were evaluated included hypertensive diseases, anemia, gestational diabetes mellitus, preterm labor, preterm premature rupture of membranes, chorioamnionitis, oligohydramnios, obstetric shock/trauma, uterine tumors, short umbilical cord, and velamentous cord insertion. Temporal trends in abruption were examined before and after adjustment for determinants through multivariable logistic regression. RESULTS: The rate of abruption increased 92% (95% CI, 88, 96) among black women between 1979-1981 (0.76%; n = 13,584 women) and 1999-2001 (1.43%; n = 18,960 women). Among white women, the rate increased by 15% (95% CI, 14,16) over the same period, from 0.82% (n = 66,186 women) in 1979-1981 to 0.94% (n = 59,284 women) in 1999-2001. The determinants that were associated with trends in abruption included anemia, gestational diabetes mellitus, preterm labor, short umbilical cord, and velamentous cord insertion, although their effects varied substantially by maternal race. CONCLUSION: The temporal increase in rates of abruption may reflect a true increase in risk or may be the result of improved diagnosis of both abruption and its determinants. Although the cause of abruption is still speculative, the trend is of concern and deserves scrutiny.

Abruptio Placentae↗
PubMed2004

First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population-based screening study (the FASTER Trial).

OBJECTIVE: The purpose of this study was to determine whether maternal serum levels of pregnancy-associated plasma protein A, free-beta subunit human chorionic gonadotropin, or nuchal translucency size are associated with obstetric complications. STUDY DESIGN: Data were obtained from the First and Second Trimester Evaluation of Risk trial. Pregnancy-associated plasma protein A and free-beta subunit human chorionic gonadotropin levels were analyzed, and nuchal translucency was measured between 10 weeks 3 days and 13 weeks 6 days of gestation in 34,271 pregnancies. RESULTS: Women with pregnancy-associated plasma protein A of < or =5th percentile were significantly more likely to experience spontaneous fetal loss at < or =24 weeks of gestation, low birth weight, preeclampsia, gestational hypertension, preterm birth ( P < .001) and stillbirth, preterm premature rupture of membranes, and placental abruption ( P < .02). Nuchal translucency at > or =99th percentile and free-beta subunit human chorionic gonadotropin at < or =1st percentile were associated with an increased risk of spontaneous loss at < or =24 weeks of gestation (adjusted odds ratios, 3.90, 3.62, respectively; P < .001). CONCLUSION: Low pregnancy-associated plasma protein A levels in the first trimester were associated strongly with a number of adverse pregnancy outcomes. Low free-beta subunit human chorionic gonadotropin levels and large nuchal translucency were both associated with early fetal loss.

Abortion, Spontaneous↗
PubMed2005

Etiology and prevention of stillbirth.

OBJECTIVE: This is a systematic review of the literature on the causes of stillbirth and clinical opinion regarding strategies for its prevention. STUDY DESIGN: We reviewed the causes of stillbirth by performing a Medline search limited to articles in English published in core clinical journals from January 1, 1995, to January 1, 2005. Articles before this date were included if they added historical information relevant to the topic. A total of 1445 articles obtained, 113 were the basis of this review and chosen based on the criterion that stillbirth or fetal death was central to the article. RESULTS: Fifteen risk factors for stillbirths were identified and the prevalence of these conditions and associated risks are presented The most prevalent risk factors for stillbirth are prepregnancy obesity, socioeconomic factors, and advanced maternal age. Biologic markers associated with increased stillbirth risk are also reviewed, and strategies for its prevention identified. CONCLUSION: Identification of risk factors for stillbirth assists the clinician in performing a risk assessment for each patient. Unexplained stillbirths and stillbirths related to growth restriction are the 2 categories of death that contribute the most to late fetal losses. Late pregnancy is associated with an increasing risk of stillbirth, and clinicians should have a low threshold to evaluate fetal growth. The value of antepartum testing is related to the underlying risk of stillbirth and, although the strategy of antepartum testing in patients with increased risk will decrease the risk of late fetal loss, it is of necessity associated with higher intervention rates.

Abruptio Placentae↗
PubMed2006

Acute and chronic respiratory diseases in pregnancy: associations with placental abruption.

OBJECTIVE: This study was undertaken to examine the associations between maternal respiratory diseases and placental abruption. STUDY DESIGN: A population-based, retrospective cohort study was conducted to examine the associations between maternal respiratory diseases and abruption in the United States. Data on women who delivered singleton births (n = 37,314,022) were derived from the National Hospital Discharge Survey for the years 1993 to 2003. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify pregnant women hospitalized for acute upper respiratory diseases, viral and bacterial pneumonia, acute bronchitis, and acute bronchiolitis, chronic bronchitis, asthma, and abruption. Relative risk (RR) and 95% CI were derived from multivariable logistic regression models to evaluate the associations after adjusting for maternal age, race, marital status, smoking, cocaine use, adequacy of prenatal care, maternal insurance status, geographic location, and year of birth (although data on smoking and cocaine use are likely underreported). RESULTS: The rate of abruption was 9.7 per 1,000 singleton births. The overall rate for acute respiratory conditions was 2.2 per 1000 pregnancies. Acute upper respiratory diseases (RR 3.2, 95% CI 3.0-3.4) and viral/bacterial pneumonia (RR 2.2, 95% CI 1.9-2.4) were associated with abruption. The rate of chronic respiratory conditions was 9.0 per 1,000 pregnancies. Chronic bronchitis was strongly associated with abruption (RR 31.8, 95% CI 29.6-34.3), but the association between asthma and abruption was modest (RR 1.1, 95% CI 1.0-1.2). Stratified analysis by maternal race showed that asthma was associated with abruption among black women but not white women. CONCLUSION: Pregnancies complicated by acute and chronic respiratory diseases requiring hospitalization are associated with placental abruption.

Abruptio Placentae↗