胎盘早剥的早期诊断

胎盘早剥最常见的症状是伴有疼痛性的阴道流血。预后的关键在于早期诊断和及时治疗。要提高对胎盘早剥的早期诊断能力,必须重视诱因和不典型的临床表现,并结合实验室检查早期诊断胎盘早剥,同其他重要的孕晚期出血疾病进行鉴别,及时处理,以改善母儿预后。     

重型胎盘早剥的诊断和处理

胎盘早剥病因未明,是妊娠晚期严重并发症,起病急,发展快,甚至危及母儿生命。尽早发现胎盘早剥能够避免母儿不良结局,如果发生重型胎盘早剥,及时的诊断及处理能够改善母儿预后。     

Seasonal variation in placental abruption

Objective: To characterize seasonal patterns of placental abruption among Jewish and Bedouin parturients in the Southern part of Israel. Methods: A retrospective population-based study comparing all singleton pregnancies of patients with and without placental abruption was conducted. Deliveries occurred between the years 1988 and 2010. A ‘classical’ model of time series was used, allowing to assess trend and periodic patterns of placental abruption. Results: During the study period, 241,408 deliveries took place, of which 1685 (0.7%) were complicated with placental abruption. Placental abruption was significantly more common among Bedouin parturients: 0.77% (n = 948) vs. 0.623% (n = 737), p < 0.001. A non-linear negative correlation was noted in the incidence of placental abruption (coefficient = ?0.002) during the entire study period. Time series analysis demonstrated annual cycle frequency, seasonal cycle and weekly cycle of placental abruption. The seasonal incidence of placental abruption was higher during spring (B = 7.15) and lower during summer (reference) for both populations (Jewish and Bedouins). Weekly cycle showed significantly higher incidence on Saturday (B = 3.4) and lowest on Tuesday (B = ?4.66) for both groups. The daily differences were accentuated in the Bedouin population (B = 3.7 vs. B = 2.93 in the Jewish population). Conclusion: Placental abruption was significantly more common in the Bedouin population. Both populations demonstrated the same annual and seasonal patterns, with higher incidence in spring and autumn.     

Clinical significance of primary symptoms in women with placental abruption

Background: To evaluate the clinical significance of primary symptoms in women with placental abruption.

Methods: A retrospective study of 273 cases of placental abruption was performed. The subjects were classified into two groups according to primary symptoms: 210 cases of the vaginal bleeding group and 63 cases of the abdominal pain group. The clinical features, maternal and neonatal outcomes were compared between two groups.

Results: The incidence of preeclampsia and preterm birth in the vaginal bleeding group was significantly lower than abdominal pain group, while the incidence of premature rupture of membrane (PROM) in the former group was higher than that in the latter group. Both fetal and maternal outcomes were significantly poorer in the abdominal pain group than in the vaginal bleeding group in terms of rate of abnormal fetal heart monitoring (FHR), concealed abruption, abruption area over 50%, uteroplacental apoplexy, volume of postpartum hemorrhage, rate of blood transfusion, neonatal asphyxia and acidemia.

Conclusions: Primary symptoms of placental abruption were associated with preterm birth, preeclampsia and PROM, which could predict pregnancy outcomes effectively.     

胎盘早剥合并弥漫性血管内凝血急诊处理

胎盘早剥是妊娠中晚期的严重并发症,合并弥漫性血管内凝血(DIC)时,可导致孕产妇和围产儿的发病率及死亡率明显增加,早期诊断和急诊处理是改善围产结局的关键。急诊处理胎盘早剥合并DIC的主要措施在于维持血容量,补充凝血因子,并及时终止妊娠。胎儿存活者应剖宫产终止妊娠,胎儿已死亡者可考虑经阴道分娩。     

Inheritance and perinatal consequences of inherited thrombophilia in Greece.

OBJECTIVE: To investigate the impact of inherited thrombophilic factors on the gestational outcome of unselected pregnant women. METHOD: A total of 392 women with spontaneous pregnancy were investigated for Factor V Leiden, prothrombin G20210A, and MTHFR C677T mutations. Adverse pregnancy outcomes were recorded. RESULTS: Thrombophilic genotypes were significantly higher in women with placental abruption. Heterozygocity for Factor V Leiden increased the risk for placental abruption 9.1 times. The MTHFR T677T genotype increased the risk for placental abruption 4.8 times despite folate supplements, and normal serum folate and B(12) levels. Women with inherited thrombophilia and previous obstetric complications were at significant risk for complications in a subsequent pregnancy (P<0.05). CONCLUSION: Women with placental abruption should be screened for thrombophilic factors and plasma homocysteine should be measured. Subgroups of women with inherited thrombophilia and obstetric complications might benefit from prophylactic anticoagulation in subsequent pregnancies.     

