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Cited by 149Maternal and fetal healthcarePregnancy and preeclampsia studiesMaternal and Perinatal Health Interventions

Severe placental abruption: clinical definition and associations with maternal complications

Ananth, Cande V., Lavery, Jessica A., Vintzileos, Anthony M., Skupski, Daniel W., Varner, Michael, Saade, George, Biggio, Joseph, Williams, Michelle A. +2 more·2016·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2015.09.069
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Abstract

Background Placental abruption traditionally is defined as the premature separation of the implanted placenta before the delivery of the fetus. The existing clinical criteria of severity rely exclusively on fetal (fetal distress or fetal death) and maternal complications without consideration of neonatal or preterm delivery-related complications. However, two-thirds of abruption cases are accompanied by fetal or neonatal complications, including preterm delivery. A clinically meaningful classification for abruption therefore should include not only maternal complications but also adverse fetal and neonatal outcomes that include intrauterine growth restriction and preterm delivery.Objectives The purpose of this study was to define severe placental abruption and to compare serious maternal morbidity profiles of such cases with all other cases of abruption (ie, mild abruption) and nonabruption cases.Study design We performed a retrospective cohort analysis using the Premier database of hospitalizations that resulted in singleton births in the United States between 2006 and 2012 (n = 27,796,465). Severe abruption was defined as abruption accompanied by at least 1 of the following events: maternal (disseminated intravascular coagulation, hypovolemic shock, blood transfusion, hysterectomy, renal failure, or in-hospital death), fetal (nonreassuring fetal status, intrauterine growth restriction, or fetal death), or neonatal (neonatal death, preterm delivery or small for gestational age) complications. Abruption cases that did not qualify as being severe were classified as mild abruption cases. The morbidity profile included amniotic fluid embolism, pulmonary edema, acute respiratory or heart failure, acute myocardial infarction, cardiomyopathy, puerperal cerebrovascular disorders, or coma. Associations were expressed as rate ratios with 95% confidence intervals that were derived from fitting log-linear Poisson regression models.Results The overall prevalence rate of abruption was 9.6 per 1000, of which two-thirds of cases were classified as being severe (6.5 per 1000). Serious maternal complications occurred in 15.4, 33.3, and 141.7 per 10,000 among nonabruption cases and mild and severe abruption cases, respectively. In comparison with no abruption, the rate ratio for serious maternal complications were 1.52 (95% confidence interval, 1.35-1.72) and 4.29 (95% confidence interval, 4.11-4.47) in women with mild and severe placental abruption, respectively. Rate ratios for the individual complications were 2- to 7-fold higher among severe abruption cases. Furthermore, the rate ratios for serious maternal complications among severe abruption cases compared with mild abruption cases was 3.47 (95% confidence interval, 3.05-3.95). This association was considerably stronger for virtually all maternal complications among cases with severe abruption compared with mild abruption. Annual rates of mild and severe abruption were fairly constant during the study period. Although the maternal complication rate among non-abruption births was stable from 2006-2012, the rate of complications among mild abruption cases dropped from 2006-2008 and then leveled off thereafter. In contrast, the rate of serious complications among severe abruption cases remained fairly stable from 2006-2010 and increased sharply thereafter.Conclusions Severe abruption was associated with a distinctively higher morbidity risk profile compared with the other 2 groups. The clinical characteristics and morbidity profile of mild abruption were more similar to those of women without an abruption. These findings suggest that the definition of severe placental abruption based on the proposed specific criteria is clinically relevant and may facilitate epidemiologic and genetic research.

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  • The risk of abruption is 3 to 4-fold higher among pregnant people with chronic hypertension.

    “The risk of abruption is 3 to 4-fold higher among pregnant people with chronic hypertension, and 4 to 6-fold higher among those with preeclampsia, particularly preeclampsia with severe features and superimposed preeclampsia (28–31).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [29]

  • The risk of abruption is 4 to 6-fold higher among those with preeclampsia, particularly preeclampsia with severe features and superimposed preeclampsia.

    “The risk of abruption is 3 to 4-fold higher among pregnant people with chronic hypertension, and 4 to 6-fold higher among those with preeclampsia, particularly preeclampsia with severe features and superimposed preeclampsia (28–31).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [29]

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Authors
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.
Affiliations
  • Columbia University Irving Medical Center (US)
  • Winthrop-University Hospital (US)
  • Cornell University (US)
  • University of Utah (US)
  • The University of Texas Medical Branch at Galveston (US)
  • University of Alabama at Birmingham (US)
  • Harvard University (US)
  • Columbia University (US)
Corresponding author
Ananth, Cande V.
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2016-02
Volume
214
Issue
2
Pages
272.e1-272.e9
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2015.09.069
OpenAlex
W1699315466
Cited by
149
References
51
Citations by year
2026: 16 · 2025: 19 · 2024: 13 · 2023: 12 · 2022: 19 · 2021: 11 · 2020: 16 · 2019: 12 · 2018: 19 · 2017: 9 · 2016: 3
FWCI
10.29
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Journal of Obstetrics and Gynecology (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, maternal morbidity, maternal mortality, preterm birth, fetal growth restriction, neonatal complications, disseminated intravascular coagulation, amniotic fluid embolism, puerperal complications, obstetric hemorrhage, hospital costs, health care utilization
MeSH terms
Abruptio Placentae, Adult, Blood Transfusion, Cerebrovascular Disorders, Coma, Disseminated Intravascular Coagulation, Embolism, Amniotic Fluid, Female, Fetal Death, Fetal Distress, Fetal Growth Retardation, Heart Failure, Humans, Hysterectomy, Infant, Newborn, Middle Aged, Cardiomyopathies, Myocardial Infarction, Pregnancy, Puerperal Disorders, Pulmonary Edema, Respiratory Insufficiency, Retrospective Studies, Severity of Illness Index, Shock, Cohort Studies, Prevalence, Poisson Distribution, Linear Models, Databases, Factual, Hospital Mortality, Premature Birth, Renal Insufficiency, Young Adult

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