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| |  Placental Abruption Increases Risk Of Stillbirth And Preterm Delivery CHICAGO, IL -- November 2, 1999 -- There is an increased risk of stillbirth, premature delivery and low birth weight among infants born to mothers who experience separation of the placenta before delivery, according to an article in the November 3 issue of The Journal of the American Medical Association (JAMA). Cande V. Ananth, Ph.D., M.P.H., of the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, N.J., and colleagues, studied pregnancies that were complicated by a condition known as placental abruption. The researchers analyzed data on 53,371 pregnancies occurring among 40,789 women who gave birth between 1986 and 1996 at Mount Sinai Hospital in New York. The placenta develops in the uterus during pregnancy. It transfers oxygen from mother to baby and removes waste products from the baby's blood. The placenta is firmly attached to the lining of the woman's uterus and is connected to the baby by the umbilical cord. Placental abruption, which results from a cascade of pathophysiological processes, involves separation of the placenta from the inner wall of the uterus prior to delivery. The researchers found that 530 (1 percent) of the studied pregnancies were complicated by placental abruption. They report that abruption had a profound impact on stillbirth, preterm delivery, and low birth weight. "Our results indicate that neonates born to mothers with abruption have poor rates of survival at birth and are delivered early, compared with infants born to women without abruption," they write. "Much of the risk in low birth weight due to abruption is the consequence of shortened gestation, and, to a lesser extent, fetal growth restriction." "The risk of stillbirth was dramatically increased for severe placental separation, but preterm delivery was common even among women with lesser degrees of placental separation," they continue. Among the findings of the study: -- The frequency of stillbirth occurring after 20 weeks' gestation was 5.3 percent among women with placental abruption, compared with 0.5 percent among all other pregnancies, resulting in an 8.9-fold adjusted relative risk.
The authors note that the established risk factors for placental abruption -- such as cigarette smoking, drug use, hypertension, and preeclampsia -- are potentially preventable. "Some randomized trials and observational studies have shown that low dosages of aspirin (60 and 80 mg/d) and calcium supplementation (2 g/d) may prevent pregnancy-induced hypertension and preeclampsia," they write. "Similarly, prenatal patient counseling and education on the harmful effects of smoking and drug abuse during pregnancy can help to reduce the incidence of placental abruption and other adverse outcomes of pregnancy, including preterm delivery and growth restriction," they continue. They suggest that programs to prevent preterm birth would benefit if patients suspected to be at risk for developing placental abruption are identified. "Clinicians should suspect abruption in patients presenting with spontaneous preterm labor or unexplained vaginal bleeding during the latter half of pregnancy," they write. "Other common symptoms such as uterine tenderness, excessive uterine contractions, and fetal distress are highly suggestive of placental abruption." (JAMA. 1999; 282:1646-1651)
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