胎膜早破并发胎盘早剥的临床分析

目的　探讨妊娠晚期胎膜早破并发胎盘早剥的发生率、早期诊断和处理要点。方法　回顾分析2 0 0 1年～2 0 0 4年郑州大学第三附属医院产科分娩的胎膜早破病例,其中并发胎盘早期剥离者8例,与非胎膜早破发生胎盘早剥者进行比较。分析早期诊断和母婴结局。结果　3年分娩总数为4 12 4例,胎膜早破并发胎盘早剥者占全部胎盘早剥的2 8 6 % ,胎膜早破是胎盘早剥的首位发病诱因。胎膜早破并发胎盘早剥的发生率为2 77% ,而非胎膜早破者为0 5 2 % ,两者相比差异有显著性(P <0 0 1)。间断腰痛、血性羊水、胎心异常为常见的临床表现。胎膜早破并发胎盘早剥时围产儿的死亡率为12 5‰,无孕产妇死亡。结论　胎膜早破是胎盘早剥的诱因之一,重视临床表现,并结合B超和胎心监护有助于早期诊断,以降低母儿并发症。     

Placental telomere length and risk of placental abruption

Objective: To investigate the associations of placental telomere length with placental abruption (PA) risk and interactions between placental telomere length and placental mitochondrial DNA (mtDNA) copy number on PA risk.

Materials and methods: Relative telomere length and mtDNA copy number in placental samples collected from 105 cases and 73 controls were measured in two batches using qRT-PCR. Mean differences in relative telomere length between PA cases and controls were examined. After creating batch-specific median cutoffs for relative telomere length (84.92 and 102.53) and mtDNA copy number (2.32 and 1.42), interaction between the two variables was examined using stratified logistic regression models.

Results: Adjusted mean difference in relative telomere length between PA cases and controls was ?0.07 (p?>?0.05). Among participants with low mtDNA copy number, participants with short relative telomere length had a 3.07-fold higher odds (95% CI: 1.13–8.38) of PA as compared with participants with long relative telomere length (the reference group). Among participants with high mtDNA copy number, participants with short relative telomere length had a 0.71-fold lower odds (95% CI: 0.28–1.83) of PA as compared with the reference group (interaction p values?=?0.03). Conclusion: Findings suggest complex relationships between placental telomere length, mtDNA copy number and PA risk which warrant further larger studies.     

MTHFR C677T Polymorphism is Not Associated with Placental Abruption or Preeclampsia in Finnish Women

Objective: The aim of our study was to examine genetic variability in the gene encoding methylenetetrahydrofolate reductase (MTHFR) and individual susceptibility to the placental abruption or preeclampsia. Methods: 362 women (133 with preeclampsia, 117 with placental abruption, and 112 healthy controls) were genotyped for C677T polymorphism in the MTHFR gene. Results: Similar genotype distributions were observed in the frequencies of C/C homozygotes (58.6%, 64.1%, and 57.1% for the three groups, respectively) and mutant homozygotes T/T (9.0%, 5.1% and 5.4%). No significant differences were detected in T allele frequencies (25.2%, 20.5%, and 24.1% for the three groups, respectively). Conclusions: MTHFR C677T polymorphism does not have a major role in the development of preeclampsia or placental abruption in the Finnish population.     

Circulating endothelial progenitor cells and placental abruption in women with preeclampsia

ObjectiveAbnormalities in circulating angiogenic factors and endothelial progenitor cells (EPCs) have been reported in patients with preeclampsia and placental abruption. The objective of this study was to determine whether the number of EPCs is altered in patients with placental abruption.DesignA case control study.SettingHiroshima University Hospital in Japan.SamplePregnant Japanese women with preeclampsia (n = 27) and those without any complications (n = 15).MethodThe EPC (CD45^lowCD34⁺CD133⁺ cells) counts were examined using flow cytometry in peripheral blood collected from 27 women with preeclampsia and 15 normal pregnant women. Among the 27 women with preeclampsia, five subsequently developed placental abruption. All subjects were divided into three groups: normal pregnancy (NP, n = 15), preeclampsia without placenta abruption (PE, n = 22) and preeclampsia with placental abruption (PA, n = 5).Main outcome measuresThe EPC counts were measured in pregnant women with preeclampsia who subsequently developed placental abruption.ResultsThe EPC count in the PE group significantly decreased in comparison to that observed in the NP group (620 cells/ml versus 1918 cells/ml, P < 0.01). In the PA group, the EPC count was found to markedly decrease in comparison to that observed in the PE group (221 cells/ml, P < 0.05).ConclusionsThe number of EPCs was found to significantly decrease in preeclamptic women who subsequently developed placental abruption.     

