Obstetric history and the risk of placenta previa

OBJECTIVE: To evaluate secular trends in the occurrence of placenta previa and whether placenta previa is associated with the outcome of previous pregnancies, cesarean section, and sociodemographic factors. DESIGN: A cohort study based on the Medical Birth Registry of Norway. Placenta previa in the second pregnancy was investigated for associations with outcomes in the first pregnancy and sociodemographic factors. RESULTS: In birth orders 1 and 2 the occurrence of placenta previa was 1.2 and 2.2 per 1,000, respectively, with no secular trend. The occurrence increased with maternal age and was lowest in women aged 20-29 years. The recurrence rate was 23 per 1,000 (adjusted odds ratio (OR) of recurrence=9.7). In women with prior delivery at < or =25 gestational weeks the risk of placenta previa was 6.7 per 1,000 (adjusted OR=3.0). In women with prior placental abruption the risk was 5.8 per 1,000 (OR=2.6). In women with prior perinatal death the risk was 4.4 per 1,000 (adjusted OR= 1.8). No independent relationship emerged with socio-economic factors, previous birthweight, and a history of pregnancy induced hypertension. Cesarean section was associated with subsequent development of placenta previa (adjusted OR= 1.3). CONCLUSIONS: We found no secular trends in the occurrence of placenta previa. Placenta previa is associated with previously described risk factors for placental abruption. The increased risk of placenta previa subsequent to placental abruption supports the theory of a shared etiologic factor. However, placenta previa and placental abruption do not share a common etiology in relation to a history of pregnancy induced hypertension, fetal growth retardation, and socio-economic factors.     

Obstetrics and perinatal outcome of pregnancies after the age of 45.

We set out to describe the maternal and perinatal outcome of pregnancies in women >/= 45 years old at the time of delivery. A retrospective review of hospital deliveries after 28 weeks of pregnancy was performed at the Princess Badeea Teaching Hospital (PBTH) in North Jordan for patients delivered between 1 April 1994 and 31 December 1997. During the study period, there were 114 women aged >/= 45 years at delivery at the PBTH. The incidence was 3.3 per 1000 births. The median maternal age was 45 years. The majority of women (81.6%) were 45-46 years old. Maternal ages were 45 (n =64), 46 (n =29), 47 (n =9), 48 (n =8), 49 (n =2) and 50 (n =2) years. Median gravidity was 10, median parity was seven. Forty-four (38.6%) patients had obstetric complications. The most frequent complication was diabetes mellitus (9.6%), followed by hypertension (4.4%). Caesarean section was performed in 32.5%. There were nine stillbirths and four early neonatal deaths, the perinatal mortality rate was 114/1000 births. We conclude that women >/= 45 years old at delivery have high perinatal mortality rate and we also noted a higher incidence of placental abruption, placenta praevia and caesarean delivery, compared with a younger group of women.     

Predicting placental abruption and previa in women with a previous cesarean delivery

The purpose of this study was to determine if placental abruption or previa in women with a history of a prior cesarean delivery (CD) can be predicted. A retrospective cohort study of pregnant women with previous CD was conducted in 17 centers between 1996 and 2000. Women developing placenta previa or abruption in the subsequent pregnancy were compared with those without these complications. Bivariate and multivariable techniques were used to develop predictive models for placenta previa or abruption. The area under the receiver-operator characteristic curves, sensitivity, specificity, and accuracy of the models were compared. Among 25,076 women with prior CD, there were 361 (15 per 1000 births) with placenta previa and 309 (13 per 1000 births) with abruption. The significant risk factors for these complications include advanced maternal age, Asian race, increased parity, illicit drug use, history of spontaneous abortion, and three or more prior cesarean deliveries. Prediction models for abruption and previa had poor sensitivity (12% and 13% for abruption and previa, respectively). In women with at least one prior cesarean delivery, the risk factors for placental previa and abruption can be identified. However, prediction models combining these risk factors were too inefficient to be useful.     

