RESUMEN
Background and Objectives: Risk factors for neonatal/maternal morbidity and mortality in placental abruption have been incompletely studied in the current literature. Most of the research overlooked the African American population as mostly Caucasian populations are selected. We aimed to find which risk factor influence the neonatal and maternal outcome in cases of placental abruption occurring in African American pregnant women in an inner-city urban setting. Materials and Methods: We performed a retrospective cohort study at St. Joseph's Regional Medical Center, NJ United States of America (USA), between 1986 and 1996. Inclusion criteria were African American race, singleton pregnancy with gestational age over 20 weeks and placental abruption. Maternal age, gravidity, parity, gestational age at delivery/occurrence of placental abruption and mode of delivery were collected. Risk factors for placental abruption such as placenta previa, hypertensive disorders of pregnancy, cigarette smoking, crack/cocaine and alcohol use, mechanical trauma, preterm premature rupture of membranes (PPROM), and premature rupture of membranes (PROM) were recorded. Poor neonatal outcome was considered when anyone of the following occurred: 1st and 5th minute Apgar score lower than 7, intrauterine fetal demise (IUFD), perinatal death, and neonatal arterial umbilical cord pH less than 7.15. Poor maternal outcome was considered if any of the following presented at delivery: hemorrhagic shock, disseminated intravascular coagulation (DIC), hysterectomy, postpartum hemorrhage (PPH), maternal intensive care unit (ICU) admission, and maternal death. Results: A population of 271 singleton African American pregnant women was included in the study. Lower gestational age at delivery and cesarean section were statistically significantly correlated with poor neonatal outcomes (p = 0.018; p < 0.001; p = 0.015) in the univariate analysis; only lower gestational age at delivery remained significant in the multivariate analysis (p = < 0.001). Crack/cocaine use was statistically significantly associated with poor maternal outcome (p = 0.033) in the univariate analysis, while in the multivariate analysis, hemolysis, elevated enzymes, low platelet (HELLP) syndrome, crack/cocaine use and previous cesarean section resulted significantly associated with poor maternal outcome (p = 0.029, p = 0.017, p = 0.015, p = 0.047). PROM was associated with better neonatal outcome in the univariate analysis, and preeclampsia was associated with a better maternal outcome in the multivariate analysis. Conclusions: Lower gestational age at delivery is the most important risk factor for poor neonatal outcome in African American women with placental abruption. Poor maternal outcome correlated with HELLP syndrome, crack/cocaine use and previous cesarean section. More research in this understudied population is needed to establish reliable risk factors and coordinate preventive interventions.
Asunto(s)
Desprendimiento Prematuro de la Placenta/etnología , Negro o Afroamericano/etnología , Mortalidad Infantil/tendencias , Mortalidad Materna/tendencias , Desprendimiento Prematuro de la Placenta/epidemiología , Adulto , Negro o Afroamericano/estadística & datos numéricos , Área Bajo la Curva , Estudios de Cohortes , Femenino , Edad Gestacional , Humanos , Lactante , Mortalidad Infantil/etnología , Recién Nacido , Mortalidad Materna/etnología , New Jersey/etnología , Embarazo , Curva ROC , Estudios Retrospectivos , Factores de RiesgoRESUMEN
PURPOSE: Experiencing childhood abuse (CA) or intimate partner violence (IPV) has been linked to adverse pregnancy outcomes. We examined whether CA history and current IPV are independently and jointly associated with placental abruption (PA). METHODS: We recruited 662 PA cases and 665 controls in Lima, Peru. We used multivariate logistic regression to calculate odds ratios (OR), adjusting for age, education, and parity. RESULTS: Approximately 42% of cases and controls reported CA; 50% of cases and 49% of controls reported IPV. History of any CA was not associated with PA, but history of severe CA was associated with 38% increased odds of PA (adjusted OR [aOR], 1.38; 95% confidence interval (CI), 1.07-1.80), adjusting for IPV. There was a statistically nonsignificant association between severe IPV and odds of PA (aOR, 1.22; 95% CI, 0.92-1.62), adjusting for CA. Women who experienced severe CA and severe IPV had 2.06-fold (95% CI, 1.25-3.40) increased odds of PA compared with women who did not experience severe abuse. The joint effect of CA and IPV was positive but statistically nonsignificant on the multiplicative (aOR, 1.48; 95% CI, 0.79-2.80) and additive scale (relative excess risk due to interaction, 0.70; 95% CI, -0.39 to 1.78). CONCLUSIONS: Preventing exposure to violence may improve maternal outcomes.
