European Journal of Obstetrics & Gynecology and Reproductive Biology
Diagnosis of placental abruption: relationship between clinical and histopathological findings
Introduction
Placental abruption, the premature separation of the placenta, is a serious obstetric complication that occurs in about 1–2 per 100 pregnancies [1], [2], [3]. Over half of all pregnancies complicated by abruption deliver preterm [4], [5], [6], and abruption is associated with an array of adverse maternal and fetal outcomes [7], [8], [9]. The etiology of placental abruption remains speculative but is thought to be the consequence of abnormal trophoblast invasion leading to rupture of the spiral arteries and premature separation of the placenta [10].
Despite being an important obstetrical condition, placental abruption lacks a unified diagnostic clinical criterion. Histologic evidence supporting a chronic process that frequently accompanies placental abruption has led researchers to speculate that the condition is the end-result of an underlying chronic process with origins very early in pregnancy, and perhaps even extending to the time of implantation [11], [12]. In the presence of vaginal bleeding accompanied by abdominal pain, uterine contractions, or uterine tenderness [13], placental abruption is first considered in the differential clinical diagnosis. At delivery, old or freshly adherent blood clots are diagnostic of abruption. Some of these placentas, but not all, may have histologic features of placental abruption. Moreover, there have been cases of women diagnosed with placental abruption based on histological markers that showed a clinically unremarkable obstetrical course and outcome [14].
Given these uncertainties surrounding the diagnosis of placental abruption, we sought to determine the concordance between a clinical and histologic diagnosis of placental abruption. Additionally, we evaluated associations between acute and chronic placental lesions and abruption to determine if findings from the placenta might provide some insights as to whether placental abruption is the result of an acute event or a chronic process.
Section snippets
New Jersey-Placental Abruption Study (NJ-PAS)
Women with a clinically diagnosed placental abruption were recruited from either Saint Peters University Hospital (SPUH) or Robert Wood Johnson University Hospital (RWJUH) in New Brunswick, NJ. Subjects were recruited between August 2002 and June 2004 at SPUH and between July 2003 and June 2007 at RWJUH. Placental abruption cases were matched to controls based on their race/ethnicity and parity to those who experienced an otherwise normal delivery. Because the original study was designed to
Results
Of a total of 424 enrolled patients, placental histological examination was completed in 88.2% (n = 374) patients. The study was restricted to those with completed placental examination and women that delivered a singleton birth, leaving a total of 162 abruption cases and 173 controls. One hundred and seventeen patients were enrolled at RWJUH (60% of abruption cases) and 218 patients were enrolled at SPUH (42% of abruption cases). Among the 162 clinically diagnosed abruption cases, 30.2% (n = 49)
Discussion
Despite extensive research, the etiology of placental abruption remains speculative, perhaps, to a large extent the lack of appropriate diagnostic criteria. Our study reveals several important and clinically relevant findings regarding placental abruption: (i) the diagnosis of abruption should be based on clinical criteria, since an examination of the placenta for confirmational purposes is not sensitive; (ii) the diagnostic criteria should include the presence of retroplacental clot(s) or
Funding
This study was funded by the United States National Institutes of Health (R01-HD038902) awarded to Dr. Ananth.
References (32)
- et al.
Placental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis
Obstet Gynecol
(1996) - et al.
Placental abruption in the United States, 1979 through 2001: temporal trends and potential determinants
Am J Obstet Gynecol
(2005) - et al.
Birth weight discordancy and adverse perinatal outcomes among twin gestations in the United States: the effect of placental abruption
Am J Obstet Gynecol
(2003) - et al.
Etiologic determinants of abruptio placentae
Obstet Gynecol
(1997) - et al.
Polymorphisms in methionine synthase reductase and betaine-homocysteine S-methyltransferase genes: risk of placental abruption
Mol Genet Metab
(2007) - et al.
The placental bed in pregnancies complicated by primary antiphospholipid syndrome
Placenta
(2006) - et al.
Histologic evidence of old intrauterine bleeding is more frequent in prematurity
Am J Obstet Gynecol
(1995) - et al.
Evidence of placental abruption as a chronic process: associations with vaginal bleeding early in pregnancy and placental lesions
Eur J Obstet Gynecol Reprod Biol
(2006) - et al.
Intrauterine growth restriction in infants of less than thirty-two weeks’ gestation: associated placental pathologic features
Am J Obstet Gynecol
(1995) - et al.
Placental abruption
Obstet Gynecol
(2006)
Placental abruption in term and preterm gestations: evidence for heterogeneity in clinical pathways
Obstet Gynecol
A history of placental dysfunction and risk of placental abruption
Paediatr Perinat Epidemiol
Placental abruption. Maternal risk factors and associated fetal conditions
Acta Obstet Gynecol Scand
Placental abruption and adverse perinatal outcomes
JAMA
Placental bed biopsies in placental abruption
Br J Obstet Gynaecol
Placental abruption and perinatal mortality in the United States
Am J Epidemiol
Cited by (110)
Placental abruption at near-term and term gestations: pathophysiology, epidemiology, diagnosis, and management
2023, American Journal of Obstetrics and GynecologyRisk factors for hypoxic-ischemic encephalopathy or neonatal death in placental abruption
2023, Journal of Gynecology Obstetrics and Human ReproductionToward a new taxonomy of obstetrical disease: improved performance of maternal blood biomarkers for the great obstetrical syndromes when classified according to placental pathology
2022, American Journal of Obstetrics and GynecologyUltrasound differential diagnosis between amniotic fluid sludge and blood clot from placental edge separation
2022, American Journal of Obstetrics and Gynecology