Preterm placental abruption and its association with adverse maternal and neonatal outcomes: a retrospective study.

BACKGROUND

Placental abruption (PA), a severe obstetric complication, defined as the partial or complete detachment of a normally situated placenta from the uterine wall before birth, after 20 weeks of gestation, is associated with significant maternal and neonatal morbidity and mortality. Despite its clinical importance, the pathogenesis of PA remains unclear, and there is limited research specifically comparing outcomes in term and preterm pregnancies with PA. This study aimed to evaluate maternal and neonatal outcomes in pregnancies complicated by PA on basis of the timing of PA onset, with a focus on differences between term and preterm deliveries.

METHODS

This retrospective study included a total of 757 singleton pregnant women with confirmed PA from a tertiary obstetrics hospital care center between June 2020 to March 2024, who were classified into the preterm group (n = 300) and the full-term group (n = 457) based on their gestational age of PA onset. The baseline characteristics, maternal and newborn outcomes were collected from electronic health records in hospital information system, and further analyzed between two groups. The adjusted odds ratios (aORs) for the risk of adverse pregnancy outcomes on basis of term or preterm delivery in women with PA were analyzed by using multivariate logistic regression models.

RESULTS

Women with preterm delivery had about 3 times greater risk for uterus-placenta apoplexy (aOR: 2.93, 95% CI 1.33-6.47, P = 0.01), 3 times greater risk for fetal growth restriction (aOR: 3.47, 95% CI 1.45-8.30, P = 0.01), 3 times greater risk for adult intensive care unit (ICU, aOR: 3.28, 95% CI 1.27-8.46, P = 0.01), and less chances to use oxytocin (aOR: 0.21, 95% CI 0.13-0.32, P < 0.01). Premature newborns had less chances to use forceps (aOR: 0.09, 95% CI 0.01-0.76, P = 0.02), but about 10 times greater risk for stillbirth (aOR: 9.38, 95% CI 1.10 - 79.68, P < 0.01).

CONCLUSIONS

Preterm pregnancies with PA are associated with higher risks of severe maternal complications and adverse neonatal outcomes, underscoring the need for enhanced clinical surveillance and timely intervention. Future research should focus on elucidating underlying mechanisms and developing effective prevention strategies, while long-term follow-up is essential to assess the health outcomes of affected infants.

CLINICAL TRIAL NUMBER

Not applicable.