Placental abruption and perinatal mortality in the United States
Abstract
Placental abruption is an uncommon obstetric complication associated with high perinatal mortality rates. The authors explored the associations of abruption with fetal growth restriction, preterm delivery, and perinatal survival. The study was based on 7,508,655 singleton births delivered in 1995 and 1996 in the United States. Abruption was recorded in 6.5 per 1,000 births. Perinatal mortality was 119 per 1,000 births with abruption compared with 8.2 per 1,000 among all other births. The high mortality with abruption was due, in part, to its strong association with preterm delivery; 55% of the excess perinatal deaths with abruption were due to early delivery. Furthermore, babies in the lowest centile of weight (<1% adjusted for gestational age) were almost nine times as likely to be born with abruption than those in the heaviest (> or =90%) birth weight centiles. This relative risk progressively declined with higher birth weight centiles. After controlling for fetal growth restriction and early delivery, the high risk of perinatal death associated with abruption persisted. Even babies born at 40 weeks of gestation and birth weight of 3,500-3,999 g (where mortality was lowest) had a 25-fold higher mortality with abruption. The link between fetal growth restriction and abruption suggests that the origins of abruption lie at least in midpregnancy and perhaps even earlier.
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The perinatal mortality rate among abruption births is about 120 per 1000, 15-fold greater than among non-abruption births.
“which is in sharp contrast to the mortality rate among abruption births (15-fold greater, 120 per 1000) (116).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [116]
Among non-abruption births, the perinatal mortality rate is about 8 per 1000.
“Among non-abruption births, the perinatal mortality rate is about 8 per 1000”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [116]
Well over half of the increased perinatal mortality risk that accompanies abruption is attributed to preterm delivery.
“Well over half of the increased perinatal mortality risk that accompanies abruption is attributed to preterm delivery and an additional 9% to FGR (116).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [116]
An additional 9% of the increased perinatal mortality risk that accompanies abruption is attributed to fetal growth restriction.
“Well over half of the increased perinatal mortality risk that accompanies abruption is attributed to preterm delivery and an additional 9% to FGR (116).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [116]
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Pacora, P., Romero, R. J., Jaiman, S., Erez, O., Bhatti, G., Panaitescu, B., Benshalom-Tirosh, N., Jung, E., Hsu, C., Hassan, S. S., et al. (2018) · Journal of Perinatal Medicine · doi:10.1515/jpm-2018-0216 · Cited by 48 · see citing works
Macheku, G. S., Philemon, R. N., Oneko, O., Mlay, P. S., Masenga, G. G., Obure, J., & Mahande, M. J. (2015) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-015-0678-x · Cited by 44 · see citing works
Alcohol Consumption During Pregnancy and Risk of Placental Abruption and Placenta Previa
Aliyu, M. H., Lynch, O., Nana, P. N., Alio, A. P., Wilson, R. E., Marty, P. J., Zoorob, R., & Salihu, H. M. (2010) · Maternal and Child Health Journal · doi:10.1007/s10995-010-0615-6 · Cited by 44 · see citing works
Cesarean Section and Risk of Unexplained Stillbirth in Subsequent Pregnancy
Smith, G. C. S., Pell, J. P., & Dobbie, R. (2004) · Obstetrical & Gynecological Survey · doi:10.1097/00006254-200406000-00006 · Cited by 44 · see citing works
Abruption-Associated Prematurity
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Acute and chronic respiratory diseases in pregnancy: Associations with placental abruption
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Self-citationRisk factors of abruptio placentae among Peruvian women
Sánchez, S. E., Pacora, P., Farfán, J., Fernández, A., Qiu, C., Ananth, C. V., & Williams, M. A. (2006) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2005.05.013 · Cited by 39 · see citing works
Self-citationAnanth, C. V., Hansen, A. V., Williams, M. A., & Andersen, A. N. (2017) · Paediatric and Perinatal Epidemiology · doi:10.1111/ppe.12347 · Cited by 38 · see citing works
