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PubMed1990

Complications in the emergency transport of pregnant women.

Emergency transport of pregnant women is increasing in frequency. The physiologic changes of pregnancy cause a gravid woman and her fetus to be particularly vulnerable during transport. As the uterus enlarges, it compresses the vena cava and the aorta of the mother when she is in the supine position. Aortocaval compression may lead to uteroplacental insufficiency, supine hypotension, and potentially cardiopulmonary arrest. In addition, aortocaval compression is associated with placental abruption. This report presents three cases that illustrate the tragic outcomes of transporting pregnant women in the supine position. Pregnant women should be transported in a position of lateral tilt.

Abruptio Placentae↗
PubMed2004

Preterm premature rupture of membranes, intrauterine infection, and oligohydramnios: risk factors for placental abruption.

OBJECTIVE: To examine whether preterm premature rupture of membranes (PROM), intrauterine infection, and oligohydramnios are risk factors for placental abruption. METHODS: Data for this retrospective cohort study were derived from the 1988 National Maternal and Infant Health Survey (N = 11,777). Association between abruption and these clinical risk factors was expressed as relative risk (RR) and 95% confidence interval (CI), with multivariate adjustment for potential confounders. RESULTS: The overall incidence of abruption was 0.87%. The risk of abruption was 3.58-fold higher (95% CI 1.74-7.39) among women with preterm PROM (2.29%) compared with women with intact membranes (0.86%). The rates of abruption among women with and without intrauterine infection were 4.81% and 0.83%, respectively (RR 9.71, 95% CI 3.23-29.17). However, oligohydramnios was not associated with abruption (1.46% compared with 0.87%; RR 2.09, 95% CI 0.92-5.31). Compared with women with intact membranes, the RR for abruption among preterm PROM and whose membranes were ruptured for 24-47 hours and 48 hours or more before delivery, respectively, were 2.37 (95% CI 0.99-9.09), and 9.87 (95% CI 3.57-27.82). When preterm PROM was accompanied by intrauterine infections, the RR for abruption was 9.03 (95% CI 2.80-29.15) compared with women with intact membranes and no infections. Similarly, preterm PROM accompanied by oligohydramnios conferred over a 7.17-fold risk (95% CI 1.35-38.10) for abruption compared with women with neither of these 2 conditions. CONCLUSION: Women presenting with preterm PROM are at increased risk of developing abruption, with the risk being higher either in the presence of intrauterine infections or oligohydramnios. Physicians managing patients with preterm PROM should be aware that these patients are at increased risk of developing abruption after 24 hours following preterm PROM.

Abruptio Placentae↗
PubMed2006

Placental abruption in term and preterm gestations: evidence for heterogeneity in clinical pathways.

OBJECTIVE: To estimate the magnitude of associations of acute and chronic processes with abruption in preterm and term gestations. METHODS: A retrospective cohort study was performed using data on women that delivered singleton live births and stillbirths at 20 or more weeks of gestation in the United States, 1995-2002 (n = 30,378,902). Rates of 1) acute-inflammation-associated clinical conditions (premature rupture of membranes and intrauterine infection); 2) chronic processes associated with vascular dysfunction or chronic inflammation (chronic and pregnancy-induced hypertension, preexisting or gestational diabetes, small for gestational age, and maternal smoking); and 3) both acute and chronic processes, were examined among women with and without abruption. Rates were examined separately among preterm (< 37 weeks) and term births, with adjustment for confounders. Relative risk (RR) for aforementioned groups in relation to abruption was derived from multivariate logistic regression models after adjusting for potential confounders. RESULTS: At preterm gestation, the rates of acute-inflammation-associated conditions were higher among women with than without abruption (12.0% compared with 10.2%; RR 1.38, 95% confidence interval [CI] 1.34-1.42). At term, acute-inflammation-associated conditions were present in 4.2% and 3.3% of births with and without abruption, respectively (RR 1.39, 95% CI 1.33-1.45). At preterm gestation, the rates of chronic processes were 43.9% and 30.0% among women with and without abruption, respectively (RR 1.87, 95% CI 1.85-1.90). At term, the corresponding rates of chronic processes were 41.0% and 22.7%, respectively (RR 2.37, 95% CI 2.34-2.41). Association between both acute and chronic processes and abruption are similar to those of acute-inflammation-associated conditions. CONCLUSION: Among women with placental abruption, conditions associated with acute inflammation are more prevalent at preterm than term gestations, whereas chronic processes are present throughout gestation. LEVEL OF EVIDENCE: II-2.

Abruptio Placentae↗
PubMed2004

Pathophysiology of fetal growth restriction: implications for diagnosis and surveillance.