Asunto(s)
Desprendimiento Prematuro de la Placenta/epidemiología , Desprendimiento Prematuro de la Placenta/etiología , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricos , Violencia de Pareja/psicología , Violencia de Pareja/estadística & datos numéricos , Maltrato Conyugal/psicología , Desprendimiento Prematuro de la Placenta/etnología , Adolescente , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Violencia de Pareja/etnología , Perú/epidemiología , Embarazo , Maltrato Conyugal/estadística & datos numéricos , Adulto JovenRESUMEN
PURPOSE: To examine whether maternal asthma contributes to racial/ethnic differences in obstetrical and neonatal complications. METHODS: Data on white (n = 110,603), black (n = 50,284), and Hispanic (n = 38,831) singleton deliveries came from the Consortium on Safe Labor. Multilevel logistic regression models, with an interaction term for asthma and race/ethnicity, estimated within-group adjusted odds ratios (aORs) for gestational diabetes, gestational hypertension, pre-eclampsia, placental abruption, premature rupture of membranes, preterm delivery, maternal hemorrhage, neonatal intensive care unit admissions, small for gestational age, apnea, respiratory distress syndrome, transient tachypnea of the newborn, anemia, and hyperbilirubinemia after adjustment for clinical and demographic confounders. Nonasthmatics of the same racial/ethnic group were the reference group. RESULTS: Compared with nonasthmatics, white asthmatics had increased odds of pre-eclampsia (aOR, 1.28; 95% confidence interval [CI], 1.15-1.43) and maternal hemorrhage (aOR, 1.14; 95% CI, 1.04-1.23). White and Hispanic infants were more likely to have neonatal intensive care unit admissions (aOR, 1.19; 95% CI, 1.11-1.28; aOR, 1.16; 95% CI, 1.02-1.32, respectively) and be small for gestational age (aOR, 1.11; 95% CI, 1.02-1.20; aOR, 1.26; 95% CI, 1.10-1.44, respectively), and Hispanic infants were more likely to have apnea (aOR, 1.32; 95% CI, 1.02-1.69). CONCLUSIONS: Maternal asthma did not affect most obstetrical and neonatal complication risks within racial/ethnic groups. Despite their increased risk for both asthma and many complications, our findings for black women were null. Asthma did not contribute to racial/ethnic disparities in complications.
