T Boisramé1, N Sananès2, G Fritz3, E Boudier3, G Aissi4, R Favre4, B Langer3. 1. Department of Gynecology-Obstetrics, Strasbourg University Hospitals, Centre Médico-Chirurgical Obstétrique (CMCO), 1 Place de l'Hôpital - BP 426, 67091 Strasbourg Cedex, France; Department of Gynecology-Obstetrics, Strasbourg University Hospitals, Hôpital de Hautepierre, 1 Avenue Molière, 67098 Strasbourg Cedex, France. Electronic address: thomas.boisrame@chru-strasbourg.fr. 2. Department of Gynecology-Obstetrics, Strasbourg University Hospitals, Hôpital de Hautepierre, 1 Avenue Molière, 67098 Strasbourg Cedex, France; INSERM, UMR-S 1121, Biomatériaux et Bioingénierie, 11 rue Humann, F-67085 Strasbourg Cedex, France. 3. Department of Gynecology-Obstetrics, Strasbourg University Hospitals, Hôpital de Hautepierre, 1 Avenue Molière, 67098 Strasbourg Cedex, France. 4. Department of Gynecology-Obstetrics, Strasbourg University Hospitals, Centre Médico-Chirurgical Obstétrique (CMCO), 1 Place de l'Hôpital - BP 426, 67091 Strasbourg Cedex, France.
Abstract
OBJECTIVE: 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.
OBJECTIVE: 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.
Authors: Alexandre Persu; Piotr Dobrowolski; Heather L Gornik; Jeffrey W Olin; David Adlam; Michel Azizi; Pierre Boutouyrie; Rosa Maria Bruno; Marion Boulanger; Jean-Baptiste Demoulin; Santhi K Ganesh; Tomasz J Guzik; Magdalena Januszewicz; Jason C Kovacic; Mariusz Kruk; Peter de Leeuw; Bart L Loeys; Marco Pappaccogli; Melanie H A M Perik; Emmanuel Touzé; Patricia Van der Niepen; Daan J L Van Twist; Ewa Warchoł-Celińska; Aleksander Prejbisz; Andrzej Januszewicz Journal: Cardiovasc Res Date: 2022-01-07 Impact factor: 10.787
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