Rasmussen S, Irgens L M, Dalaker K
Medical Birth Registry of Norway, University of Bergen, Norway.
Paediatr Perinat Epidemiol. 1999 Jan;13(1):9-21. doi: 10.1046/j.1365-3016.1999.00159.x.
In a population-based historic cohort study, we assessed the possible association of fetal growth retardation, preterm birth and pregnancy-induced hypertension in the immediately preceding pregnancy with placental abruption in the current pregnancy, which would suggest a shared aetiological factor. We also assessed whether chronic hypertension, diabetes mellitus and a history of Caesarean section are associated with placental abruption. Preterm birth and small-for-gestational-age (SGA) in the immediately preceding delivery were associated with an increased risk of placental abruption with unadjusted odds ratios (ORs) of 2.1 [95% CI = 1.9, 2.4] and 1.6 [95% CI = 1.5, 1.8] respectively. Women with a history of an SGA preterm birth in the immediately preceding delivery and an appropriate-for-gestational-age infant in the current had an adjusted OR of 3.2 [95% CI = 2.3, 4.5]. The adjusted odds ratio of placental abruption in women who had pregnancy-induced hypertension in the previous pregnancy, but not in the current, was 1.4 [95% CI = 1.2, 1.7]. Women who delivered a preterm or SGA infant in the previous delivery and had chronic hypertension or diabetes mellitus in the current had adjusted ORs of 2.3-5.7 and 2.5-6.0 respectively. Caesarean section in the previous delivery increased the risk of placental abruption by 40%. These results suggest that pregnancy-induced hypertension, intrauterine growth retardation, preterm delivery and placental abruption share an aetiological factor or represent different clinical expressions of recurring placental dysfunction. Chronic hypertension and diabetes mellitus may cause or aggravate such dysfunction thus causing placental abruption. A history of Caesarean section is associated with an increased risk of placental abruption.
在一项基于人群的历史性队列研究中，我们评估了前次妊娠中的胎儿生长受限、早产和妊娠高血压与本次妊娠胎盘早剥之间可能存在的关联，这可能提示存在共同的病因学因素。我们还评估了慢性高血压、糖尿病和剖宫产史是否与胎盘早剥有关。前次分娩中的早产和小于胎龄儿（SGA）与胎盘早剥风险增加相关，未调整的比值比（OR）分别为2.1 [95%可信区间（CI）= 1.9, 2.4]和1.6 [95% CI = 1.5, 1.8]。前次分娩为SGA早产且本次为适于胎龄儿的女性，调整后的OR为3.2 [95% CI = 2.3, 4.5]。前次妊娠有妊娠高血压但本次没有的女性，胎盘早剥的调整后比值比为1.4 [95% CI = 1.2, 1.7]。前次分娩为早产或SGA婴儿且本次患有慢性高血压或糖尿病的女性，调整后的OR分别为2.3 - 5.7和2.5 - 6.0。前次分娩剖宫产使胎盘早剥风险增加40%。这些结果表明，妊娠高血压、宫内生长受限、早产和胎盘早剥共享一个病因学因素，或代表复发性胎盘功能障碍的不同临床表现。慢性高血压和糖尿病可能导致或加重这种功能障碍，从而引起胎盘早剥。剖宫产史与胎盘早剥风险增加有关。
