Placental abruption at near-term and term gestations: pathophysiology, epidemiology, diagnosis, and management

Brandt, Justin S.; Ananth, Cande V.

doi:10.1016/j.ajog.2022.06.059

Cited by 18 publications

(12 citation statements)

References 118 publications

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“…Placental abruption is associated with uterine cavity decompression, such as spontaneous or artificial membrane rupture. 24 To the best of our knowledge, IOL has not been identified as an independent risk factor for placental abruption, although several indications for inducing labor, such as hypertensive disorders and polyhydramnios, are known risk factors. 25 In this case, no risk factors for placental abruption were identified in the woman's medical record.…”

Section: Discussionmentioning

confidence: 96%

Outpatient labor induction—Exploring future potential by assessing eligibility in a historical cohort

Marsdal,

Sørbye,

Bernitz

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionLabor induction rates have increased over the last decades, and in many high‐income countries, more than one in four labors are induced. Outpatient management of labor induction has been suggested in low‐risk pregnancies to improve women's birth experiences while also promoting a more efficient use of healthcare resources. The primary aim of this paper was to assess the proportion of women in a historical cohort that would have been eligible for outpatient labor induction with oral misoprostol. Second, we wanted to report safety outcomes and assess efficacy outcomes for mothers and infants in pregnancies that met the criteria for outpatient care.Material and methodsCriteria for outpatient labor induction with oral misoprostol were applied to a historical cohort of women with induction of labor at two Norwegian tertiary hospitals in the period January 1, through July 31, 2021. The criteria included low‐risk women with an unscarred uterus expecting a healthy, singleton baby in cephalic position at term. The primary outcome was the proportion of women eligible for outpatient labor induction. Secondary outcomes included reasons for ineligibility and, for eligible women, safety and efficacy outcomes.ResultsOverall, 29.7% of the 1320 women who underwent labor induction in a singleton term pregnancy met the criteria for outpatient labor induction. We identified two serious adverse events that potentially could have occurred outside the hospital if the women had received outpatient care. The mean duration from initiation of labor induction to administration of the last misoprostol was 22.4 h. One in 14 multiparous women gave birth within 3 h after the last misoprostol dose.ConclusionsIn this historical cohort, three in ten women met the criteria for outpatient management of labor induction with oral misoprostol. Serious adverse events were rare. The average time span from the initiation of labor induction to the last misoprostol was nearly 24 h. This suggests a potential for low‐risk women with an induced labor to spend a substantial period of time at home before labor onset. However, larger studies testing or evaluating labor induction with oral misoprostol as an outpatient procedure are needed to draw conclusions.

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Section: Discussionmentioning

confidence: 96%

Outpatient labor induction—Exploring future potential by assessing eligibility in a historical cohort

Marsdal,

Sørbye,

Bernitz

et al. 2024

Acta Obstet Gynecol Scand

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“…Related clinical information was picked from the participants delivery record, including systolic and diastolic blood pressure (BP) at admission(The same arm of the pregnant woman should be measured at least twice, and the interval between the two measurements should be ≥4 h), proteinuria (protein excretion in a 24 h urine collection), antiphospholipid syndrome (APS) [ 11 ], gestational diabetes mellitus (GDM)(any one of fasting blood glucose ≥5.1 mmol/L, 1 h blood glucose ≥10.0 mmol/L, or 2 h blood glucose ≥8.5 mmol/L at 24 to 28 weeks of gestation by the 75 g oral glucose tolerance test (OGTT)) [ 12 ], postpartum hemorrhage [ 13 ], placental abruption [ 14 ], gestational age of delivery, mode of delivery (divided into vaginal delivery and cesarean section), placental weight, neonatal birthweight, sex, and distress. Apgar score [ 15 ] includes appearance, pulse, grimace, activity, and respiration.…”

Section: Methodsmentioning

confidence: 99%

Characteristics of Serum Lipid Metabolism among Women Complicated with Hypertensive Disorders in Pregnancy: A Retrospective Cohort Study in Mainland China

