Painless abruptio placentae.

Three cases of abruption of a posteriorly inserted fundal placenta are described. This condition is characterized by vaginal bleeding associated with backache, a nontender uterus, and if unrecognized, high fetal mortality. Ultrasonography permits early recognition and definitive diagnosis. Fetal survival is ensured by closely supervised monitoring and early recourse to cesarean section.     

Thromboelastography in abruptio placentae.

The purpose of this study was to document thromboelastographic (TEG) changes in abruptio placentae and to compare these results with that of conventional tests used to monitor coagulation. This was a prospective study of 30 patients with abruptio placentae. All coagulation investigations including the TEG were performed on admission, immediately following delivery, and after periods of 4 hours and 24 hours. Results showed that standard coagulation tests detected coagulation abnormalities except the platelet count returned to normal limits within 24 hours of delivery. There was strong correlation between fibrinogen levels and the TEG parameters, ma and k time (r=0.8). There was moderate correlation between platelet count and ma (r=0.6). In conclusion, minor abnormalities in the clotting profile are clinically unimportant. The TEG does not detect such minor abnormalities because of its inherent ability to test the coagulation cascade as a whole. Major abnormalities are clinically relevant and the TEG detect 75% of them. Further, the TEG establishes the diagnosis of hypercoagulability an early sign of disseminated intravascular coagulation. Although standard laboratory tests are still necessary to detect coagulation abnormalities on admission, the TEG is a useful test in large obstetric units where laboratory results are not immediately available for the purposes of monitoring and treating ongoing coagulation defects.     

Cardiotocographic findings in abruptio placentae

The findings in cardiotocograms of 18 patients with placental abruption were analysed. Eleven out of 16 cases monitored during the 2-h period preceding delivery had five or more contractions in 10 min, with a mean of 5.6. Signs of fetal distress in heart rate recordings in the same period were found in 14 monitored cases. The diagnostic value of the cardiotocogram, especially the interpretation of tocograms in placental abruption, is stressed.     

Comparison of neonatal outcome including cerebral palsy between abruptio placentae and placenta previa

OBJECTIVE: Our purpose was to evaluate the neonatal prognosis after abruptio placentae and placenta previa during pre-term gestation. STUDY DESIGN: A case-control study was performed using a logistic regression model. A poor outcome was defined as neonatal death occurring before hospital discharge or a diagnosis of cerebral palsy. RESULTS: A poor outcome was more frequent in cases of abruptio placentae (11/42, 26.2%) than in placenta previa (2/72, 2.8%) and pre-term labor (1/120, 0.8%). The difference was mainly due to the incidence of cerebral palsy. A significant association of abruptio placentae (odds ratio (OR) 61.0, 95% confidence interval (CI 3.4-1084), delivery at <31 weeks of gestation (OR 19.0, CI 2.8-128.8), and low Apgar score (<7) at 5min (OR 70.8, CI 16.5-304.9) with increased risk of poor outcome was found in the logistic regression model that controlled for confounding effects. In abruptio placentae, a low Apgar score (<7) at 5min (OR 19.8, CI 2.0-197.8) was associated with increased risk of poor outcome in the logistic regression model. CONCLUSION: From the standpoint of poor perinatal outcome including cerebral palsy, abruptio placentae was the most significant clinical entity in pre-term gestation.     

Mathematic modeling to predict abruptio placentae

OBJECTIVE: This study was undertaken to identify correlates of abruptio placentae and to develop a mathematic model for the prediction of abruptio placentae. STUDY DESIGN: A total of 170,258 singleton birth records from 1991 to 1996 contained in the Schleswig-Holstein perinatal database were analyzed. Fifty-two recognized obstetric risk factors were subjected to univariate analysis. Correlates of abruptio placentae then underwent stepwise forward binary logistic regression. A constant value B(0), coefficients B(1) through B(p), an odds ratio, and a 95% confidence interval were calculated for individual correlates. RESULTS: Abruptio placentae occurred in 874 of 170,258 singleton gestations (0.5%). Of the 52 risk factors 31 proved to be correlates of abruptio placentae, with 16 among primiparous women and 25 among multiparous women. Ten correlates for primiparous, women and 13 for multiparous women emerged from the linear regression, with 7 correlates being shared by both primiparous and multiparous women. CONCLUSION: The probability that abruptio placentae will occur (p) can be calculated according to the following expression: p = e (z)/(1 + e (z)), where z = B(0) + B(1), em leaderB(p). For example, for a primiparous woman who smokes with bleeding at >28 weeks' gestation and a male fetus in the breech position, the following calculation would yield the chance of abruptio placentae:z = -2.25 + 2.51 + 0.41 + 0.24 + 0.60 = 1.51; p = e (1.51)/ (1 + e (1.51)) = 4. 53/5.53 = 0.82, or 82%.     

Tetany following resuscitation after abruptio placentae

BACKGROUND: Serum ionized calcium and magnesium are normally decreased during later stages of pregnancy. A further rapid decline may be caused by the rapid infusion of blood bank products in which citrate is used as an anticoagulant/preservative. Tetany, as reported here, may be precipitated by such infusions.CASE: A gravid woman presented in hemorrhagic shock due to abruptio placentae. Rapid infusion of packed red blood cells and fresh frozen plasma precipitated signs of tetany, muscle rigidity, posturing, high airway pressure during mechanical ventilation, etc. Ionized calcium and magnesium blood levels were very low (0.58 mmol/L and 1.0 mg/dL, respectively), but responded to rapid electrolyte administration.CONCLUSION: Binding of calcium and magnesium by citrate may lead to hypo-ionized calcemic and hypomagnesemic tetany after rapid replacement of blood products in the pregnant patient. This consequence is worsened when extreme alkalemia due to respiratory or metabolic causes is also present.     

Incidence and recurrence rate of abruptio placentae in Sweden

It is desirable to identify those pregnancies that run an increased risk of abruptio placentae, as this disorder still is associated with a high perinatal mortality. Data were collected from the Swedish nationwide birth registry system on all 894,619 births in Sweden in the period 1973 to 1981. The overall incidence of abruptio placentae was 0.44%, with a perinatal mortality of 20.2% and a cesarean section frequency of 74.6%. The incidence of abruptio placentae was significantly increased in the case of twin birth, male offspring, mothers below 20 years of age, and with every delivery after the second one. A history of abruptio placentae increased the risk of a similar incident in a subsequent pregnancy by 10.2-fold. The frequency of cesarean section in subsequent parturitions remained high (32.1%) even in the absence of reabruptio placentae, thus demonstrating the need to identify further risk groups.     

Ultrasound diagnosis of abruptio placentae with fetomaternal hemorrhage

Fetomaternal hemorrhage and abruptio placentae may occur concurrently. A prospective study was done to determine the incidence of fetomaternal hemorrhage in noncatastrophic cases of abruptio placentae consistent with sonographic findings. Significant fetomaternal hemorrhage was found in 75% of noncatastrophic cases. Implications of conservative management of abruptio placentae with fetomaternal hemorrhage are discussed.