Placental abruption and adverse perinatal outcomes
Abstract
CONTEXT: Pregnancies complicated by abruption result in increased frequency of perinatal death and decreased fetal size and gestational duration, yet the extent of placental separation and its effect on these adverse outcomes is unknown. OBJECTIVE: To assess the contribution of placental abruption and extent of placental separation to stillbirth, preterm delivery, and fetal growth restriction. DESIGN: Hospital-based, retrospective cohort study. SETTING: Mount Sinai Hospital, New York City, NY. PARTICIPANTS: A total of 53,371 pregnancies occurring in 40,789 women who were delivered of singleton births between 1986 and 1996. MAIN OUTCOME MEASURES: Risks and relative risks for stillbirth (>20 weeks), preterm delivery (<37 weeks), and fetal growth restriction (birth weight below 10th percentile for gestational age) in relation to abruption. RESULTS: The incidence of abruption was 1 % (n = 530). Abruption was associated with an 8.9-fold (95% confidence interval [CI], 6.0-13.0) adjusted relative risk (aRR) of stillbirth. Preterm birth proportions among women with and without abruption were 39.6% and 9.1 %, respectively, yielding an aRR of 3.9 (95% CI, 3.5-4.4). In the abruption group, 14.3% of neonates were growth restricted, compared with 8.1 % among all other births (aRR, 2.0; 95% CI, 1.5-2.4). Extent of placental separation had a profound effect on stillbirth (aRR for 75% separation, 31.5; 95% CI, 17.0-58.4), although evident only among those with at least 50% separation. However, the risk of preterm delivery was substantially increased even for mild abruptions (aRR for 25% separation, 5.5; 95% CI, 4.2-7.3). CONCLUSIONS: In this cohort, placental abruption had a profound impact on stillbirth, preterm delivery, and fetal growth restriction. The risk of stillbirth was dramatically increased for severe placental separation, but preterm delivery was common even among women with lesser degrees of placental separation.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Approximately 10% of spontaneous preterm labor has been attributed to concealed abruption.
“Approximately 10% of spontaneous preterm labor has been attributed to concealed abruption (53), but the impact of concealed abruption on labor at near-term and term gestations is less clear.”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [53]
Cites
Longitudinal data analysis using generalized linear models
LIANG, K.-Y., & ZEGER, S. L. (1986) · Biometrika · doi:10.1093/biomet/73.1.13 · Cited by 18,550 · see citing works
Flexible regression models with cubic splines
Durrleman, S., & Simon, R. M. (1989) · Statistics in Medicine · doi:10.1002/sim.4780080504 · Cited by 2,701 · see citing works
A simplified score for assessment of fetal maturation of newly born infants
Ballard, J. L., Novak, K. K., & Driver, M. (1979) · The Journal of Pediatrics · doi:10.1016/s0022-3476(79)80734-9 · Cited by 938 · see citing works
Schiff, E., Peleg, E., Goldenberg, M., Rosenthal, T., Ruppin, E., Tamarkin, M., Barkai, G., Ben‐Baruch, G., Yahal, I., Blankstein, J., et al. (1989) · New England Journal of Medicine · doi:10.1056/nejm198908103210603 · Cited by 380 · see citing works
Birth-Weight-for-Gestational-Age Patterns by Race, Sex, and Parity in the United States Population
Zhang, J. (1995) · Obstetrics and Gynecology · doi:10.1016/0029-7844(95)00142-e · Cited by 297 · see citing works
Race/Ethnicity and Other Risk Factors for Gestational Diabetes
Berkowitz, G. S., Lapinski, R. H., Wein, R., & Lee, D. (1992) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116408 · Cited by 256 · see citing works
Low-dose aspirin therapy to prevent preeclampsia
Hauth, J. C., Goldenberg, R. L., Parker, C. R., Philips, J. B., Copper, R. L., DuBard, M. B., & Cutter, G. (1993) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(93)90351-i · Cited by 202 · see citing works
Calcium supplementation to prevent hypertensive disorders of pregnancy
Belizán, J. M., Villar, J., Gonzalez, L., Campodónico, L., & Bergel, E. F. (1992) · International Journal of Gynecology & Obstetrics · doi:10.1016/0020-7292(92)91075-y · Cited by 200 · see citing works
Preterm birth prevention: Where are we?
Creasy, R. K. (1993) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(93)90373-q · Cited by 199 · see citing works
Abruptio placentae and placenta previa: frequency, perinatal mortality, and cigarette smoking.
Naeye, R. L. (1980) · PubMed · Cited by 151 · see citing works
Selective management of abruptio placentae: a prospective study.
Hurd, W. W., Miodovnik, M., Hertzberg, V., & Jp, L. (1983) · PubMed · Cited by 101 · see citing works
National trends in the incidence of abruptio placentae, 1979-1987.
