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Cited by 148Pregnancy and preeclampsia studiesMaternal and fetal healthcarePreterm Birth and Chorioamnionitis

Placental Abruption in Term and Preterm Gestations: Evidence for Heterogeneity in Clinical Pathways

Ananth, Cande V., Getahun, Darios, Peltier, Morgan R., Smulian, John C.·2006·Obstetrics & Gynecology
DOI 10.1097/01.aog.0000207560.41604.19
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Abstract

OBJECTIVE: To estimate the magnitude of associations of acute and chronic processes with abruption in preterm and term gestations. METHODS: A retrospective cohort study was performed using data on women that delivered singleton live births and stillbirths at 20 or more weeks of gestation in the United States, 1995-2002 (n = 30,378,902). Rates of 1) acute-inflammation-associated clinical conditions (premature rupture of membranes and intrauterine infection); 2) chronic processes associated with vascular dysfunction or chronic inflammation (chronic and pregnancy-induced hypertension, preexisting or gestational diabetes, small for gestational age, and maternal smoking); and 3) both acute and chronic processes, were examined among women with and without abruption. Rates were examined separately among preterm (< 37 weeks) and term births, with adjustment for confounders. Relative risk (RR) for aforementioned groups in relation to abruption was derived from multivariate logistic regression models after adjusting for potential confounders. RESULTS: At preterm gestation, the rates of acute-inflammation-associated conditions were higher among women with than without abruption (12.0% compared with 10.2%; RR 1.38, 95% confidence interval [CI] 1.34-1.42). At term, acute-inflammation-associated conditions were present in 4.2% and 3.3% of births with and without abruption, respectively (RR 1.39, 95% CI 1.33-1.45). At preterm gestation, the rates of chronic processes were 43.9% and 30.0% among women with and without abruption, respectively (RR 1.87, 95% CI 1.85-1.90). At term, the corresponding rates of chronic processes were 41.0% and 22.7%, respectively (RR 2.37, 95% CI 2.34-2.41). Association between both acute and chronic processes and abruption are similar to those of acute-inflammation-associated conditions. CONCLUSION: Among women with placental abruption, conditions associated with acute inflammation are more prevalent at preterm than term gestations, whereas chronic processes are present throughout gestation. LEVEL OF EVIDENCE: II-2.

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  • The pathophysiology of abruption includes both long-standing chronic processes and acute triggers as well as the interaction between the two processes.

    “The pathophysiology of abruption includes both long-standing chronic processes and acute “triggers” as well as the interaction between the two processes (FIGURE 1) (8, 9).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [9]

  • Risk factor assessments for term versus preterm abruption reveal significant overlap.

    “Risk factor assessments for term versus preterm abruption reveals significant overlap (9).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [9]

  • In a large retrospective cohort study of over 30 million births in the US from 1995-2002, chronic clinical processes associated with oxidative stress, vascular reactivity, and platelet activation, such as fetal growth restriction and preeclampsia, were associated with increased risk for abruption across all gestations, whereas acute inflammatory conditions such as chorioamnionitis and preterm prel

    “In a large retrospective cohort study of over 30 million births in the US from 1995–2002 that sought to distinguish causal pathways of abruption at term versus preterm gestations, the authors found that chronic clinical processes associated with oxidative stress, vascular reactivity, and platelet activation, such as FGR and preeclampsia, were associated with increased risk for abruption across all”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [9]

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Authors
Ananth, C. V., Getahun, D., Peltier, M. R., & Smulian, J. C.
Affiliations
Robert Wood Johnson University Hospital (US)
ORCID
Venue
Obstetrics & Gynecology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2006-04
Volume
107
Issue
4
Pages
785-792
ISSN
0029-7844 (ISSN-L)
DOI
10.1097/01.aog.0000207560.41604.19
OpenAlex
W2056196232
Cited by
148
References
33
Citations by year
2026: 6 · 2025: 3 · 2024: 6 · 2023: 4 · 2022: 7 · 2021: 4 · 2020: 5 · 2019: 4 · 2018: 11 · 2017: 8 · 2016: 2 · 2015: 9 · 2014: 8 · 2013: 6 · 2012: 13
FWCI
12.30
Type
journal article
Language
en
Open access
closed
Locations
  • Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Funders
Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD038902, R01HD038902)
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 › Epidemiology › Preterm Birth and Chorioamnionitis
Keywords
placental abruption, preterm birth, term birth, acute inflammation, chronic inflammation, vascular dysfunction, premature rupture of membranes, intrauterine infection, gestational hypertension, gestational diabetes mellitus, small for gestational age, maternal smoking, risk factors
MeSH terms
Abruptio Placentae, Adolescent, Adult, Age Factors, Female, Follow-Up Studies, Gestational Age, Humans, Infant, Newborn, Infant, Premature, Parity, Pregnancy, Pregnancy Outcome, Retrospective Studies, United States, Cohort Studies, Prevalence, Logistic Models, Risk Assessment, Term Birth, Stillbirth, Live Birth

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