Placental ratio and risk of velamentous umbilical cord insertion are increased in women with placenta previa

The purpose of this study was to explore the maternal risk profile and obstetric outcome in pregnancies affected by placenta previa. Retrospective case-control study involved all women (93 [0.37%] women with diagnosed placenta previa and 24,857 unaffected controls) who gave birth to singleton infants at Kuopio University Hospital between the years 1989 and 2000. Grand multiparity, infertility problems, and advanced maternal age were independent risk factors of placenta previa, with adjusted relative risks of 5.8, 3.7, and 2.4, respectively. Most women with placenta previa (88.2%) underwent cesarean delivery before term. They also more often had velamentous umbilical cord insertion (7.5%) and higher placental-to-birthweight ratios than the controls. Placenta previa was associated with risks of preterm delivery, low birthweight infants, and need for neonatal intensive care, at odds ratios of 27.7, 7.4, and 3.4, respectively. In conclusion, placenta previa is an infrequent pregnancy complication associated with multiparity, advanced maternal age, infertility problems, elevated placental ratio, and velamentous umbilical cord insertion.     

The effect on the likelihood of further pregnancy of placental abruption and the rate of its recurrence

Objective To assess the effect of having a placental abruption on 1. the probability of having further pregnancies, and 2. the rate of recurrence in such pregnancies.
Design A cohort study based on the Medical Birth Registry of Norway.
Results From 1967 to 1989, placental abruption occurred in 218/4951 subsequent deliveries after a placental abruption index case. After placental abruption with perinatal survival in the first delivery 59% of women had a further delivery, compared with 71% who did not have placental abruption at delivery. After a perinatal loss corresponding rates were 83% and 85%, respectively. Odds ratios of recurrence of abruption, crude and adjusted for maternal age, birth order and time period were 7.1 and 6.4, respectively. No secular trends were found. Caesarean section rates increased and were higher in pregnancies with recurrent placental abruption and in subsequent pregnancies without placental abruption than in the total birth population.
Conclusions Women who have placental abruption are less likely than other women to have another pregnancy. For women who do have subsequent pregnancies placental abruption occurs significantly more frequently.     

低置胎盘的分娩方式探讨

目的:探讨低置胎盘的合理分娩方式。方法:选取2012年1月1日至2014年4月30日在我院分娩的单胎头位低置胎盘产妇650例。按是否试产将患者分为试产组和选择性剖宫产组;按分娩前最后一次超声胎盘下缘距离宫颈内口的距离将患者分为低置胎盘1组(下缘距内口≥0mm但20mm)、低置胎盘2组(下缘距内口≥20mm但40mm)和低置胎盘3组(下缘距内口≥40mm但70mm)。分析患者的阴道试产成功率、试产失败原因、产后出血量及分娩期并发症。结果:(1)试产组的试产总成功率为82.64%,低置胎盘1、2、3组的阴道试产成功率分别为62.5%、82.61%和84.65%,其中因产前出血而改行剖宫产的风险分别为31.25%、8.7%和1.49%;(2)低置胎盘1组患者中阴道试产和选择性剖宫产的产后出血量无显著差异[(590.94±382.79)ml vs(465.68±367.83)ml];低置胎盘2组和3组中阴道试产的产后出血量明显少于剖宫产组[(267.17±104.47)ml vs(388.10±205.61)ml,P0.0001]及[(293.00±263.731)ml vs(348.59±98.68)ml,P0.0001]。结论:胎盘下缘距宫颈内口≥20mm不应作为孕妇选择性剖宫产的手术指征。     

Placenta previa and the risk of preterm delivery.