Asunto(s)
Asma/etnología , Disparidades en el Estado de Salud , Enfermedades del Recién Nacido/etnología , Complicaciones del Embarazo/etnología , Desprendimiento Prematuro de la Placenta/etnología , Adulto , Apnea/etnología , Asma/complicaciones , Población Negra , Parto Obstétrico , Diabetes Gestacional/etnología , Etnicidad , Femenino , Rotura Prematura de Membranas Fetales/etnología , Hispánicos o Latinos , Humanos , Hiperbilirrubinemia/etnología , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Hemorragia Posparto/etnología , Preeclampsia/etnología , Embarazo , Nacimiento Prematuro/etnología , Síndrome de Dificultad Respiratoria del Recién Nacido/etnología , Estudios Retrospectivos , Taquipnea/etnología , Estados Unidos , Población Blanca , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this study was to examine the association between restraint use, race, and perinatal outcome after motor vehicle accidents (MVAs) during pregnancy. STUDY DESIGN: The Duke Trauma Registry and medical records were searched for information on pregnant women at >14 weeks' gestation who were involved in an MVA and who received care through the Emergency Department and the Obstetric Units. Between January 1994 and December 31, 2010, 126 women were identified. Variables that were collected included type of trauma, gestational age at presentation, and delivery outcomes. A prognostic study was performed that evaluated the associations between maternal demographics, details of the accident that included restraint use, and maternal treatment that was related to the accident in relationship to perinatal outcome. RESULTS: There was no difference in the mean age or median gravidity or parity by race among pregnant women who were cared for after an MVA. There was no difference in mean age or racial distribution between women who were restrained compared with women who were unrestrained; unrestrained women were more likely to be nulliparous. Unrestrained women were more likely to require nonobstetric surgery that was related to the trauma. The overall rate of placental abruption was 6%. There were 6 intrauterine fetal deaths, 3 each in the unrestrained (25%) and restrained groups (3.5%; P = .018). Airbags deployed in 17 accidents. Among the 7 women with placenta abruption, 4 women (57%) experienced air bag deployment. CONCLUSION: Lack of restraint use during pregnancy is associated with an increased risk of fetal death.
Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Complicaciones del Embarazo , Cinturones de Seguridad/estadística & datos numéricos , Heridas y Lesiones/epidemiología , Desprendimiento Prematuro de la Placenta/epidemiología , Desprendimiento Prematuro de la Placenta/etnología , Desprendimiento Prematuro de la Placenta/etiología , Adolescente , Adulto , Airbags/efectos adversos , Airbags/estadística & datos numéricos , Femenino , Muerte Fetal/epidemiología , Muerte Fetal/etnología , Muerte Fetal/etiología , Humanos , Registros Médicos , Vehículos a Motor , Embarazo , Resultado del Embarazo , Grupos Raciales , Sistema de Registros , Factores de Riesgo , Heridas y Lesiones/complicaciones , Heridas y Lesiones/etnología , Adulto JovenRESUMEN
AIM: A case-cohort study was performed to clarify and compare the risk factors for placental abruption and placenta previa. MATERIAL & METHODS: This study reviewed 242,715 births at 125 centers of the perinatal network in Japan from 2001 through to 2005 as a base-cohort. Women with singleton pregnancies delivered after 22 weeks of gestation were included. The evaluation determined the risk factors for placental abruption and placenta previa. Five thousand and thirty-six births (2.1%) were determined as the subcohort by random selection. Acute-inflammation-associated clinical conditions (premature rupture of membranes and clinical chorioamnionitis) and chronic processes associated with vascular dysfunction or chronic inflammation (chronic and pregnancy-induced hypertension, pre-existing or gestational diabetes and maternal smoking) was examined between the two groups. RESULTS: Placental abruption and placenta previa were recorded in 10.1 per 1000 and 13.9 per 1000 singleton births. Risk factors for abruption and previa, respectively, included maternal age over 35 years (adjusted risk ratios [RRs]=1.20 and 1.78), IVF-ET (RRs = 1.38 and 2.94), preterm labor (RRs = 1.63 and 3.09). Smoking (RRs = 1.37), hypertension (RRs = 2.48), and pregnancy-induced hypertension (RR = 4.45) were risk factors for abruption but not for previa. On the other hand, multiparity (RR= 1.18) was a risk factor for previa but not for abruption. The rates of acute-inflammation-associated conditions and chronic processes were higher among women with abruption than with previa. (RR 2.0 and 4.08, respectively). CONCLUSION: The case-cohort study technique elucidated the difference in the risk factors for placental abruption and placenta previa.
