Summary
There is considerable interest in using pathology to confirm acute
abruptions. It has been suggested that pathologic findings can help to determine
the timing of abruptions. Because of the dearth of evidence in the literature
supporting this claim and its medicolegal implications, we undertook this study
to explore further the possibility of timing abruptions by histopathology. We
sought to correlate bleeding interval (duration from maternal presentation with
vaginal bleeding (revealed abruption) to placental delivery) with placental
histopathologic findings. We performed a retrospective review of clinical data
and placental pathology from all cases of clinically-diagnosed, acute, revealed
abruptions at a single, large institution in New England, between 2000 and 2015.
Cases were identified based on clinical diagnoses, bleeding intervals were
calculated from clinical notes, and histologic evaluations were performed by two
pathologists blinded to the bleeding intervals. A total of 177 cases were
analyzed. Of these, 103 (58%) had histologic findings corroborating the
clinical diagnosis of abruption. The most frequent finding was maternal surface
indentation (51 cases), followed by intravillous hemorrhage (50 cases). The
former was also the earliest finding, with a minimum bleeding interval of 4
minutes. In multivariate modeling, plasma cell deciduitis was significantly
associated with a longer bleeding interval (median 63 hours). If there were two
pathologic findings, there was a trend toward a longer bleeding interval. There
was modest sensitivity for the pathologic diagnosis of acute revealed abruption.
Although there was not a clear, step-wise progression of histologic lesions, the
presence of two or more findings tended to be seen with longer bleeding
intervals. Our results suggest that histologic findings cannot be used to time
acute revealed abruptions reliably and any interpretation of such should be made
with caution.