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Cited by 236Pregnancy and preeclampsia studiesMaternal and fetal healthcareMaternal and Perinatal Health Interventions

Pracental abruption and its association with hypertension and prolonged rupture of membranes: A methodologic review and meta-analysis

ANANTH, C, SAVITZ, D, WILLIAMS, M·1996·Obstetrics & Gynecology
DOI 10.1016/0029-7844(96)00088-9
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Abstract

OBJECTIVE: To conduct a meta-analysis of published studies on placental abruption to examine its incidence, recurrence, and association with hypertensive disorders (chronic hypertension and preeclampsia) and prolonged rupture of membranes (PROM) in pregnancy. DATA SOURCES: We reviewed studies on placental abruption published since 1950, based on a comprehensive literature search using MEDLINE, and by identifying studies cited in the references of published reports. METHODS OF STUDY SELECTION: We identified 54 studies, excluding case reports on placental abruption and studies relating to placenta previa and vaginal bleeding of unknown origin. We also restricted the search to articles published in English. TABULATION, INTEGRATION, AND RESULTS: Studies chosen for the meta-analysis were categorized based on their study design (case-control or cohort), where they were conducted (United States or other countries), source of the data (vital records versus other sources), and magnitude of risk (risk of abruption greater or less than 1.0%). We used both fixed- and random-effects analysis to identify sources of heterogeneity in results among studies. There were striking differences in the incidence of placental abruption between cohort (0.69%) and case-control (0.35%) studies. United States-based studies found a somewhat higher incidence both for cohort (0.81%) and case-control (0.37%) studies compared with studies conducted outside the U.S. (0.60% and 0.26%, respectively). Abruption was more than ten times more common in pregnancies preceded by a pregnancy with abruption. Chronically hypertensive patients were more than three times as likely to develop placental abruption (odds ratio [OR] 3.13, 95% confidence interval [CI] 2.04-4.80) as normotensive patients. The OR for placental abruption was 1.73 (95% CI 1.47-2.04) for patients with preeclampsia. Similarly, women with pregnancies complicated by PROM were more than three times as likely to develop placental abruption (OR 3.05, 95% CI 2.16-4.32). United States-based studies, case-control studies, and studies with an incidence of abruption greater than 1% demonstrated stronger associations between abruption and hypertension and PROM. CONCLUSION: Risk of abruption is strongly associated with chronic hypertension, PROM, and especially abruption in a prior pregnancy, and somewhat more modestly with preeclampsia. The criteria for the diagnosis of placental abruption, hypertensive disorders, and PROM may have introduced variability among the results of these studies. More standardized definitions of these pregnancy complications would improve the comparability of the study results.

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Crossref · 10.1016/0029-7844(96)00088-9

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  • Pregnant people with an abruption in one pregnancy carry up to a 10-fold increased risk of recurrence in a subsequent pregnancy.

    “Pregnant people with an abruption in one pregnancy carry up to a 10-fold increased risk of recurrence in a subsequent pregnancy; the recurrence risk is 25-fold higher in a third pregnancy when two prior pregnancies are complicated by abruption (23–26).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [23]

  • The recurrence risk is 25-fold higher in a third pregnancy when two prior pregnancies are complicated by abruption.

    “Pregnant people with an abruption in one pregnancy carry up to a 10-fold increased risk of recurrence in a subsequent pregnancy; the recurrence risk is 25-fold higher in a third pregnancy when two prior pregnancies are complicated by abruption (23–26).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [23]

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Authors
ANANTH, C., SAVITZ, D., & WILLIAMS, M.
Affiliations
University of North Carolina at Chapel Hill (US)
Corresponding author
SAVITZ, D
ORCID
Venue
Obstetrics & Gynecology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1996-08
Volume
88
Issue
2
Pages
309-318
ISSN
0029-7844 (ISSN-L)
DOI
10.1016/0029-7844(96)00088-9
OpenAlex
W2041094959
Cited by
236
References
53
Citations by year
2026: 4 · 2025: 7 · 2024: 6 · 2023: 8 · 2022: 8 · 2021: 10 · 2020: 5 · 2019: 9 · 2018: 10 · 2017: 12 · 2016: 5 · 2015: 8 · 2014: 12 · 2013: 8 · 2012: 11
FWCI
4.08
Type
journal article
Language
en
Open access
closed
Locations
  • Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Keywords
placental abruption, chronic hypertension in pregnancy, preeclampsia, prolonged rupture of membranes, risk factors, study design bias, risk of bias in meta-analysis, pregnancy complications, maternal mortality, fetal death, preterm birth, placenta previa, vaginal bleeding
MeSH terms
Abruptio Placentae, Chronic Disease, Female, Fetal Membranes, Premature Rupture, Premature Rupture of Fetal Membranes, Humans, Hypertension, Pre-Eclampsia, Pregnancy, Pregnancy Complications, Cardiovascular, Recurrence, Time Factors, Incidence

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