The effect of maternal thrombophilia on placental abruption: Histologic correlates

Objective.?To determine if the histology of placental abruption differs by maternal thrombophilia status.

Study design.?This was a multicentre, case–control study of women with abruption and delivering at ≥20 weeks' gestation, collected as part of the ongoing New Jersey-placental abruption study. Women were identified by clinical criteria of abruption. Maternal blood was collected postpartum and tested for anticardiolipin antibodies, and mutations in the Factor V Leiden and prothrombin genes. Cases were comprised of women with an abruption and a positive thrombophilia screen. Controls were comprised of women with an abruption and a negative thrombophilia screen. All placental histology was systematically reviewed by two perinatal pathologists, blinded to the abruption status.

Results.?A total of 135 women with placental abruption were identified, of which 63.0% (n = 85) had at least one diagnosed maternal thrombophilia. There were increases in the rates of meconium-stained membranes (7.9%vs. 2.1%, p = 0.015) and decidual necrosis (4.5%vs. 2.1%, p = 0.023) when a maternal thrombophilia was diagnosed. Although there was no difference in the overall presence of infarcts between the two groups (27.0%vs. 38.3%, p = 0.064), the presence of an old infarct was more common among women with a positive thrombophilia screen (83.3%vs. 44.4%, p = 0.003).

Conclusion.?Placental abruption with a positive maternal thrombophilia screen is associated with higher rates of old placental infarcts and decidual necrosis compared with abruption when thrombophilia is not diagnosed. These lesions suggest a chronic etiology of placental abruption in the presence of a maternal thrombophilia.     

胎盘早剥的诊断和处理策略

胎盘早剥是妊娠晚期发生的一种危急重症,多致严重的产前和（或）产后出血,危及母儿生命。其典型症状为突发持续性腹痛,伴或不伴阴道流血,危重者可出现休克、弥漫性血管内凝血（DIC）等。超声、实验室检查及胎心监护可实时监测病情的进展,根据病情进展和胎儿宫内状况综合评估终止妊娠的时机和方式,争取良好的母儿结局。     

胎盘早剥的早期临床诊断

目的探讨胎盘早剥临床漏诊的原因,提高胎盘早剥的早期诊断。方法对近5年在我院产科发生的40例胎盘早剥的临床资料进行回顾性分析。结果胎盘早剥的发生率为0.60%。19例合并妊娠高血压疾病（47.5%）,16例孕妇没有任何胎盘早剥的高危因素（40%）。大部分孕妇临床表现不典型。前壁胎盘B超诊断率高于后壁胎盘（P〈0.05）,重度胎盘早剥B超诊断率高于轻度胎盘早剥（P〈0.05）。结论识别胎盘早剥的高危因素,根据病史、临床症状和体征,结合B超以及电子胎心监护,进行综合分析判断是提高胎盘早剥诊断的有效手段。     

Inherited thrombophilias and pre-eclampsia in Brazilian women

OBJECTIVE: The aim of the present study was to compare the distribution of G1691A, G20210A and C677T mutations in pre-eclamptic Brazilian women and in matched control women with an uncomplicated normal pregnancy. STUDY DESIGN: these mutations were investigated by PCR-RFLP in 83 normal pregnancies (control group) and in 30 pre-eclamptic pregnant women (severe form). RESULTS: G1691A mutation was detected neither in the control group nor in pre-eclamsia women. G20210A mutation was detected in heterozygosis in 3 (3.61%) control subjects, but not in pre-eclampsia group. C677T mutation was detected in homozygosis in 6 (7.23%) control subjects and 2 (6.67%) pre-eclamptic women and in heterozygosis in 31 (37.3%) control subjects and 12 (40%) pre-eclamptic women. Differences in the mutation frequencies detected in the two groups were not statistically significant. CONCLUSION: No correlation was observed between pre-eclampsia and presence of G1691A, G20210A and C677T mutations in Brazilian women.     