Asunto(s)
Desprendimiento Prematuro de la Placenta/epidemiología , Placenta Previa/epidemiología , Desprendimiento Prematuro de la Placenta/etnología , Adolescente , Adulto , Estudios de Cohortes , Femenino , Humanos , Japón/epidemiología , Persona de Mediana Edad , Placenta Previa/etnología , Embarazo , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Efforts to elucidate risk factors for placental abruption are imperative due to the severity of complications it produces for both mother and fetus, and its contribution to preterm birth. Ethnicity-based differences in risk of placental abruption and preterm birth have been reported. We tested the hypotheses that race, after adjusting for other factors, is associated with the risk of placental abruption at specific gestational ages, and that there is a greater contribution of placental abruption to the increased risk of preterm birth in Black mothers, compared to White mothers. METHODS: We conducted a population-based cohort study using the Missouri Department of Health's maternally-linked database of all births in Missouri (1989-1997) to assess racial effects on placental abruption and the contribution of placental abruption to preterm birth, at different gestational age categories (n = 664,303). RESULTS: Among 108,806 births to Black mothers and 555,497 births to White mothers, 1.02% (95% CI 0.96-1.08) of Black births were complicated by placental abruption, compared to 0.71% (95% CI 0.69-0.73) of White births (aOR 1.32, 95% CI 1.22-1.43). The magnitude of risk of placental abruption for Black mothers, compared to White mothers, increased with younger gestational age categories. The risk of placental abruption resulting in term and extreme preterm births (< 28 weeks) was higher for Black mothers (aOR 1.15, 95% CI 1.02-1.29 and aOR 1.98, 95% CI 1.58-2.48, respectively). Compared to White women delivering in the same gestational age category, there were a significantly higher proportion of placental abruption in Black mothers who delivered at term, and a significantly lower proportion of placental abruption in Black mothers who delivered in all preterm categories (p < 0.05). CONCLUSION: Black women have an increased risk of placental abruption compared to White women, even when controlling for known coexisting risk factors. This risk increase is greatest at the earliest preterm gestational ages when outcomes are the poorest. The relative contribution of placental abruption to term births was greater in Black women, whereas the relative contribution of placental abruption to preterm birth was greater in White women.
Asunto(s)
Desprendimiento Prematuro de la Placenta/etnología , Negro o Afroamericano/estadística & datos numéricos , Adulto , Estudios de Cohortes , Femenino , Edad Gestacional , Humanos , Missouri/epidemiología , Análisis Multivariante , Embarazo , Factores de RiesgoRESUMEN
It was the objective of this study to analyse the influence of confounders, such as ethnicity, severity of illness and method of testing, in articles concerning the still moot relationship of thrombophilias to adverse pregnancy outcome (APO). Relevant case-control studies were identified using Medline and EMBASE databases between 1966 and 2006. Search terms were recurrent fetal loss, intrauterine fetal death, preeclampsia, HELLP-syndrome, eclampsia, fetal growth restriction, abruptio placentae, combined with maternal thrombophilias. Data was extracted from the articles per subgroup of APO regardless of confounder. These subgroups were tested if they fulfilled the heterogeneity testing criterion (I(2) > 35%) to weigh the influence of the confounder. Confounders were selected and examined with Mantel-Haenszel method. Increased thrombophilia prevalence was confirmed in most adverse pregnancy outcomes. Ethnicity, genetic testing only and severity of illness were confounders in the various forms of APO. Stronger relationships between factor V Leiden and severity of disease were found in 2(nd) and 3(rd) trimester than 1(st) trimester recurrent fetal loss, in preeclampsia with: blood pressure > or =160/110 mmHg than > or =140/90 mmHg; proteinuria > or =5 grams per day than <5 grams; onset before than after 28 weeks, in fetal growth restriction <3(rd) percentile than <5(th), than <10(th), and in earlier occurrence of abruptio placentae than 3(rd) trimester. In conclusion, reports on the prevalence of maternal thrombophilias and APO are influenced by various confounders, which are not always appropriately analysed. The differences we have identified reflect the differential impact of these confounders. These data emphasise the importance of more uniform research.
