Abbreviations: CI, confidence interval; LOS, length of stay; NICU, neonatal intensive care unit; RR, relative risk. There are 2 types of placental abruption. Previous reports of the association between abruption and need for medical intervention are limited by small sample sizes or focused on specific high-risk subpopulations, such as neonates requiring positive pressure ventilation at birth (34) or pregnancies complicated specifically by chronic abruption-oligohydramnios sequence (35). It can lead to premature birth, low birth weight, blood loss in the mother, and in rare cases, it can cause the baby’s death. is an employee of the US government. Am J Epidemiol 1996; 144:881. This approach was used to estimate direct effects, assess the potential impact of unmeasured confounding, and yield a range of bias-corrected risk estimates for individuals with preterm birth and SGA (32). Abruption is well-established as a risk factor for growth restriction (5–11), prematurity (6–9, 11–15), and perinatal mortal… Oxford University Press is a department of the University of Oxford. , Arpino C, Longo B, et al. To our knowledge, this is the first study to examine the association between abruption and risk of neonatal apnea. g Excluding site 6, which did not report neonatal apnea. During a normal pregnancy, the placenta (an organ within the uterus that provides an unborn baby with oxygen and nutrients) remains attached to the uterine wall throughout pregnancy and labor. Placental abruption, defined as the premature detachment of the placenta from the uterine wall, before birth and after 20 weeks’ gestation, occurs in 0.6%–1% of all pregnancies in the United States (1, 2). Finally, it is unclear how much of the risk of neonatal morbidity associated with abruption is attributable to preterm birth or being small for gestational age (SGA). Spong
. The association between abruption and delivery-room resuscitation, NICU admission, and longer LOS in the NICU is in accord with extant research; however, the few previous reports are based on samples with fewer than 250 cases and primarily from single sites (9, 19, 33–35). J
The incidence rate ratio for NICU LOS is interpreted as a relative increase in the rate (i.e., incidence rate ratio = 2.0 would be interpreted as the exposed group having a rate of NICU LOS that was twice as long as the unexposed group—2 days for every 1 day in the unexposed group). Early and skilled medical intervention is needed to ensure a good outcome, and this is not available in many parts of the world. Correspondence to Dr. Katheryne L. Downes, Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 421 Curie Boulevard, 1351 BRB II/III, Philadelphia, PA 19104 (e-mail: Search for other works by this author on: Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, Department of Epidemiology and Biostatistics, School of Medicine, University of Maryland, Baltimore, Maryland, Epidemiology Department, School of Public Health, Brown University, Providence, Rhode Island, Placental abruption: epidemiology, risk factors and consequences, Intergenerational transmission of programmed effects: public health consequences, Ischemic placental disease: a unifying concept for preeclampsia, intrauterine growth restriction, and placental abruption, Epidemiology of ischemic placental disease: a focus on preterm gestations, Prevalence and risk factors for low birth weight in Northern Zimbabwe, Risk of infant mortality among twins in relation to placental abruption: contributions of preterm birth and restricted fetal growth, Placental abruption in term and preterm gestations: evidence for heterogeneity in clinical pathways, Decreasing incidence of placental abruption in Finland during 1980–2005, Placental abruption: risk factors, management and maternal-fetal prognosis. Epidemiology of pertussis in individuals of all ages hospitalised with respiratory illness in South Africa, January 2013 - December 2018. T
Corrected estimates for the preterm stratum are available in Web Table 1. b Relative risk estimated with modified Poisson model adjusting for maternal age, race/ethnicity, parity, prepregnancy body mass index, maternal comorbidities (chronic hypertension, gestational hypertension, preeclampsia, pregestational diabetes, and gestational diabetes), insurance, marital status, smoking status, alcohol use, drug use, and study site. Incidence of placental abruption in relation to cigarette smoking and hypertensive disorders during pregnancy: a meta-analysis of observational studies. However, these limitations are not unique to our study. Zhang
The risk estimates within the term and non-SGA strata represent the natural direct effects for abruption and risk of neonatal morbidity. M
It attaches to the wall of the uterus and supplies the baby with nutrients and oxygen. It’s always alarming to notice vaginal bleeding during … , Morris KR. 2, 3 Perinatal mortality is ∼10%. . Placental abruption has been associated with a 20% to 40% rate of preterm delivery. Placental abruption was recorded in 46,731 pregnancies, an incidence of 6.2 per 1,000 pregnancies (table 1). Additionally, our finding of elevated risk of both respiratory distress syndrome and apnea among both preterm and term neonates suggests that abruption may be associated with physiologic underdevelopment, which has not been previously recognized. This work was supported by the Intramural Research Program of the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development. Goldenberg