Saftlas, A. F., Olson, D. R., Atrash, H. K., Rochat, R. W., & Rowley, D. L. (1991) · PubMed · Cited by 96 · see citing works
Abruptio placentae. An assessment of the time and method of delivery.
Knab, D. R. (1978) · PubMed · Cited by 67 · see citing works
Fetal morbidity following potentially anoxigenic obstetric conditions
Niswander, K. R., Berendes, H. W., Deutschberger, J., Weiss, W., Lipko, N., & Kantor, A. G. (1968) · American Journal of Obstetrics and Gynecology · doi:10.1016/s0002-9378(15)33591-2 · Cited by 66 · see citing works
Cocaine and cigarettes: a comparison of risks
Kistin, N., Handler, A. S., Davis, F. G., & Ferré, C. D. (1996) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.1996.tb00050.x · Cited by 60 · see citing works
Coustan, D. R., & Carr, S. R. (1990) · PubMed · Cited by 41 · see citing works
The Principal Pregnancy Complications Resulting in Preterm Birth in Singleton and Twin Gestations
Wolf, E. J., Mallozzi, A., Rodis, J. F., et al. (1992) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.3109/14767059209161920 · Cited by 15 · see citing works
Abruptio placentae and placenta previa.
HU, H. (1954) · PubMed · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
The global epidemiology of preterm birth
Vogel, J. P., Chawanpaiboon, S., Moller, A.-B., Watananirun, K., Bonet, M., & Lumbiganon, P. (2018) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2018.04.003 · Cited by 1,005 · see citing works
Oyelese, Y., & Ananth, C. V. (2006) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000239439.04364.9a · Cited by 508 · see citing works
Self-citationPrevious Cesarean Delivery and Risks of Placenta Previa and Placental Abruption
Getahun, D., Oyelese, Y., Salihu, H. M., & Ananth, C. V. (2006) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000206182.63788.80 · Cited by 449 · see citing works
Self-citationPlacental abruption and perinatal mortality in the United States
Ananth, C. V., & Wilcox, A. J. (2001) · American Journal of Epidemiology · doi:10.1093/aje/153.4.332 · Cited by 311 · see citing works
Self-citationAnanth, C. V., Oyelese, Y., Srinivas, N., Yeo, L., & Vintzileos, A. M. (2004) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000128172.71408.a0 · Cited by 208 · see citing works
Clinical presentation and risk factors of placental abruption
Tikkanen, M., Nuutila, M., Hiilesmaa, V., Paavonen, J., & Ylikorkala, O. (2006) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1080/00016340500449915 · Cited by 186 · see citing works
Levels and Causes of Maternal Mortality and Morbidity
Filippi, V., Chou, D., Ronsmans, C., Graham, W., & Say, L. (2016) · Disease Control Priorities, Third Edition (Volume 2): Reproductive, Maternal, Newborn, and Child Health · doi:10.1596/978-1-4648-0348-2_ch3 · Cited by 166 · see citing works
Ananth, C. V., Oyelese, Y., Prasad, V., Getahun, D., & Smulian, J. C. (2006) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2006.01.016 · Cited by 155 · see citing works
Self-citationSevere placental abruption: clinical definition and associations with maternal complications
Ananth, C. V., Lavery, J. A., Vintzileos, A. M., Skupski, D. W., Varner, M., Saade, G., Biggio, J., Williams, M. A., Wapner, R. J., & Wright, J. D. (2016) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2015.09.069 · Cited by 149 · see citing works
Self-citationDiagnosis of placental abruption: relationship between clinical and histopathological findings
Elsasser, D. A., Ananth, C. V., Prasad, V., & Vintzileos, A. M. (2010) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2009.10.005 · Cited by 151 · see citing works
Self-citationPlacental Abruption in Term and Preterm Gestations: Evidence for Heterogeneity in Clinical Pathways
Ananth, C. V., Getahun, D., Peltier, M. R., & Smulian, J. C. (2006) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000207560.41604.19 · Cited by 148 · see citing works
Ananth, C. V., & VanderWeele, T. J. (2011) · American Journal of Epidemiology · doi:10.1093/aje/kwr045 · Cited by 123 · see citing works
Pregnancy outcome in severe placental abruption
Kayani, S. I., Walkinshaw, S. A., & Preston, C. (2003) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1046/j.1471-0528.2003.02088.x · Cited by 131 · see citing works
Brandt, J. S., & Ananth, C. V. (2023) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2022.06.059 · Cited by 115 · see citing works
Self-citationPlacental abruption in term pregnancies: clinical significance and obstetric risk factors