OBJECTIVES: We aimed to quantify the risk of preterm delivery and maternal and neonatal morbidities associated with placenta previa. STUDY DESIGN: We conducted a retrospective cohort study of singleton births that occurred between 1976 and 2001, examining outcomes including preterm delivery and perinatal complications. Multivariate logistic regression was used to control for potential confounders. Kaplan-Meier survival curves were constructed to compare preterm delivery in pregnancies complicated by previa vs. no previa. RESULTS: Among the 38 540 women, 230 women had previas (0.6%). Compared to controls, pregnancies with previa were significantly associated with preterm delivery prior to 28 weeks (3.5% vs. 1.3%; p = 0.003), 32 weeks (11.7% vs. 2.5%; p < 0.001), and 34 weeks (16.1% vs. 3.0%; p < 0.001) of gestation. Patients with previa were more likely to be diagnosed with postpartum hemorrhage (59.7% vs. 17.3%; p < 0.001) and to receive a blood transfusion (11.8% vs. 1.1%; p < 0.001). Survival curves demonstrate the risk of preterm delivery at each week and showed an overall higher rate of preterm delivery for patients with a placenta previa. CONCLUSIONS: Placenta previa is associated with maternal and neonatal complications, including preterm delivery and postpartum hemorrhage. These specific outcomes can be used to counsel women with previa.     

Adverse obstetric outcome in low- and high- risk pregnancies: predictive value of maternal serum screening

OBJECTIVE: To determine whether the relationship between adverse pregnancy outcome and elevated maternal serum alpha-fetoprotein (MSAFP) and/or maternal serum hCG levels in women whose fetuses have no chromosomal abnormalities or neural tube defects is restricted to pregnancies with a priori elevated risk for pathology or also present in low-risk pregnancies. METHODS: The outcomes of pregnancy in two groups of patients with elevated MSAFP and/or maternal serum hCG values were compared with the outcomes of a reference group with normal serum values. The first study group consisted of 83 women without pre-existing risk for poor outcome as defined by the guidelines of the Dutch Society of Obstetrics and Gynecology. The second study group consisted of 62 women with a priori elevated risk according to these guidelines. RESULTS: Fetal or neonatal death, pregnancy-induced hypertension, placental abruption, placenta previa, preterm delivery, delivery of infants with birth weights in the 2.3rd percentile, and complications during the third stage of labor occurred significantly more often in patients with elevated values and low a priori risk than in women with normal values and without pre-existing risk factors. There was no significant increase in adverse pregnancy outcome in women with elevated values and high a priori risk compared with women with normal values and elevated a priori risk. CONCLUSION: In women at low risk, elevated MSAFP and/or maternal serum hCG values are predictive of adverse pregnancy outcome. In women with a priori elevated risk, abnormal serum values do not increase this risk.     

Placenta previa: obstetric risk factors and pregnancy outcome

Objective: To determine the incidence, obstetric risk factors and perinatal outcome of placenta previa. Study design: All singleton deliveries at our institution between 1990 and 1998 complicated with placenta previa were compared with those without placenta previa. Results: Placenta previa complicated 0.38% ( n = 298) of all singleton deliveries ( n = 78 524). A back-step multiple logistic regression model found the following factors to be independently correlated with the occurrence of placenta previa: maternal age above 40 years (OR 3.1, 95% CI 2.0-4.9), infertility treatments (OR 3.1, 95% CI 1.8-5.6), a previous Cesarean section (OR 1.8, 95% CI 1.4-2.4), a history of habitual abortions (OR 1.3, 95% CI 1.3-2.7) and Jewish ethnicity (OR 1.3, 95% CI 1.1-1.8). Pregnancies complicated with placenta previa had significantly higher rates of second-trimester bleeding (OR 156.0, 95% CI 87.2-277.5), pathological presentations (OR 7.6, 95% CI 5.7-10.1), abruptio placentae (OR 13.1, 95% CI 8.2-20.7), congenital malformations (OR 2.6, 95% CI 1.5-4.2), perinatal mortality (OR 2.6, 95% CI 1.1-5.6), Cesarean delivery (OR 57.4, 95% CI 40.7-81.4), Apgar scores at 5 min lower than 7 (OR 4.4, 95% CI 2.3-8.3), placenta accreta (OR 3.6, 95% CI 1.1-9.9) postpartum hemorrhage (OR 3.8, 95% CI 1.2-10.5), postpartum anemia (OR 5.5, 95% CI 4.4-6.9) and delayed maternal and infant discharge from the hospital (OR 10.9, 95% CI 7.3-16.1) as compared to pregnancies without placenta previa. In a multivariable analysis investigating risk factors for perinatal mortality, the following were found to be independent significant factors: congenital malformations, placental abruption, pathological presentations and preterm delivery. In contrast, placenta previa and Cesarean section were found to be protective factors against the occurrence of perinatal mortality while controlling for confounders. Conclusion: Although an abnormal implantation per se was not an independent risk factor for perinatal mortality, placenta previa should be considered as a marker for possible obstetric complications. Hence, the detection of placenta previa should encourage a careful evaluation with timely delivery in order to reduce the associated maternal and perinatal complications.     

