Incidence, risk factors, and clinical outcomes of placental abruption in a tertiary hospital in Hong Kong: a retrospective case-control study

Authors

  • Jade Wing Ngan SHEK
  • Po Lam SO
  • Lee Ting KWONG
  • Sai Fun WONG

DOI:

https://doi.org/10.12809/hkjgom.23.1.04

Keywords:

Abruptio placentae, Risk factors

Abstract

Introduction: This study aims to identify risk factors for placental abruption and evaluate maternal and fetal outcomes of patients with placental abruption in a tertiary hospital in Hong Kong.
Methods: Medical records of patients with placental abruption treated at the Tuen Mun Hospital between January 2017 and December 2021 were retrospectively reviewed. Data retrieved included patient demographics, alcohol/substance abuse and smoking status, obstetric history, antenatal characteristics, body mass index at first antenatal visit, clinical presentation, intrapartum events, complications, and maternal and perinatal outcomes. Each patient was matched with a control who delivered just before the patient.
Results: Of 22 990 deliveries and 23 230 live births, there were 86 placental abruption cases; the incidence was 0.37%. After adjusting for confounders, the risk factor for placental abruption was a history of antepartum haemorrhage. Compared with controls, patients with placental abruption had higher rates of caesarean sections (91.9% vs 23.3%, p<0.001), postpartum haemorrhage (62.8% vs 15.1%, p<0.001), uterine atony (31.4% vs 3.5%, p<0.001), blood transfusion (25.6% vs 3.5%, p<0.001), and disseminated intravascular coagulopathy (7.0% vs 0%, p=0.029). Compared with controls, neonates complicated with placental abruption had lower Apgar score at 1 minute (7 vs 8, p<0.001), higher preterm birth rate (64.0% vs 9.3%, p<0.001), lower birth weight (2296.4 g vs 3088.8 g, p<0.001), and more perinatal morbidities. Patients with a Couvelaire uterus had higher rates of uterine atony (56.3% vs 27.0%, p=0.026), postpartum haemorrhage (93.8% vs 61.9%, p=0.014), disseminated intravascular coagulopathy (25.0% vs 3.2%, p=0.014), blood transfusion (68.8% vs 17.5%, p<0.001), and secondary intervention (25.0% vs 1.6%, p=0.005). Neonates born from patients with a Couvelaire uterus had higher rates of acidosis (umbilical cord blood pH <7.1) [53.3% vs 5.8%, p<0.001], lower Apgar score at 1 minute (25.0% vs 4.8%, p=0.028), and hypoxic-ischaemic encephalopathy (12.5% vs 0%, p=0.039).
Conclusion: Clinicians should be vigilant for placental abruption in patients with antepartum haemorrhage, especially in high-risk patients with a history of placental abruption, hypertension, or pre-eclampsia. Early and consistent antenatal care is imperative to identify those with risk factors. Proper education and timely preventive management should be provided to improve maternal and fetal outcomes.

References

Maeland KS, Morken NH, Schytt E, Aasheim V, Nilsen RM. Placental abruption in immigrant women in Norway: a population-based study. Acta Obstet Gynecol Scand 2021;100:658-65.

Lueth A, Blue N, Silver RM, et al. Prospective evaluation of placental abruption in nulliparous women. J Matern Fetal Neonatal Med 2022;35:8603-10.

Sheiner E. Textbook of Perinatal Epidemiology. Nova Science; 2010.

Gaufberg SA. Abruptio placentae from emergency medicine/obstetrics and gynaecology. e-Med J 2001;2(3).

Bonnar J. Massive obstetric haemorrhage. Baillieres Best Pract Res Clin Obstet Gynaecol 2000;14:1-18.

Spinillo A, Fazzi E, Stronati M, Ometto A, Lasci A, Guaschino S. Severity of abruptio placentae and neurodevelopmental outcome in low birth weight infants. Early Hum Dev 1993;35:45-54.

Ananth CV, Oyelese Y, Yeo L, Pradhan A, Vintzileos AM. Placental abruption in the United States, 1979 through 2001: temporal trends and potential determinants. Am J Obstet Gynecol 2005;192:191-8.

Ananth CV, Smulian JC, Demissie K, Vintzileos AM, Knuppel RA. Placental abruption among singleton and twin births in the United States: risk factor profiles. Am J Epidemiol 2001;153:771-8.

Jenabi E, Ebrahimzadeh Zagami S. The association between uterine leiomyoma and placenta abruption: a meta-analysis. J Matern Fetal Neonatal Med 2017;30:2742-6.

Panagiotopoulos M, Tseke P, Michala L. Obstetric complications in women with congenital uterine anomalies according to the 2013 European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy Classification: a systematic review and meta-analysis. Obstet Gynecol 2022;139:138-

Sheiner E, Shoham-Vardi I, Hadar A, Hallak M, Hackmon R, Mazor M. Incidence, obstetric risk factors and pregnancy outcome of preterm placental abruption: a retrospective analysis. J Matern Fetal Neonatal Med 2002;11:34-9.

