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Diagnosis of placental abruption: relationship between clinical and histopathological findings
Open accessAbstract
Objective We evaluated the extent to which histologic lesions bearing a diagnosis of abruption conform to a diagnosis based on established clinical criteria. We further examined the profile of chronic and acute histologic lesions associated with clinical abruption.Methods Data from the New Jersey-Placental Abruption Study - a multi-center, case-control study - were utilized to compare the clinical and histologic criteria for abruption. The study was based on 162 women with clinically diagnosed abruption and 173 controls. We examined the concordance between clinical indicators for abruption with those of a histopathological diagnosis. The clinical criteria for a diagnosis of abruption included (i) evidence of retroplacental clot(s); (ii) abruption diagnosed on prenatal ultrasound; or (iii) vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity. The pathological criteria for abruption diagnosis included hematoma, fibrin deposition, compressed villi, and hemosiderin-laden histiocytes in cases with older hematomas. Acute lesions included chorioamnionitis, funisitis, acute deciduitis, meconium stained membranes, villous stromal hemorrhage, and villous edema. Chronic lesions included chronic deciduitis, decidual necrosis, decidual vasculopathy, placental infarctions, villous mal-development (delayed or accelerated maturation), hemosiderin deposition, intervillous thrombus, and chronic villitis.Results Of clinically diagnosed cases, the sensitivity and specificity for a histologic confirmation of abruption were 30.2% and 100%, respectively. Presence of retroplacental clots remained the single most common finding (77.1%) among clinically diagnosed cases. Among the acute lesions, chorioamnionitis and funisitis were associated with abruption. The only chronic histologic lesion associated with abruption was placental infarctions.Conclusions The concordance between clinical and pathologic criteria for abruption diagnosis is poor. The criteria for diagnosing a clinical abruption should include sonographic visualization of abruption, evidence of retroplacental clots, or vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity.
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“Ultrasound may identify findings concerning for abruption, especially when abnormal blood collections adjacent to and within the placenta are large (FIGURE 3–5) (50).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [50]
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“The amount of vaginal bleeding, which may be difficult to quantify due to concealed bleeding, does not correlate with clinical sequelae (50).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [50]
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Metadata
- Authors
- Elsasser, D. A., Ananth, C. V., Prasad, V., & Vintzileos, A. M.
- Affiliations
- Nationwide Children's Hospital (US)
- Winthrop-University Hospital (US)
- Venue
- European Journal of Obstetrics & Gynecology and Reproductive Biology
- Publisher
- Elsevier BV
- Published
- 2010-02
- Volume
- 148
- Issue
- 2
- Pages
- 125-130
- ISSN
- 0028-2243 (ISSN-L)
- 0301-2115
- PMC
- PMC2814948
- OpenAlex
- W1966530833
- Cited by
- 151
- References
- 38
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 8 · 2023: 11 · 2022: 15 · 2021: 14 · 2020: 8 · 2019: 12 · 2018: 9 · 2017: 8 · 2016: 9 · 2015: 10 · 2014: 6 · 2013: 9 · 2012: 7
- FWCI
- 4.75
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- European Journal of Obstetrics & Gynecology and Reproductive Biology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD038902)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Keywords
- placental abruption, diagnosis, histopathological diagnosis, diagnostic agreement, chorioamnionitis, funisitis, placental infarction, decidual vasculopathy, chronic villitis, sensitivity and specificity
- MeSH terms
- Abruptio Placentae, Adult, Female, Humans, Placenta, Pregnancy, Case-Control Studies, Young Adult
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