Placenta previa: obstetric risk factors and pregnancy outcome.

OBJECTIVE: To determine the incidence, obstetric risk factors and perinatal outcome of placenta previa. STUDY DESIGN: All singleton deliveries at our institution between 1990 and 1998 complicated with placenta previa were compared with those without placenta previa. RESULTS: Placenta previa complicated 0.38% (n = 298) of all singleton deliveries (n = 78 524). A back-step multiple logistic regression model found the following factors to be independently correlated with the occurrence of placenta previa: maternal age above 40 years (OR 3.1, 95% CI 2.0-4.9), infertility treatments (OR 3.1, 95% CI 1.8-5.6), a previous Cesarean section (OR 1.8, 95% CI 1.4-2.4), a history of habitual abortions (OR 1.3, 95% CI 1.3-2.7) and Jewish ethnicity (OR 1.3, 95% CI 1.1-1.8). Pregnancies complicated with placenta previa had significantly higher rates of second-trimester bleeding (OR 156.0, 95% CI 87.2-277.5), pathological presentations (OR 7.6, 95% CI 5.7-10.1), abruptio placentae (OR 13.1, 95% CI 8.2-20.7), congenital malformations (OR 2.6, 95% CI 1.5-4.2), perinatal mortality (OR 2.6, 95% CI 1.1-5.6), Cesarean delivery (OR 57.4, 95% CI 40.7-81.4), Apgar scores at 5 min lower than 7 (OR 4.4, 95% CI 2.3-8.3), placenta accreta (OR 3.6, 95% CI 1.1-9.9) postpartum hemorrhage (OR 3.8, 95% CI 1.2-10.5), postpartum anemia (OR 5.5, 95% CI 4.4-6.9) and delayed maternal and infant discharge from the hospital (OR 10.9, 95% CI 7.3-16.1) as compared to pregnancies without placenta previa. In a multivariable analysis investigating risk factors for perinatal mortality, the following were found to be independent significant factors: congenital malformations, placental abruption, pathological presentations and preterm delivery. In contrast, placenta previa and Cesarean section were found to be protective factors against the occurrence of perinatal mortality while controlling for confounders. CONCLUSION: Although an abnormal implantation per se was not an independent risk factor for perinatal mortality, placenta previa should be considered as a marker for possible obstetric complications. Hence, the detection of placenta previa should encourage a careful evaluation with timely delivery in order to reduce the associated maternal and perinatal complications.     

Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy

Objective  To quantify the risk of placenta praevia and placental abruption in singleton, second pregnancies after a caesarean delivery of the first pregnancy.
Design  Retrospective cohort study.
Setting  Linked birth and infant mortality database of the USA between 1995 and 2000.
Population  A total of 5 146 742 singleton second pregnancies were available for the final analysis after excluding missing information.
Methods  Multiple logistic regressions were used to describe the relationship between caesarean section at first birth and placenta praevia and placental abruption in second-birth singletons.
Main outcome measures  Placenta praevia and placental abruption.
Results  Placenta praevia was recorded in 4.4 per 1000 second-birth singletons whose first births delivered by caesarean section and 2.7 per 1000 second-birth singletons whose first births delivered vaginally. About 6.8 per 1000 births were complicated with placental abruption in second-birth singletons whose first births delivered by caesarean section and 4.8 per 1000 birth in second-birth singletons whose first births delivered vaginally. The adjusted odds ratio (95% CIs) of previous caesarean section for placenta praevia in following second pregnancies was 1.47 (1.41, 1.52) after controlling for maternal age, race, education, marital status, maternal drinking and smoking during pregnancy, adequacy of prenatal care, and fetal gender. The corresponding figure for placental abruption was 1.40 (1.36, 1.45).
Conclusion  Caesarean section for first live birth is associated with a 47% increased risk of placenta praevia and 40% increased risk of placental abruption in second pregnancy with a singleton.     