Ananth CV, Savitz DA, Williams MA. Placental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis. Obstet Gynecol 1996;88:309-18.

Kojima T, Takami M, Shindo R, Saigusa Y, Miyagi E, Aoki S. Perinatal outcomes of recurrent placental abruption. J Matern Fetal Neonatal Med 2021;34:2192-6.

Bellos I, Pergialiotis V, Papapanagiotou A, Loutradis D, Daskalakis G. Comparative efficacy and safety of oral antihypertensive agents in pregnant women with chronic hypertension: a network metaanalysis. Am J Obstet Gynecol 2020;223:525-37.

Ananth CV, Patrick HS, Ananth S, Zhang Y, Kostis WJ, Schuster M. Maternal cardiovascular and cerebrovascular health after placental abruption: a systematic review and meta-analysis (CHAP-SR). Am J Epidemiol 2021;190:2718-29.

Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand 2011;90:140-9.

Roberge S, Bujold E, Nicolaides KH. Meta-analysis on the effect of aspirin use for prevention of preeclampsia on placental abruption and antepartum hemorrhage. Am J Obstet Gynecol 2018;218:483-9.

Roberge S, Bujold E, Nicolaides K. Aspirin for the prevention of preterm and term preeclampsia : systematic review and metaanalysis. Am J Obstet Gynecol 2018;218:287-93.e1.

Elsasser DA, Ananth CV, Prasad V, Vintzileos AM; New Jersey-Placental Abruption Study Investigators. Diagnosis of placental abruption: relationship between clinical and histopathological findings. Eur J Obstet Gynecol Reprod Biol 2010;148:125-30.

Shinde GR, Vaswani BP, Patange RP, Laddad MM, Bhosale RB. Diagnostic performance of ultrasonography for detection of abruption and its clinical correlation and maternal and foetal outcome. J Clin Diagn Res 2016;10:QC04-7.

Glantz C, Purnell L. Clinical utility of sonography in the diagnosis and treatment of placental abruption. J Ultrasound Med 2002;21:837-40.

Sholl JS. Abruptio placentae: clinical management in nonacute cases. Am J Obstet Gynecol 1987;156:40-51.

Jaffe MH, Schoen WC, Silver TM, Bowerman RA, Stuck KJ. Sonography of abruptio placentae. AJR Am J Roentgenol 1981;137:1049-54.

Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol 2006;108:1005-16.

Lee YJ, Calvert K, Jape K. Couvelaire uterus resulting in haemoperitoneum. J Surg Case Rep 2022;2022:rjab618.

Ananth CV, Berkowitz GS, Savitz DA, Lapinski RH. Placental abruption and adverse perinatal outcomes. JAMA 1999;282:1646-51.

Ananth CV, Wilcox AJ. Placental abruption and perinatal mortality in the United States. Am J Epidemiol 2001;153:332-7.

Ananth CV, Smulian JC, Srinivas N, Getahun D, Salihu HM. Risk of infant mortality among twins in relation to placental abruption: contributions of preterm birth and restricted fetal growth. Twin Res Hum Genet 2005;8:524-31.

Raymond EG, Mills JL. Placental abruption. Maternal risk factors and associated fetal conditions. Acta Obstet Gynecol Scand 1993;72:633-9.

Rasmussen S, Irgens LM, Bergsjo P, Dalaker K. Perinatal mortality and case fatality after placental abruption in Norway 1967-1991. Acta Obstet Gynecol Scand 1996;75:229-34.

Tikkanen M, Luukkaala T, Gissler M, et al. Decreasing perinatal mortality in placental abruption. Acta Obstet Gynecol Scand 2013;92:298-305.

Faiz AS, Demissie K, Rich DQ, Kruse L, Rhoads GG. Trends and risk factors of stillbirth in New Jersey 1997-2005. J Matern Fetal Neonatal Med 2012;25:699-705.

Brailovschi Y, Sheiner E, Wiznitzer A, Shahaf P, Levy A. Risk factors for intrapartum fetal death and trends over the years. Arch Gynecol Obstet 2012;285:323-9.

Downes KL, Shenassa ED, Grantz KL. Neonatal outcomes associated with placental abruption. Am J Epidemiol 2017;186:1319-28.

Downloads

Published

2023-04-06

How to Cite

1.
SHEK JWN, SO PL, KWONG LT, WONG SF. Incidence, risk factors, and clinical outcomes of placental abruption in a tertiary hospital in Hong Kong: a retrospective case-control study. Hong Kong J Gynaecol Obstet Midwifery [Internet]. 2023 Apr. 6 [cited 2024 Jul. 13];23(1). Available from: https://hkjgom.org/home/article/view/327

Issue

Section

Original Article

Most read articles by the same author(s)