Placental Histopathology and Pregnancy Outcomes in “Early” vs. “Late” Placental Abruption

Noa Gonen, Michal Levy, Michal Kovo, Letizia Schreiber, Lilach Kornblit Noy, Eldar Volpert, Jacob Bar, Eran Weiner*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Placenta-associated pregnancy complications (fetal growth restriction and preeclampsia) are traditionally classified as “early” and “late” due to their different pathophysiology, histopathology, and pregnancy outcomes. As placental abruption (PA) represents another placenta-associated complication, we aimed to study if this categorization can be applied to PA as well. Pregnancy and placental reports of all pregnancies complicated by PA between November 2008 and January 2019 were reviewed. Maternal background, pregnancy outcomes, and placental histopathology were compared between cases of PA < 34 weeks (early PA group) vs. > 34 weeks (late PA group). Placental lesions were classified according to the “Amsterdam” criteria. The primary outcome was severe neonatal morbidity (≥ 1 severe neonatal complications: seizures, IVH, HIE, PVL, blood transfusion, NEC, or death). Included were 305 cases of PA, 71 (23.3%) in the early group and 234 (76.7%) in the late group. The early PA group was characterized by higher rates of vaginal bleeding upon presentation (p = 0.003), DIC (p = 0.018), and severe neonatal morbidity (p < 0.001). The late PA group was characterized by a higher rate of urgent Cesarean deliveries (p < 0.001). The early PA group was characterized by higher rates of placental maternal vascular malperfusion (MVM) lesions (p < 0.001), maternal inflammatory response (MIR) lesions (p < 0.001), placental hemorrhage (p < 0.001), and a lower feto-placental ratio (p < 0.001). Using regression analysis, we found that severe neonatal morbidity was independently associated with early abruption (aOR = 5.3, 95% CI = 3.9–7.6), placental MVM (aOR = 1.5, 95% CI = 1.2–1.9), placental MIR (aOR = 1.9, 95% CI = 1.4–2.3), and inversely associated with antenatal corticosteroids (aOR = 0.9, 95% CI = 0.6–0.98). “Early” and “late” PA significantly differ in their presentation, placental pathology, and pregnancy outcomes.

Original languageEnglish
Pages (from-to)351-360
Number of pages10
JournalReproductive Sciences
Volume28
Issue number2
DOIs
StatePublished - Feb 2021

Keywords

  • Malperfusion
  • Neonatal outcome
  • Placental abryption
  • Placental pathology

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