Self-citationFirst-Trimester and Second-Trimester Maternal Serum Biomarkers as Predictors of Placental Abruption
Ananth, C. V., Wapner, R. J., Ananth, S., D’Alton, M. E., & Vintzileos, A. M. (2017) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000001889 · Cited by 37 · see citing works
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Interventions for treating placental abruption
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Z‐scores and the birthweight paradox
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Ananth, C. V., Peltier, M. R., Marco, C. D., Elsasser, D. A., Getahun, D. T., Rozen, R. R., & Smulian, J. C. (2007) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2007.06.046 · Cited by 34 · see citing works
Self-citationDenis, M., Enquobahrie, D. A., Tadesse, M. G., Gelaye, B., Sánchez, S. E., Salazar, M., Ananth, C. V., & Williams, M. A. (2014) · PLoS ONE · doi:10.1371/journal.pone.0116346 · Cited by 32 · see citing works
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Takeda, J., & Takeda, S. (2019) · Obstetrics & Gynecology Science · doi:10.5468/ogs.2019.62.5.299 · Cited by 31 · see citing works
Exposures to Air Pollution and Risk of Acute-onset Placental Abruption
Ananth, C. V., Kioumourtzoglou, M., Huang, Y., Ross, Z., Friedman, A. M., Williams, M. A., Wang, S., Mittleman, M. A., & Schwartz, J. D. (2018) · Epidemiology · doi:10.1097/ede.0000000000000859 · Cited by 31 · see citing works
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Self-citationRCAS1 Decidual Immunoreactivity During Placental Abruption: Immune Cell Presence and Activity
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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
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Fetal and neonatal deaths among cases of maternal near miss
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Medically Indicated—Iatrogenic Prematurity
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Placental abruption, offspring sex, and birth outcomes in a large cohort of mothers
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Berhan, Y. (2014) · Journal of Pregnancy · doi:10.1155/2014/307043 · Cited by 29 · see citing works
“Regardless of the delay in time, however, several studies have shown that placenta previa and placental abruption are known to triple the rate of perinatal mortality primarily due to prematurity [7, 8, 10, 12, 13, 17, 25].”
BackgroundResultCervical Varix as a Cause of Vaginal Bleeding During Pregnancy
Kusanovic, J. P., Soto, E., Espinoza, J., Stites, S., Gonçalves, L. F., Santolaya, J., Nien, J. K., Erez, O., Sorokin, Y., & Romero, R. J. (2006) · Journal of Ultrasound in Medicine · doi:10.7863/jum.2006.25.4.545 · Cited by 29 · see citing works
Risk of placental abruption in relation to migraines and headaches
Sanchez, S. E., Williams, M. A., Pacora, P. N., Ananth, C. V., Qiu, C., Aurora, S. K., & Sorensen, T. K. (2010) · BMC Women s Health · doi:10.1186/1472-6874-10-30 · Cited by 28 · see citing works
Self-citationMaternal Risk Factors for Stillbirth: A Registry–Based Study
Zīle, I., Ebela, I., & Rumba-Rozenfelde, I. (2019) · Medicina · doi:10.3390/medicina55070326 · Cited by 28 · see citing works
Li, M., Zhang, C.-Y., & Yue, C. (2022) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443615.2021.1945009 · Cited by 30 · see citing works
- Authors
- Ananth, C. V., & Wilcox, A. J.
- Affiliations
- University of Medicine and Dentistry of New Jersey (US)
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2001-02-15
- Volume
- 153
- Issue
- 4
- Pages
- 332-337
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- OpenAlex
- W2169259236
- Cited by
- 311
- References
- 20
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 11 · 2023: 4 · 2022: 9 · 2021: 7 · 2020: 23 · 2019: 18 · 2018: 22 · 2017: 12 · 2016: 10 · 2015: 16 · 2014: 16 · 2013: 11 · 2012: 11
- FWCI
- 7.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Robert Wood Johnson Foundation
- 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, perinatal mortality, fetal growth restriction, preterm birth, birth weight, singleton births, perinatal survival, pregnancy complications, gestational age
- MeSH terms
- Abruptio Placentae, Birth Weight, Female, Fetal Growth Retardation, Gestational Age, Humans, Infant Mortality, Infant, Newborn, Pregnancy, Risk Factors, United States, Survival Analysis
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