Levy Michal, Gonen Noa, Kovo Michal, Schreiber Letizia, Marom Or, Barda Giulia, Volpert Eldar, Bar Jacob, Weiner Eran
Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eur J Obstet Gynecol Reprod Biol. 2020 Nov;254:188-194. doi: 10.1016/j.ejogrb.2020.09.039. Epub 2020 Sep 25.
We aimed to study the correlation between the extent of placental abruption (PA), as grossly estimated immediately after delivery, and pregnancy outcomes, in correlation with placental histopathology.
Pregnancy and placental reports of all pregnancies complicated by PA (clinically diagnosed) between 11/2008-12/2018 were reviewed. We compared maternal background, pregnancy outcomes, and placental histopathology between cases of PA divided into three groups according to the extent of abruption: Group 1-<30 %, Group 2-30-49 %, and Group 3->50 % of placental surface. Placental lesions were classified according to the current "Amsterdam" criteria. The primary outcome was defined as a composite of severe neonatal morbidity and included ≥ 1 of the following complications: seizures, intraventricular hemorrhage, hypoxic-ischemic encephalopathy, periventricular leukomalacia, blood transfusion, necrotizing enterocolitis, intrauterine fetal demise, or neonatal death.
A total of 260 PA cases were included: 111 (42.7 %) in Group 1, 94 (36.2 %) in Group 2, and 55 (21.1 %) in Group 3. The rate of the primary outcome (7.2 % vs. 11.7 % vs. 27.3 %, p = 0.02) was associated with the degree of PA as well as maternal heavy smoking (p = 0.04), DIC (p = 0.03), umbilical artery Ph <7.1 (p = 0.02), 5-minute Apgar scores <7 (p = 0.03), NICU admissions, placental maternal vascular malperfusion lesions (p = 0.04), and neonatal weights <5th percentile (0.04). In multivariable analysis severe adverse neonatal outcome was independently associated with the percentage of PA (aOR = 1.4, 95 % CI = 1.3-3.9).
The extent of placental abruption, as estimated by the examiner, correlated with DIC and severe neonatal outcomes and may serve as an early alarming sign in deliveries complicated by PA.
我们旨在研究分娩后立即粗略估计的胎盘早剥（PA）程度与妊娠结局之间的相关性，并与胎盘组织病理学相关联。
回顾了2008年11月至2018年12月期间所有并发PA（临床诊断）的妊娠的妊娠及胎盘报告。我们比较了根据早剥程度分为三组的PA病例的母亲背景、妊娠结局和胎盘组织病理学：第1组<30%，第2组30%-49%，第3组>50%的胎盘表面。胎盘病变根据当前的“阿姆斯特丹”标准进行分类。主要结局定义为严重新生儿发病率的综合指标，包括以下并发症中的≥1种：惊厥、脑室内出血、缺氧缺血性脑病、脑室周围白质软化、输血、坏死性小肠结肠炎、宫内胎儿死亡或新生儿死亡。
共纳入260例PA病例：第1组111例（42.7%），第2组94例（36.2%），第3组55例（21.1%）。主要结局的发生率（7.2%对11.7%对27.3%，p = 0.02）与PA程度以及母亲大量吸烟（p = 0.04）、弥散性血管内凝血（DIC）（p = 0.03）、脐动脉pH<7.1（p = 0.02）、5分钟阿氏评分<7（p = 0.03）、新生儿重症监护病房（NICU）入院、胎盘母体血管灌注不良病变（p = 0.04）和新生儿体重<第5百分位数（0.04）相关。在多变量分析中，严重不良新生儿结局与PA百分比独立相关（调整后比值比[aOR]=1.4，95%置信区间[CI]=1.3-3.9）。
检查者估计的胎盘早剥程度与DIC和严重新生儿结局相关，可作为并发PA分娩的早期警示信号。