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Aborto Habitual/epidemiología , Desprendimiento Prematuro de la Placenta/epidemiología , Retardo del Crecimiento Fetal/epidemiología , Complicaciones Hematológicas del Embarazo/epidemiología , Resultado del Embarazo , Trombofilia/epidemiología , Aborto Habitual/etnología , Aborto Habitual/genética , Desprendimiento Prematuro de la Placenta/etnología , Desprendimiento Prematuro de la Placenta/genética , Estudios de Casos y Controles , Factores de Confusión Epidemiológicos , Diseño de Investigaciones Epidemiológicas , Femenino , Retardo del Crecimiento Fetal/etnología , Retardo del Crecimiento Fetal/genética , Predisposición Genética a la Enfermedad , Pruebas Genéticas , Genotipo , Humanos , Fenotipo , Embarazo , Complicaciones Hematológicas del Embarazo/etnología , Complicaciones Hematológicas del Embarazo/genética , Resultado del Embarazo/etnología , Resultado del Embarazo/genética , Prevalencia , Reproducibilidad de los Resultados , Factores de Riesgo , Índice de Severidad de la Enfermedad , Trombofilia/etnología , Trombofilia/genéticaAsunto(s)
Desprendimiento Prematuro de la Placenta/genética , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Polimorfismo de Nucleótido Simple/genética , Grupos de Población/genética , Desprendimiento Prematuro de la Placenta/etnología , Adolescente , Adulto , Población Negra/genética , Femenino , Frecuencia de los Genes , Humanos , Hiperhomocisteinemia/etnología , Hiperhomocisteinemia/genética , Embarazo , Sudáfrica/epidemiología , Mortinato/genéticaRESUMEN
OBJECTIVE: The purpose of this study was to evaluate temporal trends in abruption risk and to assess how much underlying changes in the clinical determinants may have affected these trends. STUDY DESIGN: We used the National Hospital Discharge Summary data (1979-2001), an annual survey of sampled non-federal, short stay, general, and specialty hospitals in the United States. Trends in abruption were assessed for the periods 1979 through 1981 and 1999 through 2001. Clinical determinants of abruption that were evaluated included hypertensive diseases, anemia, gestational diabetes mellitus, preterm labor, preterm premature rupture of membranes, chorioamnionitis, oligohydramnios, obstetric shock/trauma, uterine tumors, short umbilical cord, and velamentous cord insertion. Temporal trends in abruption were examined before and after adjustment for determinants through multivariable logistic regression. RESULTS: The rate of abruption increased 92% (95% CI, 88, 96) among black women between 1979-1981 (0.76%; n = 13,584 women) and 1999-2001 (1.43%; n = 18,960 women). Among white women, the rate increased by 15% (95% CI, 14,16) over the same period, from 0.82% (n = 66,186 women) in 1979-1981 to 0.94% (n = 59,284 women) in 1999-2001. The determinants that were associated with trends in abruption included anemia, gestational diabetes mellitus, preterm labor, short umbilical cord, and velamentous cord insertion, although their effects varied substantially by maternal race. CONCLUSION: The temporal increase in rates of abruption may reflect a true increase in risk or may be the result of improved diagnosis of both abruption and its determinants. Although the cause of abruption is still speculative, the trend is of concern and deserves scrutiny.
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Desprendimiento Prematuro de la Placenta/epidemiología , Desprendimiento Prematuro de la Placenta/etiología , Hospitales/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Desprendimiento Prematuro de la Placenta/etnología , Adulto , Distribución por Edad , Población Negra/estadística & datos numéricos , Femenino , Encuestas de Atención de la Salud , Humanos , Incidencia , Modelos Logísticos , Alta del Paciente/estadística & datos numéricos , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/etnología , Complicaciones del Embarazo/etiología , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
This pilot study examined Factor V Leiden (R506Q), prothrombin (20210G-->A), thrombomodulin (A455V) and MTHFR (677C-->T) in 100 Zulu-speaking black South African women with placental abruption and 217 controls. The Factor V Leiden and prothrombin variant gene alleles were not detected in either patient or control groups. The thrombomodulin polymorphic variant was not seen in the patient group but three heterozygotes (1%) were found in the controls. No homozygotes for the MTHFR T677 variant were detected in the patients but two (1%) were noted in the controls; the normal and heterozygote genotype and allele frequencies for this polymorphism were similar in the two groups.