Liu,

Zhang,

Qin

et al. 2024

Obstetrics and Gynecology International

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Background. Altered maternal serum lipid metabolism is associated with hypertensive disorders in pregnancy (HDP). However, its range in pregnancy and characteristic among different subgroups of HDPs are unclear. Methods. Pregnant women with HDP who underwent antenatal care and delivered in Obstetrics and Gynecology Hospital of Fudan University during January 2018 to August 2022 were enrolled. The levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), apolipoprotein (Apo)-A, B, and E, free fatty acids (FFA), and small and dense low-density lipoprotein cholesterol (sdLDL) were measured during 4–16 weeks and 28–42 weeks of pregnancy. Results. A total of 2648 pregnant women were diagnosed with HDP, 1,880 of whom were enrolled for final analysis, including 983 (52.3%) preeclampsia (PE), 676 (36.0%) gestational hypertension (GH), and 221 (11.7%) chronic hypertension (CH). For all HDPs, serum TC, TG, LDLC, HDLC, Apo-A, Apo-B, Apo-E, and sdLDL increased significantly during pregnancy, while FFA decreased significantly. Notably, the levels of TC, LDLC, Apo-B, and sdLDL in PE group were equal to or lower than those in CH group at 4–16 weeks of pregnancy, but increased greatly during pregnancy (P<0.05). Conclusions. Maternal serum lipid levels changed through pregnancy among women with HDPs. Women complicated with PE seem to have undergone a more significant serum lipid change compared to those with GH or CH.

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“…5 In uncomplicated pregnancies, placental separation from the uterus occurs immediately after birth, while in pregnancies complicated by abruption, the placenta detaches prematurely. 6 Placental abruption affects 0.7%-1.2% of pregnancies, with 10-fold higher rates of perinatal mortality than normal pregnancies. [7][8][9] The occurrence of abruption in one pregnancy, however, is associated with substantially increased recurrence.…”

Section: Backg Rou N Dmentioning

confidence: 99%

Placental Abruption and Cardiovascular Event Risk (PACER): Design, data linkage, and preliminary findings

Ananth,

Lee,

Valeri

et al. 2024

Paediatric Perinatal Epid

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BackgroundObstetrical complications impact the health of mothers and offspring along the life course, resulting in an increased burden of chronic diseases. One specific complication is abruption, a life‐threatening condition with consequences for cardiovascular health that remains poorly studied.ObjectivesTo describe the design and data linkage algorithms for the Placental Abruption and Cardiovascular Event Risk (PACER) cohort.PopulationAll subjects who delivered in New Jersey, USA, between 1993 and 2020.DesignRetrospective, population‐based, birth cohort study.MethodsWe linked the vital records data of foetal deaths and live births to delivery and all subsequent hospitalisations along the life course for birthing persons and newborns. The linkage was based on a probabilistic record‐matching algorithm.Preliminary ResultsOver the 28 years of follow‐up, we identified 1,877,824 birthing persons with 3,093,241 deliveries (1.1%, n = 33,058 abruption prevalence). The linkage rates for live births‐hospitalisations and foetal deaths‐hospitalisations were 92.4% (n = 2,842,012) and 70.7% (n = 13,796), respectively, for the maternal cohort. The corresponding linkage rate for the live births‐hospitalisations for the offspring cohort was 70.3% (n = 2,160,736). The median (interquartile range) follow‐up for the maternal and offspring cohorts was 15.4 (8.1, 22.4) and 14.4 (7.4, 21.0) years, respectively. We will undertake multiple imputations for missing data and develop inverse probability weights to account for selection bias owing to unlinked records.ConclusionsPregnancy offers a unique window to study chronic diseases along the life course and efforts to identify the aetiology of abruption may provide important insights into the causes of future CVD. This project presents an unprecedented opportunity to understand how abruption may predispose women and their offspring to develop CVD complications and chronic conditions later in life.

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Placental abruption at near-term and term gestations: pathophysiology, epidemiology, diagnosis, and management

Cited by 18 publications

References 118 publications

Outpatient labor induction—Exploring future potential by assessing eligibility in a historical cohort

Outpatient labor induction—Exploring future potential by assessing eligibility in a historical cohort

Characteristics of Serum Lipid Metabolism among Women Complicated with Hypertensive Disorders in Pregnancy: A Retrospective Cohort Study in Mainland China

Placental Abruption and Cardiovascular Event Risk (PACER): Design, data linkage, and preliminary findings

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