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PubMed1998

Preterm birth and maternal smoking: risks related to gestational age and onset of delivery.

OBJECTIVE: The object was to examine the effects of smoking on spontaneous and induced very and moderately preterm birth (< or = 32 and 33-36 completed weeks' gestation, respectively). STUDY DESIGN: Live singleton births in Sweden, 1991-1993 (n = 311,977), were examined. RESULTS: Risk of preterm birth consistently increased with amount smoked. Smoking was most heavily associated with increased risks of very preterm birth and spontaneous preterm birth. The highest impact of smoking was seen on risk of spontaneous very preterm birth among women who smoked at least 10 cigarettes/d (odds ratio 1.7). The smoking-related risks of preterm birth remained essentially unchanged after excluding pregnancies with smoking-associated pregnancy complications. CONCLUSIONS: There is a dose-related impact of smoking on risk of preterm birth. The fact that the smoking-related risk of spontaneous preterm birth is more pronounced than that of induced preterm birth suggests that smoking is associated with spontaneous preterm labor.

Abruptio Placentae↗
PubMed2002

Urinary protein excretion and expectant management of early onset, severe pre-eclampsia.

OBJECTIVE: To evaluate the importance of proteinuria in the expectant management of early onset, severe pre-eclampsia. METHODS: In this prospective series of 340 women, 24-h urine collections were performed and monitored twice weekly in a high-care ward. RESULTS: Seventy-four women with at least two 24-h urine collections were grouped into women with a proteinuria increase of > or =2 g (n=29) and with women whose proteinuria decreased, or increased by <2 g (n=45). Major maternal complications, prolongation of gestation, and perinatal outcomes were comparable. Fifty-six (75%) women experienced an increase in proteinuria. When patients with heavy proteinuria (n=83) were compared to those with moderate proteinuria (n=257), maternal and perinatal outcomes were comparable. More days were gained before delivery in the heavy proteinuria group than in the moderate (12 vs. 9; P<0.001). CONCLUSION: Most patients experienced increased proteinuria. Neither the rate of increase nor the amount of proteinuria affected maternal and perinatal outcomes.

Abruptio Placentae↗
PubMed1997

Maternal serum alpha-fetoprotein in placental abruption associated with preterm labor.

OBJECTIVE: To evaluate maternal serum alpha-fetoprotein levels in women with preterm labor. METHOD: Maternal serum alpha-fetoprotein level was measured in 58 women in preterm labor with intact membranes. Maternal levels and multiples of the median were compared in groups with preterm labors of different etiologies and between those with and without placental abruption. Women with vaginal bleeding were also studied separately. Sensitivity, specificity and predictive values were calculated for 2 multiples of the median. Chi squared, Fisher exact test, Mann Whitney U-test, Kruskal-Wallis test and logistic regression were all used. RESULTS: Those cases with placental abruption (n = 9) had a higher maternal serum alpha-fetoprotein level than the other groups (P = 0.033) and than that of all of them, in total, (n = 49) without placental abruption (P = 0.001). If only women with vaginal bleeding were taken into consideration (n = 13) the maternal serum alpha-fetoprotein level was higher in those with placental abruption (P = 0.001). If we had the criterion of 2 multiples of the median, sensitivity was 66.67%, specificity 95.92%, the positive predictive value 75%, and the negative predictive value 94%. In women with vaginal bleeding sensitivity was 100%, specificity 71.43%, the positive predictive value 75%, and the negative predictive value 100%. CONCLUSIONS: Maternal serum alpha-fetoprotein level is higher in women with preterm labor and placental abruption. This measurement could be used as a biochemical marker of placental abruption in cases of preterm labor.

Abruptio Placentae↗
PubMed1997

Elevated second trimester human chorionic gonadotropin level associated with adverse pregnancy outcome.

OBJECTIVE: Our purpose was to determine whether unexplained elevations in maternal serum human chorionic gonadotropin in the second trimester may be associated with adverse pregnancy outcome. METHOD: Between April 1992 and April 1995, 610 pregnant women undergoing second trimester triple marker screening for Down syndrome who delivered at our institution were evaluated. Eighty-one women with a hCG level greater than 2.0 multiples of the median (MoM) were included in the study group while 481 women with hCG levels < 2.0 MoM served as controls. Pregnancies with fetal chromosomal and structural anomalies and maternal serum alpha-fetoprotein levels greater than 2.0 MoM were excluded from the study. Pregnancy outcomes were obtained from hospital delivery records. Statistical analysis were performed by Student's t-test; odds ratios and 95% confidence intervals were also calculated. RESULTS: Women with elevated human chorionic gonadotropin levels showed an increased risk for preeclampsia (odds ratio (OR): 5.93, 95% confidence interval (CI): 1.97-15.88), intrauterine growth retardation (OR: 5.34, 95% CI: 2.14-13.34), preterm delivery (OR: 5.66, 95% CI: 3.22-9.98), and preterm premature rupture of membranes (OR: 3.15, 95% CI: 1.23-8.07). CONCLUSION: Unexplained elevation of human chorionic gonadotropin in the second trimester appears to be associated with adverse pregnancy outcome.

Abruptio Placentae↗
PubMed2000

Management of mild chronic hypertension during pregnancy: a review.

