Ananth C V, Wilcox A J
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick 08901-1977, USA.
Am J Epidemiol. 2001 Feb 15;153(4):332-7. doi: 10.1093/aje/153.4.332.
Placental abruption is an uncommon obstetric complication associated with high perinatal mortality rates. The authors explored the associations of abruption with fetal growth restriction, preterm delivery, and perinatal survival. The study was based on 7,508,655 singleton births delivered in 1995 and 1996 in the United States. Abruption was recorded in 6.5 per 1,000 births. Perinatal mortality was 119 per 1,000 births with abruption compared with 8.2 per 1,000 among all other births. The high mortality with abruption was due, in part, to its strong association with preterm delivery; 55% of the excess perinatal deaths with abruption were due to early delivery. Furthermore, babies in the lowest centile of weight (<1% adjusted for gestational age) were almost nine times as likely to be born with abruption than those in the heaviest (> or =90%) birth weight centiles. This relative risk progressively declined with higher birth weight centiles. After controlling for fetal growth restriction and early delivery, the high risk of perinatal death associated with abruption persisted. Even babies born at 40 weeks of gestation and birth weight of 3,500-3,999 g (where mortality was lowest) had a 25-fold higher mortality with abruption. The link between fetal growth restriction and abruption suggests that the origins of abruption lie at least in midpregnancy and perhaps even earlier.
胎盘早剥是一种罕见的产科并发症，与围产期高死亡率相关。作者探讨了胎盘早剥与胎儿生长受限、早产及围产期存活之间的关联。该研究基于1995年和1996年在美国分娩的7508655例单胎出生病例。每1000例出生中有6.5例记录有胎盘早剥。胎盘早剥组的围产期死亡率为每1000例出生中有119例死亡，而其他所有出生的围产期死亡率为每1000例中有8.2例。胎盘早剥导致的高死亡率部分归因于其与早产的密切关联；胎盘早剥导致的额外围产期死亡中有55%是由于早产。此外，体重处于最低百分位数（<1%，根据孕周调整）的婴儿发生胎盘早剥的可能性几乎是出生体重处于最高百分位数（>或=90%）婴儿的9倍。这种相对风险随着出生体重百分位数的升高而逐渐下降。在控制了胎儿生长受限和早产因素后，与胎盘早剥相关的围产期死亡高风险仍然存在。即使是孕周为40周、出生体重为3500 - 3999克（死亡率最低）的婴儿，发生胎盘早剥时的死亡率也高出25倍。胎儿生长受限与胎盘早剥之间的联系表明，胎盘早剥至少始于妊娠中期，甚至可能更早。