Sheiner, E., Shoham-Vardi, I., Hallak, M., Hadar, A., Gortzak-Uzan, L., Katz, M., & Mazor, M. (2003) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/jmf.13.1.45.49 · Cited by 113 · see citing works
Sheiner, E., Shoham-Vardi, I., Hadar, A., Hallak, M., Hackmon, R., & Mazor, M. (2002) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/jmf.11.1.34.39 · Cited by 101 · see citing works
Decreasing perinatal mortality in placental abruption
TIKKANEN, M., LUUKKAALA, T., GISSLER, M., RITVANEN, A., YLIKORKALA, O., PAAVONEN, J., NUUTILA, M., ANDERSSON, S., & METSÄRANTA, M. (2013) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.12030 · Cited by 80 · see citing works
Ananth, C. V., & Cnattingius, S. (2007) · American Journal of Epidemiology · doi:10.1093/aje/kwm073 · Cited by 71 · see citing works
Self-citationAnanth, C. V., Elsasser, D. A., Kinzler, W. L., Peltier, M. R., Getahun, D., Leclerc, D., & Rozen, R. R. (2007) · Molecular Genetics and Metabolism · doi:10.1016/j.ymgme.2007.02.004 · Cited by 59 · see citing works
Self-citationAnanth, C. V., & Friedman, A. M. (2014) · Seminars in Perinatology · doi:10.1053/j.semperi.2014.03.007 · Cited by 58 · see citing works
Novel insights into molecular mechanisms of abruption-induced preterm birth
Buhimschi, C. S., Schatz, F., Krikun, G., Buhimschi, I. A., & Lockwood, C. J. (2010) · Expert Reviews in Molecular Medicine · doi:10.1017/s1462399410001675 · Cited by 53 · see citing works
Ananth, C. V., Patrick, H. S., Ananth, S., Zhang, Y., Kostis, W. J., & Schuster, M. (2021) · American Journal of Epidemiology · doi:10.1093/aje/kwab206 · Cited by 35 · see citing works
McDonald, S. D., Vermeulen, M. J., & Ray, J. G. (2007) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/s1701-2163(16)32511-7 · Cited by 31 · see citing works
Neurodevelopmental outcomes in children in relation to placental abruption
Ananth, C., Friedman, A., Lavery, J., VanderWeele, T., Keim, S., & Williams, M. (2017) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.14049 · Cited by 30 · see citing works
Self-citationBerhan, Y. (2014) · Journal of Pregnancy · doi:10.1155/2014/307043 · Cited by 29 · see citing works
Placental histopathology and pregnancy outcomes in “early” vs. “late” placental abruption
Gonen, N., Levy, M., Kovo, M., Schreiber, L., Noy, L. K., Volpert, E., Bar, J., & Weiner, E. (2021) · Reproductive Sciences · doi:10.1007/s43032-020-00287-3 · Cited by 22 · see citing works
Fetal heart rate patterns related to neonatal brain damage and neonatal death in placental abruption
Takano, Y., Furukawa, S., Ohashi, M., Michikata, K., Sameshima, H., & Ikenoue, T. (2013) · Journal of obstetrics and gynaecology research · doi:10.1111/j.1447-0756.2012.01945.x · Cited by 20 · see citing works
Ananth, C. V., Skjaerven, R., & Klunssoyr, K. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-007023 · Cited by 17 · see citing works
Self-citationThe histologic evolution of revealed, acute abruptions
Chen, A. L., Goldfarb, I. T., Scourtas, A. O., & Roberts, D. J. (2017) · Human Pathology · doi:10.1016/j.humpath.2017.08.007 · Cited by 14 · see citing works
Inoue, A., Kondoh, E., Suginami, K., Io, S., Chigusa, Y., & Konishi, I. (2017) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.13285 · Cited by 11 · see citing works
- Authors
- Ananth, C. V.
- Affiliations
- University of Medicine and Dentistry of New Jersey (US)
- Corresponding author
- Ananth, Cande V.
- ORCID
- Ananth, Cande V.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 1999-11-03
- Volume
- 282
- Issue
- 17
- Pages
- 1646
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2124588032
- Cited by
- 412
- References
- 18
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 18 · 2023: 12 · 2022: 22 · 2021: 16 · 2020: 16 · 2019: 18 · 2018: 26 · 2017: 17 · 2016: 22 · 2015: 19 · 2014: 24 · 2013: 11 · 2012: 18
- FWCI
- 6.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- placental abruption, stillbirth, preterm birth, fetal growth restriction, perinatal complications, singleton pregnancy, pregnancy complications
- MeSH terms
- Abruptio Placentae, Adult, Female, Fetal Death, Fetal Growth Retardation, Humans, Infant, Low Birth Weight, Infant, Newborn, Infant, Premature, Obstetric Labor, Premature, Pregnancy, Pregnancy Outcome, Regression Analysis, Retrospective Studies, Risk, Multivariate Analysis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
