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Placental abruption: risk factors, management and maternal-fetal prognosis. Cohort study over 10 years.

Eur J Obstet Gynecol Reprod Biol. 2014 Aug;179:100-4. doi: 10.1016/j.ejogrb.2014.05.026. Epub 2014 Jun 2.

Boisramé T1, Sananès N2, Fritz G3, Boudier E3, Aissi G4, Favre R4, Langer B3.

Eur J Obstet Gynecol Reprod Biol
ABSTRACT
AbstractOBJECTIVE: To describe maternal and fetal risk factors, diagnosis, management and prognosis of placental abruption (PA).STUDY DESIGN: A retrospective cohort study between January 2003 and December 2012 within the three maternity units of a French university hospital. We included 55,926 deliveries after 24 weeks’ gestation including 247 cases of PA (0.4%). We conducted univariate analyses to compare PA and control groups. Multivariate models were constructed in order to study PA risk factors and perinatal morbidity and mortality.RESULTS: Independent risk factors for PA were preterm premature rupture of membranes (OR 9.5; 95% CI [6.9-13.1]), gestational hypertension (OR 7.4; 95% CI [5.1-10.8]), preeclampsia (OR 2.9; 95% CI [1.9-4.6]) and major multiparity (OR 1.6; 95% CI [1.1-2.4]). The classic clinical triad associating metrorrhagia, uterine hypertonia and abdominopelvic pains was present in only 9.7% of cases. Caesarean section rate was 90.3% with 51.8% being performed under general anesthesia. There was no case of maternal death, but maternal morbidity was considerable, with 7.7% of coagulation disorders and 16.6% of transfusion. After adjustment for the gestational age, we found an increased risk for pH=7.0 (OR 14.9; 95% CI [9.2-23.9]) and neonatal resuscitation (OR 4.6; 95% CI [3.1-6.8]). Perinatal mortality was 15.8%, including 78% of fetal deaths.CONCLUSIONS: Appropriate multidisciplinary management can limit maternal morbidity and mortality but perinatal mortality, which occurs essentially in utero, remains high.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Full Text Source: Elsevier Science
PMID:24965988 | http://www.ncbi.nlm.nih.gov/pubmed/24965988

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