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PubMed1980

Fetal growth retardation and pre-eclampsia.

In a series of 2434 patients with pre-eclampsia, the prevalence of fetal growth retardation was 8.7 per cent compared with 8.6 per cent in the total hospital population. The prevalence was increased in early-onset pre-eclampsia (18.2 per cent) (P less than 0.001) and reduced in late-onset pre-eclampsia (5.6 per cent) (P less than 0.001). In patients who later developed early-onset pre-eclampsia with fetal growth retardation, the prevalence of subnormal oestriol excretion was significantly increased (79.5 per cent) (P less than 0.001) as was the prevalence of hypoglycaemia (33.3 per cent) (P less than 0.001) suggesting that fetal growth retardation in these pregnancies preceded the clinical signs of pre-eclampsia. The prevalence of placental abruption (8.3 per cent) and the prevalence of perinatal deaths (28.7 per cent) were both significantly higher in pregnancies with early-onset pre-eclampsia and fetal growth retardation (P less than 0.001).

Abruptio Placentae↗
PubMed1981

Placental protein 5 (PP5) in complicated pregnancies.

Maternal serum PP5 concentrations were assayed in pregnancies complicated by intrauterine growth retardation, pre-eclampsia, diabetes mellitus, placental abruption and twins. Elevated PP5 levels were noted in twin pregnancies and to a lesser extent in diabetes and pre-eclampsia. Measurement of PP5 was of no value in the detection of fetal growth retardation. The great majority of PP5 levels above the normal range were associated with a placental abnormality.

Abruptio Placentae↗
PubMed1981

Placental protein 5 (PP5) in placental abruption.

The circulating levels of serum placental protein 5 (PP5) were measured in serial samples from 10 subjects who later had placental abruption. PP5 levels were elevated in five immediately prior to the clinical diagnosis of abruption.

Abruptio Placentae↗
PubMed1983

Fetal growth achievement and elevated maternal serum alpha-fetoprotein.

Maternal serum alpha-fetoprotein (AFP) was measured by radioimmunoassay in 7223 unselected patients between 16 and 20 weeks gestation. In 141 patients an elevated AFP level (greater than 2.5 multiples of the median for gestation) was found in the absence of a primary cause. When the birthweights of the 137 liveborn infants were corrected for maternal height and weight, sex and birth rank, 37 (27%) fell below the 10th centile of normal birthweight standards. No excess of premature deliveries was found, but there was a significant association with primiparity. Patients delivered of their second infant showed a significant decrement in mean birthweight when compared with their first-born infants and with a matched control group (normal maternal serum AFP levels). There was a highly significant association between elevated serum AFP and subsequent placental abruption.

Abruptio Placentae↗
PubMed1987

Correlates of placental abruption.

All cases (884) of placental abruption reported on Washington State birth or fetal death certificates in 1980 and 1981 were compared with 789 randomly selected births from the same time period. The incidence of reported cases of placental abruption was 6.5 per 1000 total births. The combined stillbirth and first month death rate of all abruption cases was 21%. Increased risks of placental abruption were associated with pre-eclampsia, diabetes, and unmarried status. Neither parity nor maternal age was associated with an increased risk. Infants born after abruption were significantly smaller-for-gestation than control infants, more likely to be male, and had malformations more frequently than control infants. Apgar scores of liveborn abruption infants were significantly lower than those of controls after adjustment for infant weight, gestational age, and sex.

Abruptio Placentae↗
PubMed1991

Placental abruption. A case-control investigation.

The course of pregnancy and labour, neonatal outcome and social circumstances, were compared between 87 women with placental abruption and a control group of 5697 women. First and second trimester haemorrhage, amniocentesis, congenital malformations, maternal smoking and a job involving much standing or walking were associated with placental abruption.

Abruptio Placentae↗
PubMed1992

Placental bed biopsies in placental abruption.