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Desprendimiento Prematuro de la Placenta/genética , Polimorfismo Genético/genética , Desprendimiento Prematuro de la Placenta/etnología , Población Negra/genética , Factor V/genética , Femenino , Heterocigoto , Humanos , Proyectos Piloto , Embarazo , Protrombina/genética , Sudáfrica/etnología , Trombomodulina/genéticaRESUMEN
OBJECTIVE: To determine whether Southern-born African-American women have higher incidence of abruptio placentae, irrespective of their region of residence. METHODS: For this retrospective cohort study we used vital statistics data of the US for the years 1995 and 1996. Age-adjusted rates of abruption were derived for combinations of regions of birth (Northeast, Midwest, South, West, and Foreign-born) and regions of residence (Northeast, Midwest, South, and West) for all singleton live births among African-American women. RESULTS: The incidence of abruptio placentae among African-American women was 6.7 per 1,000 live births. The age-adjusted rates of abruption among women who had not migrated showed that those in the Northeast had the highest rates (8.3 per 1,000), followed by those in the Midwest (6.3 per 1,000), South (6.0 per 1,000) and in the West (4.9 per 1,000). The prevalence of risk factors showed the same pattern. CONCLUSION: The results of the study suggest that place of residence rather than place of birth was associated with the risk of placental abruption. However, foreign-born African-American women had lower rates of abruption irrespective of the region of residence.
Asunto(s)
Desprendimiento Prematuro de la Placenta/epidemiología , Población Negra , Características de la Residencia/estadística & datos numéricos , Desprendimiento Prematuro de la Placenta/etnología , Adulto , Femenino , Humanos , Incidencia , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos , Estados Unidos/epidemiología , Salud de la MujerRESUMEN
OBJECTIVE: To evaluate racial variation in the frequency of intrapartum hemorrhage. METHODS: Using information from birth certificates of live singleton births in North Carolina from 1990 to 1997 (n = 807,759), we evaluated the frequency of intrapartum hemorrhage and its association with maternal race. Logistic regression models were used to evaluate the risk of any intrapartum hemorrhage, placental abruption, placenta previa, and unspecified hemorrhage in each racial group, adjusted for other risk factors. RESULTS: Black women had the highest rates of any hemorrhage (1.52% black, 1.47% white, 1.33% other race, P =.006) and placental abruption (0.79% black, 0.68% white, 0.56% other race, P =.001) but had lower rates of unspecified hemorrhage (0.37% black, 0.42% white, 0.42% other race, P =.001). Race was not associated with placenta previa. Maternal race remained associated with intrapartum hemorrhage after multivariable analysis, but the direction of the association was reversed. Black women were less likely to have any intrapartum hemorrhage (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.77, 0.85), placental abruption (OR 0.76, 95% CI 0.70, 0.82), placenta previa (OR 0.89, 95% CI 0.81, 0.98), or other unspecified hemorrhage (OR 0.84, 95% CI 0.76, 0.92) compared with white women. Women of other minority races were at lower risk for placental abruption (OR 0.76, 95% CI 0.67, 0.87) but were comparable to white women for risk of placenta previa (OR 1.06, 95% CI 0.91, 1.24) and other unspecified hemorrhage (OR 1.02, 95% CI 0.88, 1.19). CONCLUSION: Although black women had higher rates of intrapartum hemorrhage than whites, the increased frequency was attributable to differences in clinical presentation and other risk factors.