Fetal and maternal outcomes among pregnant women with placental abruption associated with disseminated intravascular coagulation attending a rural tertiary care centre

Background: Placental abruption is the separation of the placenta from the uterine wall before the delivery of the fetus, and its frequency varies between 0.4 and 1%. The objective of this study was to determine risk factors and maternal and fetal complications in cases of abruptio placentae.Methods: A record-based study was conducted in the Obstetrics and Gynaecology department at a rural tertiary care centre between January 2015 and December 2019. All 72 pregnant women admitted with suspicion of placental abruption at 28 weeks of gestation and beyond were included in the study. All data were retrieved from the maternity register, patient files. The maternal outcome was assessed by mode of delivery, need for blood transfusion, parity, and any complications. Neonatal outcome was assessed by neonatal intensive care unit admission, still and live births. Data collected was entered and analysed by using coGuide software.Results: A total of 72 subjects were included in the final analysis. Most 58 (81%) of them were 21-30 years old. Forty-three patients (59.72%) were diagnosed to be preeclamptic. Forty-three (59.72%) of them had a vaginal delivery. Out of 72, 66 (91.67%) patients did not have any maternal complications. Most 41 (56.94%) births were stillbirths, and only 7 (9.72%) newborns required intensive care unit (ICU) admission.Conclusions: Placental abruption is one of the major threats to the well-being of pregnant women, with an alarmingly high rate of 41 (56.94%) stillbirths.

Factors Affecting the Severity of Placental Abruption in Pregnant Vehicle Drivers: Analysis with a Novel Finite Element Model

We clarified factors affecting the severity of placental abruption in motor vehicle collisions by quantitively analyzing the area of placental abruption in a numerical simulation of an unrestrained pregnant vehicle driver at collision velocities of 3 and 6 m/s. For the simulation, we constructed a novel finite element model of a small 30-week pregnant woman, which was validated anthropometrically using computed tomography data and biomechanically using previous examinations of post-mortem human subjects. In the simulation, stress in the elements of the utero–placental interface was computed, and those elements exceeding a failure criterion were considered to be abrupted. It was found that a doubling of the collision velocity increased the area of placental abruption 10-fold, and the abruption area was approximately 20% for a collision velocity of 6 m/s, which is lower than the speed limit for general roads. This result implies that even low-speed vehicle collisions have negative maternal and fetal outcomes owing to placental abruption without a seatbelt restraint. Additionally, contact to the abdomen, 30 mm below the umbilicus, led to a larger placental abruption area than contact at the umbilicus level when the placenta was located at the uterus fundus. The results support that a reduction in the collision speed and seatbelt restraint at a suitable position are important to decrease the placental abruption area and therefore protect a pregnant woman and her fetus in a motor vehicle collision.

A Case of Placental Abruption Complicated by Vaginal Trial of Labor in a Unicornuate Uterus

Unicornuate uterus has a low incidence,it is a congenital uterine developmental anomaly, it has many complications during pregnancy, and it is less common in pregnancy to term. This article retrospectively analyzes a case of unicornuate uterus with a full-term vaginal trial of labor and delivery with placental abruption resulting in neonatal asphyxia. We also present the typology of unicornuate uterus, diagnosis, and discuss the mode of delivery in the light of the literature, in order to raise awareness of this type of disease among medical professionals and reduce the occurrence of adverse pregnancy outcomes.

Analysis of Risk Factors Associated With Preterm Delivery After Fetoscopic Laser Surgery for TTTS

Objective Fetoscopic laser surgery (FLS) is currently the standard treatment for twin to twin transfusion syndrome (TTTS). This study aims to improve the perinatal outcomes of TTTS patients by analyzing the risk factors associated with preterm delivery after FLS for TTTS. Methods A prospective cohort study was conducted in 97 cases of patients with TTTS who underwent FLS at the Third Affiliated Hospital of Zhengzhou University from May 2018 to December 2020. A multivariate logistic regression model was used to determine the risk factors associated with preterm delivery. Finally, ROC curve was utilized to analyze the diagnostic value of related risk factors. Results A total of 90 TTTS patients were included in the study. There were 37 cases in group A and 53 cases in group B. Through multivariate logistic regression model analysis, three risk factors related to the gestational age of childbirth <32 weeks were identified: preoperative CL < 27.5 mm (OR, 10.9; P <0.001), PPROM (OR, 4.0; P=0.024), placental abruption (OR, 17.6; P=0.018). ROC curve analysis suggested that the AUC of the combined diagnosis of the three factors was 0.799 (P<0.001), which has a high value for predicting preterm delivery at low gestational age. Conclusion Multivariate logistic regression analysis demonstrated that CL < 27.5 mm, PPROM and placental abruption were connected with preterm delivery before 32 weeks of pregnancy. Identifying and intervening the corresponding risk factors can improve the pregnancy and neonatal outcomes after fetoscopic surgery, and promote the improvement of fetoscopic surgery techniques.

Impact of Co-Existing Placental Pathologies in Pregnancies Complicated by Placental Abruption and Acute Neonatal Outcomes

Placental abruption (PA) is a concern for maternal and neonatal morbidity. Adverse neonatal outcomes in the setting of PA include higher risk of prematurity. Placental pathologies include maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), acute chorioamnionitis, and villitis of unknown etiology (VUE). We aimed to investigate how placental pathology contributes to acute neonatal outcome in PA. A retrospective cohort study of all placentas with PA were identified. Exposures were MVM, FVM, acute chorioamnionitis and VUE. The primary outcome was NICU admission and the secondary outcomes included adverse base deficit and Apgar scores, need for resuscitation, and small-for-gestational age. A total of 287 placentas were identified. There were 160 (59.9%) of placentas with PA alone vs 107 (40.1%) with PA and additional placental pathologies. Odds of NICU admission were more than two times higher in pregnancies with placental pathologies (OR = 2.37, 95% CI 1.28–4.52). These estimates were in large part mediated by prematurity and birthweight, indirect effect acting through prematurity was OR 1.79 (95% CI 1.12–2.75) and through birthweight OR 2.12 (95% CI 1.40–3.18). Odds of Apgar score ≤ 5 was more than four times higher among pregnancies with placental pathologies (OR = 4.56, 95% CI 1.28–21.26). Coexisting placental pathology may impact Apgar scores in pregnancies complicated by PA. This knowledge could be used by neonatal teams to mobilize resources in anticipation of the need for neonatal resuscitation.