Placental abruption is known to occur somewhere between the twenty-eighth and fortieth weeks of pregnancy. We examined the association between abruption and newborn outcomes. 6. It is also possible for the abruption to occur at some point after the twentieth week. Although they are highly related, these conditions are not identical and do not always overlap. , Berghella V, Wenstrom KD, et al. Two hundred women with diagnosis of placental abruption were studied using a pretested standardized structured questionnaire. Our findings also point toward the need for changes in the way information about placental disorders is clinically collected and documented. . Both scenarios could be affected by secondary placental dysfunction resulting from maternal factors, such as smoking or chronic hypertension, as well possible unmeasured confounders (U). However, cesarean delivery is a major surgical procedure that presents risks both in the short term and in subsequent pregnancies (44). , Sananès N, Fritz G, et al. . A major strength of our study was the ability to report the incidence of rare outcomes in a large, multisite US cohort. It occurs most commonly around 25 weeks of pregnancy. , Landy HJ, Branch DW, et al. Furthermore, in contrast to the majority of existing studies of abruption, which have controlled for gestational age and birth weight in the analyses, we also estimated risk of poor outcomes conditioned on preterm birth and SGA. Once the baby is born, the placenta will separate on its own and pass naturally out of the birth canal. The incidence stats for this study came in at around 6.2 per one thousand pregnancies. To address this second issue, we performed sensitivity analyses, which suggested low likelihood of significant confounding effects. G
Finally, abruption was also associated with elevated risk of apnea. a Data are given as mean values (standard deviations). Analysis of resuscitation, NICU admission, respiratory distress syndrome, apnea, asphyxia, and neonatal death was restricted to live births (n = 222,047). If you are pregnant, it’s worth keeping in mind that placental abruption occurs in … 10. The statistics for placental abruption are such this does not generally need to be a dominating, primary concern during pregnancy. Ananth
. Furthermore, we examined the direct effects of abruption, which furthers understanding of the associated risk beyond the mediators of preterm delivery and SGA. a The stratified risk estimates did not show evidence for potential collider bias, and therefore uncorrected estimates were reported here. 12. , Wiznitzer A, Sergienko R, et al. Furthermore, for neonates who survive the delivery, little is known about the extent of medical interventions used, such as admission to the neonatal intensive care unit (NICU), NICU length of stay (LOS), or newborn resuscitation in the delivery room. If the placenta begins to detach during pregnancy, there is bleeding from these vessels. With placental abruption, there are a few statistics that are worth keeping in mind: 1. CA
It is generally detected with an ultrasound. Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth. A patient was considered to have an abruption if there was a recorded diagnosis of antepartum or intrapartum abruption, abruption was recorded as the indication for cesarean delivery, or there was a discharge code for abruption. . Maternal, Pregnancy, and Neonatal Sample Characteristics According to Placental Abruption Exposure, Consortium on Safe Labor Study, United States, 2002–2008. All deliveries occurring at 23 weeks of gestation or later with the required electronic medical record data were included in the original study. Placental abruption is also known as abruptio placentae. Together, our results suggest that neonates in pregnancies complicated by abruption are vulnerable beyond the immediate perinatal time frame. e Incidence rate ratio estimated with negative binomial model. The rate of placental abruption is thought to have dramatically increased in the past few years. This analysis yielded valuable information about the direct effects of abruption on neonatal outcomes that were not attributable to the association with preterm birth or being SGA. Placental Abruption Statistics. , Riihimäki O, Gissler M, et al. Placental abruption is a serious condition in which the placenta starts to come away from the inside of the womb wall before the baby has delivered. A number of risk factors have been associated with placental abruption, including: 1. pre-eclampsiaand maternal hypertension: up to 50% of cases 2. previous placental abruption (recurrence rate 19-25%)11 3. prolonged rupture of membranes 4. maternal age: pregnant women who are y… In sensitivity analyses, there was a direct effect of abruption associated with increased neonatal risks. In total, data on 228,438 deliveries occurring from 2002–2008 were collected for the study, with 9.5% of women contributing more than 1 birth during the specified time period. In relatively minor cases, situations in which there is a slight tear that doctors believe is capable of healing on its own, bed rest is usually recommended. Published: 3 February 2021. , Koopmans L, Middleton P, et al. , Ananth CV, DeMarco C, et al. Partial separation is less severe than complete separation. It's not always possible to see a placental abruption on an ultrasound, however. d Excluding antepartum and intrapartum stillbirths. JB
Director, Division of Infectious Diseases in the School of Medicine, Brain Tumor Basic Science Faculty Position, Copyright © 2021 Johns Hopkins Bloomberg School of Public Health.
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