UNLABELLED: Normal fetal growth depends on the genetically predetermined growth potential and is modulated by fetal, placental, maternal, and external factors. Fetuses with intrauterine growth restriction (IUGR) are at high risk for poor short- and long-term outcome. Although there are many underlying etiologies, IUGR resulting from placental insufficiency is most relevant clinically because outcome could be altered by appropriate diagnosis and timely delivery. A diagnostic approach that aims to separate IUGR resulting from placental disease from constitutionally small fetuses and those with other underlying etiologies (e.g., aneuploidy, viral infection, nonaneuploid syndromes) needs to integrate multiple imaging modalities. In placental-based IUGR, cardiovascular and behavioral responses are interrelated with the disease severity. Ultrasound assessment of fetal anatomy, amniotic fluid volume, and growth is complementary to the Doppler investigation of fetoplacental blood flow dynamics. A diagnostic approach to IUGR combining these modalities is presented in this review. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the development of the placental interface, to outline the mechanisms of placental insufficiency, and to list the manifestations of placental insufficiency and the tests that can be used to diagnose fetal growth restriction.

Abruptio Placentae↗
PubMed2006

Uterine trauma in pregnancy after motor vehicle crashes with airbag deployment: A 30-case series.

BACKGROUND: We describe a cohort of women of at least 20 weeks gestation to determine the frequency of placental abruption or fetal compromise after a motor vehicle crash (MVC) with airbag deployment. METHODS: A retrospective chart review was conducted at two urban emergency departments. All women of at least 20 weeks gestation with MVCs in which their airbag deployed and who were admitted for monitoring or trauma care between 1997 and 2002 were identified by the Trauma Registry for each hospital and included. RESULTS: Thirty women in the 6-year period were identified. Gestational age (GA) at the time of the MVC ranged from 20 weeks to 37 weeks (median GA 29 weeks). Of the 30 women, 15 (50%) were belted drivers, 5 (17%) were unbelted drivers, 5 (17%) were belted front-seat passengers, and 5 (17%) were unbelted front-seat passengers. Median speed was 35 mph. One woman experienced placental abruption with subsequent intrauterine fetal demise. Twenty-two (73%, 95% CI: 58-89) experienced uterine contractions. Sixteen (53%, 95% CI: 36-71) reported abdominal pain. Abnormal fetal heart rate was documented in six patients (20%, 95% CI: 6-34). Vaginal bleeding was reported in two patients (7%). Only three women had no abnormal abdominal findings after the MVC. CONCLUSIONS: From this preliminary series, placental abruption does not appear to occur frequently in MVCs with airbag deployment. It is unclear if fetal risk is higher than that without airbags. A significant number of pregnant women do not wear seatbelts.

Abruptio Placentae↗
PubMed2005

Maternal complications in women with chronic hypertension: a population-based cohort study.

BACKGROUND: The aim of the study was to determine if pregnant women with chronic hypertensive disease have an independent risk for preeclampsia, gestational diabetes or placental abruption. To examine if superimposed preeclampsia in this group of women is related to an increased risk of placental abruption. METHODS: This study is a population-based cohort study using the Swedish Medical Birth Register 1992-98. A population of 681 515 women aged between 15-44 years with singleton pregnancies, excluding women with systemic lupus erythematosus (SLE), diabetes mellitus and chronic renal disease were studied. Among these, 3374 women were diagnosed with chronic hypertensive disease. Multiple logistic regression analysis was performed and the outcome measures of crude and adjusted odds ratios (OR) were presented with 95% confidence intervals (CI). RESULTS: Chronic hypertensive disease is associated with multiparity, age, high body mass index and Nordic ethnicity. After controlling for confounders, chronic hypertensive disease is an independent risk factor for preeclampsia (OR 3.8; 95% CI 3.4-4.3), gestational diabetes (OR 1.8; 95% CI 1.4-2.4) and placental abruption (OR 2.3; 95% CI 1.6-3.4). CONCLUSION: Chronic hypertensive disease is independently associated with an increased incidence of preeclampsia, gestational diabetes and placental abruption.

Abruptio Placentae↗
PubMed1984

Plasmin-alpha 2-antiplasmin complexes in bleeding disorders characterized by primary or secondary fibrinolysis.

A two-dimensional immunoelectrophoresis (2DIEP) method detects plasmin complexed to its major inhibitor, alpha 2-antiplasmin, in plasma in the blood of patients during (a) thrombolytic therapy with urokinase, (b) episodes of disseminated intravascular coagulation (DIC) with active fibrinolysis, and (c) episodes of fibrinolytic haemorrhage without evidence of DIC. Clearance of the complexes from the blood is rapid and their detection thus implies active plasmin generation at the time of blood sampling or within the preceding 24 h. Abolition of the complexes using tranexamic acid therapy allowed surgery without bleeding in two previously grossly haemorrhagic patients in group (c). Antithrombin III complexed with activated procoagulants was detected using a similar 2DIEP method in only two of four patients with DIC. Abnormalities of alpha 2-macroglobulin were detected on 2DIEP of plasma in the patients studied with proteolytic disorders; these did not appear to reflect complex formation.

Abruptio Placentae↗