By John C. Hobbins, MD
Professor, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora
Dr. Hobbins reports no financial relationships relevant to this field of study.
Synopsis: A study from the Netherlands involving more than 1 million patients has shown that recurrence of placental abruption happens more frequently in those patients whose first abruption occurred at term and/or in their first pregnancy, as well as in those with a history of hypertension.
Source: Ruiter L, et al. Incidence and recurrence rate of placental abruption: A longitudinal linked national cohort study in the Netherlands. Am J Obstet Gynecol 2015;213:573.e1-8.
Placental abruption can be associated with devastating results but even if the outcome is favorable, the process of getting through the pregnancy leaves an indelible impression on most patients. Before or soon after becoming pregnant again, most will seek answers regarding the chances of having a recurrence. Unfortunately, there has been little in the literature to help with the answer — until now.
Investigators searched the Netherlands Perinatal Registry for pertinent data from 1999 to 2007 regarding documented cases of abruption.1 They then tracked these patients’ reproductive histories looking for recurrences. Fortunately, the database was robust enough to search for possible risk factors that could be linked with recurrent abruption.
Of the 1,570,635 patients in the database, 3496 patients had an abruption (0.22%). Follow-up information was available on 264,424 patients, representing 528,848 deliveries. The authors found 520 patients had abruptions in their first pregnancies (0.20%), compared with 214 (0.08%) in their later pregnancies. Of those experiencing abruption, 30 had a recurrence in another pregnancy (5.8%) vs those without this history (0.07%).
Interestingly, those having abruptions at term were more likely to have a recurrence than those with preterm abruptions (32-37 weeks) or early preterm (< 32 weeks), with odds ratios (OR) of 188, 52, and 39, respectively. Not surprisingly, hypertensives had a higher rate of abruption than normotensive women (0.44% vs 0.26%). Of the entire group having abruptions in their first pregnancies, 12.6% had hypertension, while 6.6% of second pregnancy abruption patients had hypertension. Surprisingly, there was a nonsignificant trend toward a lower recurrence rate in hypertensives compared with normotensive women (OR, 0.68; 95% confidence interval, 0.27-1.6).
COMMENTARY
The most important message for a patient who has had an abruption, and who often feels like she is sitting on a powder keg, is that the overall recurrence rate is 5.8%. Or if presented in a “this glass is way more than half full” approach, she has a 19 in 20 chance of sailing through the pregnancy without a recurrence. The most striking findings were the parallel relationship between the gestational age at the time of the first abruption and the incidence of a recurrence, and in the fact that most abruptions were likely to happen after 37 weeks. This even stimulated the authors to recommend induction at 37 weeks for patients with a history of previous abruptions, the deck being loaded even further if the first abruption occurred at term.
The most frustrating part of caring for patients with previous abruptions is that little can be done to prevent the condition or to treat it once it happens. However, there are early clues available to identify those at greater risk. For example, first trimester (low pregnancy-associated plasma protein A)2 and second trimester (elevated alpha-fetoprotein)3 biochemistry have been linked with abruptions later in pregnancy. Also, abnormal uterine artery waveforms have been associated with an increased risk of abruption.4 While abnormal results can raise the antennas of providers, negative results might at least provide the patient with some reassurance against another abruption.
REFERENCES
- Ruiter L, et al. Incidence and recurrence rate of placental abruption: A longitudinal linked national cohort study in the Netherlands. Am J Obstet Gynecol 2015;213:573.e1-8.
- Dugoff L, et al. First trimester maternal serum PAPP-A and free beta subunit hCG concentrations and NT are associated with obstetric complications: A population-based screening study (the FASTER trial). Am J Obstet Gynecol 2011;191:1446-1451.
- Tikkanen M, et al. Elevated maternal serum alpha-fetoprotein as a risk factor for placental abruption. Prenat Diagn 2007;27:240-243.
- Gabrielli S, et al. Risk of placental abruption in patients with abnormal uterine artery Doppler in the second trimester of pregnancy. Ultrasound Obstet Gynecol 2011;38:83.
A study from the Netherlands involving more than 1 million patients has shown that recurrence of placental abruption happens more frequently in those patients whose first abruption occurred at term and/or in their first pregnancy, as well as in those with a history of hypertension.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content