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Placental Abruption in Term and Preterm Gestations

Evidence for Heterogeneity in Clinical Pathways

From the ¹Division of Epidemiology and Biostatistics and ²Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School/Robert Wood Johnson University Hospital, New Brunswick, New Jersey.

OBJECTIVE: To estimate the magnitude of associations of acute and chronic processes with abruption in preterm and term gestations.

METHODS: A retrospective cohort study was performed using data on women that delivered singleton live births and stillbirths at 20 or more weeks of gestation in the United States, 1995–2002 (n = 30,378,902). Rates of 1) acute-inflammation–associated clinical conditions (premature rupture of membranes and intrauterine infection); 2) chronic processes associated with vascular dysfunction or chronic inflammation (chronic and pregnancy-induced hypertension, preexisting or gestational diabetes, small for gestational age, and maternal smoking); and 3) both acute and chronic processes, were examined among women with and without abruption. Rates were examined separately among preterm (< 37 weeks) and term births, with adjustment for confounders. Relative risk (RR) for aforementioned groups in relation to abruption was derived from multivariate logistic regression models after adjusting for potential confounders.

RESULTS: At preterm gestation, the rates of acute-inflammation–associated conditions were higher among women with than without abruption (12.0% compared with 10.2%; RR 1.38, 95% confidence interval [CI] 1.34–1.42). At term, acute-inflammation–associated conditions were present in 4.2% and 3.3% of births with and without abruption, respectively (RR 1.39, 95% CI 1.33–1.45). At preterm gestation, the rates of chronic processes were 43.9% and 30.0% among women with and without abruption, respectively (RR 1.87, 95% CI 1.85–1.90). At term, the corresponding rates of chronic processes were 41.0% and 22.7%, respectively (RR 2.37, 95% CI 2.34–2.41). Association between both acute and chronic processes and abruption are similar to those of acute-inflammation–associated conditions.

CONCLUSION: Among women with placental abruption, conditions associated with acute inflammation are more prevalent at preterm than term gestations, whereas chronic processes are present throughout gestation.

LEVEL OF EVIDENCE: II-2

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