Methylenetetrahydrofolate C677T polymorphism and pre-eclamptic Egyptian women

Thrombosis of the maternal spiral arteries can be one of the causative events in pre-eclampsia disease, it has been suggested that the C677T polymorphism may also play a role in the pathogenesis of pre-eclampsia.Aims of the workTo investigate the frequency of the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism in Egyptian pregnant women’s with pre eclampsia, and compare with the control group.Type of studyA prospective comparative study among two groups of subjects: 44 preeclamptic women and 44 women with normal pregnancies from November 2008 to April 2010, at Suez Canal University, Faculty of Medicine, Obstetrics and Gynecology Department, DNA was amplified by polymerase chain reaction with sequences specific primers (SSP-PCR). DNA purification capture column kit (Gentra system, USA). Digestion was performed by restrictasc Hinf1 (Fermentas), visualization of genomic DNA by minigel electrophoresis primer sequences. The gels were then photographed under UV light (320 nm) and scored for the presence or absence of an allele specific band.ResultsThe study group had a significantly higher frequency of the homozygous mutated TT allele (34.1% vs. 0.0%, P < 0.0001) and T Allele genotype of C677T polymorphisms compared to controls, (56.8% vs. 31.8%) in both groups respectively and significant OR (46.76).The control group had a higher frequency of both the heterozygous mutated CT and homozygous CC genotypes of C677T polymorphism than the other groups (P < 0.0004)ConclusionC677T polymorphism of MTHFR gene was found to be associated with the development of pre-eclampsia. Mutant T allele and TT genotypes of C677T may be considered genetic risk factors for the development of pre-eclampsia among Egyptian pregnant women.     

Maternal sleep duration and complaints of vital exhaustion during pregnancy is associated with placental abruption

Objective: Sleep disorders are associated with cardiovascular complications and preterm delivery (PTD). Insufficient sleep results in metabolic alterations and increased inflammation, both known to contribute to placental abruption (abruption), a determinant of PTD. We examined associations of abruption with sleep duration and complaints of vital exhaustion.

Methods: The study included 164 abruption cases and 160 controls in a multicenter study in Peru. Data on habitual sleep duration and vital exhaustion during the first 6 months of pregnancy were elicited during interviews conducted following delivery. Women were categorized according to short, normal and long sleep duration (≤6, 7–8 and ≥9?h); and frequency of feeling exhausted. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.

Results: Short and long sleep durations were associated with increased odds of abruption. The ORs of abruption in relation to short (≤6?h) and long (≥9?h) sleep duration were 2.0 (95% CI 1.1–3.7) and 2.1 (95% CI 1.1–4.1), compared with normal sleep duration (7–8?h). Complaints of vital exhaustion were also associated with abruption (OR?=?2.37; 95% CI 1.46–3.85), and were independent of sleep duration.

Conclusion: We extend the existing literature and support the thesis that maternal sleep habits and disorders should be assessed among pregnant women.     

The effect of placental abruption on the outcome of extremely premature infants

Objective: To determine the effect of placental abruption on the outcome of infants born between 22 and 26 weeks of gestation.

Methods: A retrospective study involving 32 cases of placental abruption. Controls were matched to cases according to gestational age and birth weight. Medical records were reviewed to confirm maternal background and neonatal outcome. We compared characteristics of maternal background and neonatal outcome between the two groups.

Results: There were no significant differences in the incidence of pregnancy-induced hypertension, low maternal fibrinogen (<200?mg/dl), premature rupture of membrane, intrauterine infection, ischemic changes of the placenta, or funisitis between the groups. Non-reassuring fetal heart rate patterns (NRFHRs) during intrapartum were frequently seen in the placental abruption group compared to controls (75% versus 51%, p?=?0.02). However, no differences were found for the incidence of low umbilical artery pH (<7.1), cerebral palsy, or neonatal death. The incidence of chronic lung disease (CLD, 66% versus 43%, p?=?0.04) and hemosiderin deposition on the placenta (16% versus 0%, p?<?0.01) was higher in abruptions compared to controls.

Conclusion: Placental abruption has a risk for the development of NRFHRs and CLD in infants born between 22 and 26 weeks of gestation, but shows no effect on neonatal mortality.