OBJECTIVE: To investigate structural changes in the uteroplacental blood vessels in association with placental abruption. DESIGN: Prospective descriptive study. SUBJECTS: 18 women with clinical evidence of severe placental abruption delivered by caesarean section. INTERVENTIONS: Placental bed biopsies were obtained at caesarean section and studied histologically. RESULTS: Six specimens did not include trophoblast in the myometrium and were therefore not representative of the placental bed. Of the 12 representative specimens, seven demonstrated absence of physiological transformation of the utero-placental arteries (four of these were from hypertensive patients). Four biopsies showed abnormal vascular structures deep in the myometrium. One of these abnormal vessels included a fresh plug and extensive surrounding intramyometrial haemorrhage. CONCLUSIONS: Vascular malformations in association with placental abruption may be the result of trophoblastic invasion and could be the site of vessel rupture. Further descriptive and comparative studies are needed.

Abruptio Placentae↗
PubMed1997

Hyperhomocysteinaemia and protein S deficiency in complicated pregnancies.

OBJECTIVE: The aim of our study was to investigate whether women with placental abruption, intrauterine fetal death or small for gestational age infants have metabolic and/or haemostatic abnormalities which are known to be risk factors for intravascular thrombosis. DESIGN: For two years blood tests were performed at > 10 weeks after delivery on all women without hypertensive disorders either before or during pregnancy, who had been consecutively admitted to our hospital with placental abruption, intrauterine fetal death and small for gestational age. SAMPLE: A total of 62 women who had placental abruption (n = 31), intrauterine fetal death (n = 18) and a small for gestational age infant (n = 13). SETTING: Obstetric outpatient clinic in a university hospital (Free University Hospital, Amsterdam). METHODS: Presence of hyperhomocysteinaemia, various coagulation abnormalities and anticardiolipins was investigated. RESULTS: Abnormalities were found in 20 women in the placental abruption group (20/31, 65%), in 10 women in the intrauterine fetal death group (10/18, 56%) and in 11 women in the small for gestational age group (11/13, 85%). Eight out of these 31 women had more than one abnormality. In the group of 62 women protein S deficiency was demonstrated in 26%, hyperhomocysteinaemia in 24%, Protein C deficiency in 6%, anticardiolipin IgG in 11%, anticardiolipin IgM in 5%, Lupus anticoagulant in 2%. An antithrombin III deficiency was not found. Thirty-three women were tested for activated protein C resistance (9% positive) and factor V Leiden mutation (6% positive). Hyperhomocysteinaemia was treated with a daily oral dose of 250 mg pyridoxine and 5 mg folic acid. After six weeks of vitamin supplementation homocysteine levels were tested again. At that time a mean reduction of fasting homocysteine value of 68% (95% CI 57-79) was found and of post-load value of 65% (95% CI 55-76). CONCLUSIONS: Based on the results of our study, it can be concluded that women whose pregnancies are complicated by either placental abruption, intrauterine fetal death or small for gestational age, even if there is no history of thrombo-embolic disorders or hypertension during pregnancy, should be advised to undergo an examination for metabolic and/or haemostatic abnormalities.

Abruptio Placentae↗
PubMed1997

The effect on the likelihood of further pregnancy of placental abruption and the rate of its recurrence.

OBJECTIVE: To assess the effect of having a placental abruption on 1. the probability of having further pregnancies, and 2. the rate of recurrence in such pregnancies. DESIGN: A cohort study based on the Medical Birth Registry of Norway. RESULTS: From 1967 to 1989, placental abruption occurred in 218/4951 subsequent deliveries after a placental abruption index case. After placental abruption with perinatal survival in the first delivery 59% of women had a further delivery, compared with 71% who did not have placental abruption at delivery. After a perinatal loss corresponding rates were 83% and 85%, respectively. Odds ratios of recurrence of abruption, crude and adjusted for maternal age, birth order and time period were 7.1 and 6.4, respectively. No secular trends were found. Caesarean section rates increased and were higher in pregnancies with recurrent placental abruption and in subsequent pregnancies without placental abruption than in the total birth population. CONCLUSIONS: Women who have placental abruption are less likely than other women to have another pregnancy. For women who do have subsequent pregnancies placental abruption occurs significantly more frequently.

Abruptio Placentae↗