The perinatal effects of delayed childbearing

OBJECTIVE: To determine if the rates of pregnancy complications, preterm birth, small for gestational age, perinatal mortality, and serious neonatal morbidity are higher among mothers aged 35-39 years or 40 years or older, compared with mothers 20-24 years. METHODS: We performed a population-based study of all women in Nova Scotia, Canada, who delivered a singleton fetus between 1988 and 2002 (N = 157,445). Family income of women who delivered between 1988 and 1995 was obtained through a confidential linkage with tax records (n = 76,300). The primary outcome was perinatal death (excluding congenital anomalies) or serious neonatal morbidity. Analysis was based on logistic models. RESULTS: Older women were more likely to be married, affluent, weigh 70 kg or more, attend prenatal classes, and have a bad obstetric history but less likely to be nulliparous and to smoke. They were more likely to have hypertension, diabetes mellitus, placental abruption, or placenta previa. Preterm birth and small-for-gestational age rates were also higher; compared with women aged 20-24 years, adjusted rate ratios for preterm birth among women aged 35-39 years and 40 years or older were 1.61 (95% confidence interval [CI] 1.42-1.82; P < .001) and 1.80 (95% CI 1.37-2.36; P < .001), respectively. Adjusted rate ratios for perinatal mortality/morbidity were 1.46 (95% CI 1.11-1.92; P = .007) among women 35-39 years and 1.95 (95% CI 1.13-3.35; P = .02) among women 40 years or older. Perinatal mortality rates were low at all ages, especially in recent years. CONCLUSION: Older maternal age is associated with relatively higher risks of perinatal mortality/morbidity, although the absolute rate of such outcomes is low.     

Perinatal outcome associated with sonographically detected globular placenta

OBJECTIVE: To evaluate the association between the sonographic appearance of globular placenta and perinatal outcome. STUDY DESIGN: We prospectively followed the pregnancy course and perinatal outcome in women with globular placentas (hyperechoic, thick and highly vascular placentas with edges that lack the typical "tapering" appearance) during routine sonographic study. RESULTS: Fourteen women were included. In 7 women the globular appearance of the placenta normalized spontaneously, and perinatal outcome was good. The other 7 experienced poor perinatal outcomes. There were no significant differences between the 2 groups. Among pregnancies in which the globular placental appearance persisted, 3 resulted in fetal demise; 3 women had severe intrauterine growth restriction and oligohydramnios and underwent cesarean deliveries at 26, 27 and 31 weeks, respectively; and 1 patient had premature preterm rupture of membranes and underwent a cesarean delivery due to placental abruption. CONCLUSION: In half the pregnancies complicated by the sonographic appearance of a globular placenta, this shape spontaneously normalized, and the perinatal outcome was normal. However, when the globular appearance of the placenta persisted, the condition was associated with a poor perinatal outcome. Pregnancies complicated by a globular placenta should be followed closely.     

