Can we predict placental abruption based on obstetrical history?

Tamar Wainstock, Gali Pariente, Eyal Sheiner

Research output: Contribution to journalMeeting Abstract

Abstract

Objective
Placental abruption complicates 0.5-1% of pregnancies, and is associated with significant perinatal morbidity and mortality. Several risk factors and specifically a history of placental abruption are well recognized. We aimed to identify risk factors in the first pregnancy (without abruption) for placental abruption in the subsequent pregnancy.

Study Design
A retrospective population-based nested case-control study was conducted, including all women with two first singleton consecutive deliveries. Women with placental abruption in the first pregnancy were excluded. Cases were defined as women with placental abruption in their second pregnancy, and they were compared to the controls, defined as women without abruption. Characteristics and complications of the first pregnancy were compared among cases and controls, and multivariable logistic regression models were used to study the association between pregnancy complications (in the first pregnancy) and placental abruption (in the subsequent pregnancy), while adjusting for confounders.

Results
A total of 43,327 women were included in the study, 0.4% of second pregnancies ended with placental abruption (n=186, i.e., Cases). Cases, as compared to controls, were more likely to have the following complications in their first pregnancy: small for gestational age (14.5% vs. 8.3%), preterm delivery (16.7% vs. 8.3%), and preeclampsia (10.8% vs. 6.6%, Table). In the multivariable model which adjusted for maternal age and inter-pregnancy interval, either one of these first pregnancy complications were independently associated with an increased risk for placental abruption (adjusted OR=2.02 for one previous complication; 95% CI 1.46-2.74, p< 0.001), and the risk was greater for each additional complication (adjusted OR= 3.62 for 2 complications; 95% CI 2.23- 5.87, p< 0.001, and adjusted OR= 3.82 for ≥3 complications; 95% CI 1.54- 9.46, p=0.004) (Graph).

Conclusion
First pregnancy and its complications may serve as a window of opportunity to identify pregnancies at risk for future placental abruption.
Original languageEnglish
Pages (from-to)S582-S583
JournalAmerican Journal of Obstetrics and Gynecology
Volume222
Issue number1
DOIs
StatePublished - Jan 2020

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