This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (59)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Women's Health  • Pregnancy and Breast Feeding  • Alert me on articles by topic  Social Bookmarking   What's this?

Cande V. Ananth, PhD, MPH; Gertrud S. Berkowitz, PhD; David A. Savitz, PhD; Robert H. Lapinski, PhD

JAMA. 1999;282:1646-1651.

Context  Pregnancies complicated by abruption result in increased frequency of perinatal death and decreased fetal size and gestational duration, yet the extent of placental separation and its effect on these adverse outcomes is unknown.

Objective  To assess the contribution of placental abruption and extent of placental separation to stillbirth, preterm delivery, and fetal growth restriction.

Design  Hospital-based, retrospective cohort study.

Setting  Mount Sinai Hospital, New York City, NY.

Participants  A total of 53,371 pregnancies occurring in 40,789 women who were delivered of singleton births between 1986 and 1996.

Main Outcome Measures  Risks and relative risks for stillbirth (>20 weeks), preterm delivery (<37 weeks), and fetal growth restriction (birth weight below 10th percentile for gestational age) in relation to abruption.

Results  The incidence of abruption was 1% (n = 530). Abruption was associated with an 8.9-fold (95% confidence interval [CI], 6.0-13.0) adjusted relative risk (aRR) of stillbirth. Preterm birth proportions among women with and without abruption were 39.6% and 9.1%, respectively, yielding an aRR of 3.9 (95% CI, 3.5-4.4). In the abruption group, 14.3% of neonates were growth restricted, compared with 8.1% among all other births (aRR, 2.0; 95% CI, 1.5-2.4). Extent of placental separation had a profound effect on stillbirth (aRR for 75% separation, 31.5; 95% CI, 17.0-58.4), although evident only among those with at least 50% separation. However, the risk of preterm delivery was substantially increased even for mild abruptions (aRR for 25% separation, 5.5; 95% CI, 4.2-7.3).

Conclusions  In this cohort, placental abruption had a profound impact on stillbirth, preterm delivery, and fetal growth restriction. The risk of stillbirth was dramatically increased for severe placental separation, but preterm delivery was common even among women with lesser degrees of placental separation.

Author Affiliations: Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick (Dr Ananth); Departments of Community and Preventive Medicine (Dr Berkowitz) and Obstetrics, Gynecology, and Reproductive Sciences (Dr Lapinski), Mount Sinai School of Medicine, New York City, New York; Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill (Dr Savitz).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

November 3, 1999
JAMA. 1999;282(17):1689-1690.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Extreme obesity and risk of placental abruption
Salihu et al.
Hum Reprod 2009;24:438-444.
ABSTRACT | FULL TEXT  

THE ROLE OF DOMOIC ACID IN ABORTION AND PREMATURE PARTURITION OF CALIFORNIA SEA LIONS (ZALOPHUS CALIFORNIANUS) ON SAN MIGUEL ISLAND, CALIFORNIA
Goldstein et al.
J Wildl Dis 2009;45:91-108.
ABSTRACT | FULL TEXT  

Placental Volumes Measured by 3-Dimensional Ultrasonography in Normal Pregnancies From 12 to 40 Weeks' Gestation
de Paula et al.
J Ultrasound Med 2008;27:1583-1590.
ABSTRACT | FULL TEXT  

Influence of Maternal Smoking on Placental Abruption in Successive Pregnancies: A Population-based Prospective Cohort Study in Sweden
Ananth and Cnattingius
Am J Epidemiol 2007;166:289-295.
ABSTRACT | FULL TEXT  

Risk Factors for Placental Abruption in an Asian Population
Hung et al.
Reproductive Sciences 2007;14:59-65.
ABSTRACT  

Female survivors of childhood cancer: preterm birth and low birth weight among their children.
Signorello et al.
JNCI J Natl Cancer Inst 2006;98:1453-1461.
ABSTRACT | FULL TEXT  

Previous Preterm and Small-for-Gestational-Age Births and the Subsequent Risk of Stillbirth
Surkan et al.
NEJM 2004;350:777-785.
ABSTRACT | FULL TEXT  

Placental Abruption among Singleton and Twin Births in the United States: Risk Factor Profiles
Ananth et al.
Am J Epidemiol 2001;153:771-778.
ABSTRACT | FULL TEXT  

Placental Abruption and Perinatal Mortality in the United States
Ananth and Wilcox
Am J Epidemiol 2001;153:332-337.
ABSTRACT | FULL TEXT  

Placental Abruption Markedly Increases Perinatal Morbidity
JWatch General 1999;1999:5-5.
FULL TEXT