Decreasing incidence of placental abruption in Finland during 1980-2005

Objective. To study the incidence trends of placental abruption. Design. Register-based retrospective study. Setting. The Finnish Medical Birth Register and Hospital Discharge Register. Population. A total of 6231 placental abruption cases among 1 576 051 deliveries. Methods. Data on demographic and pregnancy and delivery associated outcomes were collected. Data on overall incidence and maternal age were available 1980-2005. Data on other variables were available 1987-2005. Main outcome measure. Placental abruption Results. The overall incidence of placental abruption was 395/100 000 (0.4%). The incidence decreased 31%, from 487/100 000 in 1980 to 337/100 000 in 2005 (p < 0.001). The incidence was lowest among women aged 20-24 years (305/100 000) and highest among women aged ≥45 years (1309/100 000). During 1987-2005 the incidence was lowest among women with one or two deliveries (353/100 000) and highest in nulliparous women (382/100 000) and in women with three or more deliveries (595/100 000). The incidence was nearly double (577/100 000) among smoking compared with non-smoking women (341/100 000). The incidence was highest between gestational weeks 26 and 29. Among newborns weighing <1500 g the incidence was higher (5734/100 000) than among those weighing ≥2500 g (251/100 000). The incidence was higher in multiple (903/100 000) than in singleton pregnancies (374/100 000). Conclusion. The incidence of placental abruption decreased during 1980-2005. The incidence was highest among women aged 45 years or more, multiparous and smoking women, in multiple pregnancies and in women with low birthweight newborns.     

The outcome of pregnancies complicated by bleeding during the second trimester

Vaginal bleeding during the second trimester has historically been associated with high perinatal mortality rates (33 to 82 per cent). Because this topic has not been specifically studied since the advent of obstetric ultrasound and electronic fetal heart rate monitoring, we reviewed the experience at the University of Utah with second trimester vaginal bleeding from 1 January 1983 through 15 June 1989. The cause of the bleeding was found to fit into four general categories. These are placenta previa, abruption, both previa and abruption, and other or unknown. Midtrimester bleeding is still associated with a high perinatal mortality rate (22.3 per cent), being highest when associated with placental abruption (36.6 per cent) and lowest with placenta previa (7.4 per cent). For the entire series, pregnancies maintained into the third trimester were associated with a much lower perinatal mortality rate than those in which delivery occurred during the second trimester (7.1 versus 54.5 per cent). These relatively improved outcomes suggest that aggressive obstetric management is warranted in most instances.     

Singleton pregnancy outcomes after assisted and non-assisted reproductive technology in infertile patients

Purpose

Singleton pregnancy after assisted reproductive technology (ART) has been associated with higher risks of adverse pregnancy outcome than naturally conceived singleton pregnancy. This study was to elucidate whether the ART procedure is responsible for abnormal pregnancy outcome comparing those after ART and non-ART in infertile patients.

Methods

We compare the singleton pregnancy outcome of infertile patients in our university hospital between 2000 and 2008 following ART (351 pregnancies) and non-ART (213 pregnancies) procedures. Pregnancy outcome parameters were incidence of pregnancy induced hypertension, placenta previa, placental abruption, cesarean delivery, preterm birth, very preterm birth, stillbirth, low birth weight and very low birth weight.

Results

Most of the pregnancy outcome parameters were not significantly different between the ART group and the non-ART group. Only placenta previa was significantly higher in the ART group than in the non-ART group (odds ratio 4.0; 95?% CI 1.2?C13.7).

Conclusions

ART procedure may itself be a risk factor for the development of placenta previa. Some of the abnormal perinatal outcomes that had been previously attributed to ART, however, may be due to the baseline characteristics of infertile patients.     

Neonatal outcomes with placenta previa

OBJECTIVE: To identify neonatal complications associated with placenta previa. METHODS: This was a population-based, retrospective cohort study involving all singleton deliveries in Nova Scotia from 1988 to 1995. The study group consisted of all completed singleton pregnancies complicated by placenta previa; all other singleton pregnancies were considered controls. Patient information was collected from the Nova Scotia Atlee perinatal database. Neonatal complications were evaluated while controlling for potential confounders. The data were analyzed using chi2, Fisher exact test, and multiple logistic regression. RESULTS: Among 92,983 pregnancies delivered during the study period, 305 cases of placenta previa were identified (0.33%). After controlling for potential confounders, neonatal complications significantly associated with placenta previa included major congenital anomalies (odds ratio [OR] 2.48), respiratory distress syndrome (OR 4.94), and anemia (OR 2.65). The perinatal mortality rate associated with placenta previa was 2.30% (compared with 0.78% in controls) and was explained by gestational age at delivery, occurrence of congenital anomalies, and maternal age. Although there was a higher rate of preterm births in the placenta previa group (46.56% versus 7.27%), there was no difference in birth weights between groups after controlling for gestational age at delivery. CONCLUSION: Neonatal complications of placenta previa included preterm birth, congenital anomalies, respiratory distress syndrome, and anemia. There was no increased occurrence of fetal growth restriction.     