OBJECTIVE: To conduct a systematic review of evidence relating to management of mild chronic hypertension during pregnancy, including associated risks, benefits, and harms of treatment with antihypertensive agents, nonpharmacologic measures, and aspirin and benefits of various monitoring strategies. DATA SOURCES: Using four broad search strategies, we searched English and non-English-language citations in 16 electronic databases from their inception to February 1999 and consulted relevant textbooks, references, and experts. STUDY SELECTION: Reviewers screened 6228 abstracts and found 215 articles that met multiple prespecified patient selection, study population, and design criteria. TABULATION, INTEGRATION, AND RESULTS: Forty-six studies consistently showed that chronic hypertension triples the risk for perinatal mortality (odds ratio [OR] 3.4; 95% confidence interval [CI] 3.0, 3.7) and doubles the risk for placental abruption (OR 2.1; 95% CI 1.1, 3.9). Thirteen small, randomized controlled trials had inadequate power to rule in or rule out moderate-to-large (20%-50%) benefits of antihypertensive treatment. Possible adverse effects were fetal renal failure when angiotensin-converting enzyme inhibitors are used in the second or third trimester and growth restriction when atenolol is used early in pregnancy. Trials showed that aspirin neither reduces nor increases perinatal and maternal morbidity, but they did not rule out possible small-to moderate beneficial or adverse effects. No studies provide guidance on benefits or consequences of various nonpharmacologic therapies or monitoring strategies. CONCLUSION: Mild chronic hypertension is associated with increased maternal and fetal risks. Beneficial treatment and monitoring regimens are not clear, but some treatments, such as angiotensin-converting enzyme inhibitors, are best avoided.

Abruptio Placentae↗
PubMed2002

Complications of third-trimester amniocentesis using continuous ultrasound guidance.

OBJECTIVE: The objective of the study was to estimate the risks of third-trimester amniocentesis with continuous ultrasound guidance. METHODS: Cohort study. We reviewed the medical records of women who had an amniocentesis with continuous ultrasound guidance after 30 weeks' gestation at a single institution from January 1991 through December 1994. For procedures performed from January 1991 to February 1994, we obtained information from a chart review. From March 1994 to December 1994, we collected data prospectively. The primary outcome was whether or not there were any complications within 48 hours of the procedure. We also sought to determine any risk factors associated with complications. RESULTS: Complete records and data were available for 562 amniocenteses during the study period. The mean gestational age at the time of amniocentesis was 34.9 weeks. Of the 562 procedures, five (0.8%) were unsuccessful and 50 (9%) required more than one needle stick. The complication rate was 0.7% (95% confidence level (CI) = 0.02%, 1.9%). These included spontaneous labor in a preterm gestation (1), premature rupture of the membranes (1), placental abruption (1), and fetal-maternal hemorrhage (1). No patient required an emergency cesarean delivery and none suffered a perinatal death (95% CI 0, 0.8%). Complications were not associated with the number of needle sticks, the presence of bloody amniotic fluid, or the level of operator experience. CONCLUSIONS: Third-trimester amniocentesis performed with continuous ultrasound guidance has a high success rate and low risk for complications.

Abruptio Placentae↗
PubMed2003

Successful term pregnancy after bilateral uterine artery embolization for postpartum hemorrhage.

BACKGROUND: Selective bilateral uterine artery embolization has been used since the 1970s for the conservative treatment of postpartum hemorrhage. The fertility rate after the embolization procedure is yet to be determined. CASE: A 30-year-old woman presented with placental abruption and subsequently delivered preterm at 29 weeks' gestation. Her delivery was complicated by postpartum hemorrhage, for which selective bilateral uterine artery embolization was performed with successful cessation of the hemorrhage. Three months later, the patient presented with a spontaneous pregnancy. Her pregnancy resulted in an appropriately grown fetus delivered at 39 weeks' gestation. CONCLUSION: This is one of the earliest reported successful pregnancies after a bilateral uterine artery embolization procedure performed for postpartum hemorrhage. This case adds to a growing literature demonstrating that pregnancy after embolization is possible, and can occur soon after the procedure.

Abruptio Placentae↗
PubMed2003

Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy.

OBJECTIVE: To evaluate the long-term clinical significance of intrauterine hematomas detected in the first trimester of pregnancy in a general obstetric population. METHODS: A prospective study was designed to compare perinatal outcomes in 187 pregnant women with intrauterine hematomas and 6488 controls in whom hematomas were not detected at first-trimester ultrasonographic examination. RESULTS: The incidence of intrauterine hematoma in the first trimester in a general obstetric population was 3.1%. A retroplacental position of the hematoma was significantly correlated with an increased risk for adverse maternal and neonatal complications. The presence or absence of symptoms of threatened abortion did not affect these outcomes. The rates of operative vaginal delivery (relative risk [RR] 1.9; confidence interval [CI] 1.1, 3.2) and cesarean delivery (RR 1.4; CI 1.1, 1.8), as well as the rates of pregnancy-induced hypertension (RR 2.1; CI 1.5, 2.9) and preeclampsia (RR 4.0; CI 2.4, 6.7), were significantly greater in the hematoma group. Placental abruption (RR 5.6; CI 2.8, 11.1) and placental separation abnormalities (RR 3.2; CI 2.2, 4.7) were also significantly more frequent in the hematoma group. Perinatal complications, including the rate of preterm delivery (RR 2.3; CI 1.6, 3.2), fetal growth restriction (RR 2.4; CI 1.4, 4.1), fetal distress (RR 2.6; CI 1.9, 3.5), meconium-stained amniotic fluid (RR 2.2; CI 1.7, 2.9), and neonatal intensive care unit admission (RR 5.6; CI 4.1, 7.6), were also significantly increased in this group. Furthermore, the frequency of intrauterine demise and perinatal mortality was increased in the hematoma group, but this difference did not reach statistical significance (Ps =.6 and.2). CONCLUSION: Our study suggests that the presence of an intrauterine hematoma during the first trimester may identify a population of patients at increased risk for adverse pregnancy outcome.

Abortion, Spontaneous↗