Placental abruption: epidemiology, risk factors and consequences

Placental abruption, classically defined as a premature separation of the placenta before delivery, is one of the leading causes of vaginal bleeding in the second half of pregnancy. Approximately 0.4-1% of pregnancies are complicated by placental abruption. The prevalence is lower in the Nordic countries (0.38-0.51%) compared with the USA (0.6-1.0%). Placental abruption is also one of the most important causes of maternal morbidity and perinatal mortality. Maternal risks include obstetric hemorrhage, need for blood transfusions, emergency hysterectomy, disseminated intravascular coagulopathy and renal failure. Maternal death is rare but seven times higher than the overall maternal mortality rate. Perinatal consequences include low birthweight, preterm delivery, asphyxia, stillbirth and perinatal death. In developed countries, approximately 10% of all preterm births and 10-20% of all perinatal deaths are caused by placental abruption. In many countries, the rate of placental abruption has been increasing. Although several risk factors are known, the etiopathogenesis of placental abruption is multifactorial and not well understood.     

Pregnancy after 40 years of age

Using a 1982-4 computerized data base from a perinatal network, 511 pregnancies in women whose age was 40 or more years at delivery were studied. The oldest woman was 52 years of age. This represented 1.2% of the 41,335 women delivering. Their pregnancy outcomes were compared with those in 26,759 whose age at delivery was 20 to 30 years. The older women were more parous and had higher weights. There was also an increased frequency of hypertension, diabetes mellitus, and placenta previa in the older women. These changes had a significant impact on the fetus for the older women had an increase in infant macrosomia, male sex, stillbirths, and low Apgar scores. They also had a higher incidence of cesarean section and fewer forcep deliveries. The older women whose weight was less than 67.5 kg at delivery did not show any difference in hypertension, fetal macrosomia, fetal death rates, or low infant Apgar scores. Also older of low parity did not have an increase in placenta previa. The older women of normal weight and low parity showed a higher frequency of diabetes mellitus and cesarean section delivery, but their infant outcomes were not different from the control groups. Thus older women of low parity and normal weight managed by modern obstetric methods can expect a good pregnancy outcome.     

Placental abruption: critical analysis of risk factors and perinatal outcomes

Objective.?To investigate risk factors and pregnancy outcome of patients with placental abruption.

Methods.?A population-based study comparing all pregnancies of women with and without placental abruption was conducted. Stratified analysis using multiple logistic regression models was performed to control for confounders.

Results.?During the study period there were 185,476 deliveries, of which 0.7% (1365) occurred in patients with placental abruption. The incidence of placental abruption increased between the years 1998 to 2006 from 0.6 to 0.8%. Placental abruption was more common at earlier gestational age. The following conditions were significantly associated with placental abruption, using a multivariable analysis with backward elimination: hypertensive disorders, prior cesarean section, maternal age, and gestational age. Placental abruption was significantly associated with adverse perinatal outcomes such as Apgar scores?<7 at 1 and 5?min and perinatal mortality. Patients with placental abruption were more likely to have cesarean deliveries, as well as cesarean hysterectomy.Using another multivariate analysis, with perinatal mortality as the outcome variable, controlling for gestational age, hypertensive disorders, etc., placental abruption was noted as an independent risk factor for perinatal mortality.

Conclusions.?Placental abruption is an independent risk factor for perinatal mortality. Since the incidence of placental abruption has increased during the last decade, risk factors should be carefully evaluated in an attempt to improve surveillance and outcome.