Background
Methods
Study setting
Study design
Data collection
Diagnosis of abruptio placentae
Definition of outcome measures
Statistical analysis
Results
Demographic and obstetric characteristics of the study participants
Maternal characteristics | Placental abruption (N = 112; %) | No placental abruption (n =39,881; %) | P value* |
---|---|---|---|
Maternal agea | 29.1 (5.4) | 27.5 (6.0) | 0.004 |
Maternal age (years) | 0.02 | ||
<20 | 12 (10.7) | 3528 ((8.8) | |
20–34 | 80 (71.4) | 30,782 (77.3) | |
≥35 | 20 (17.9) | 5571 (13.9) | |
Marital status | 0.03 | ||
Married | 107 (95.5) | 35,549 (89.1) | |
Single | 5 (0.5) | 4332 (10.9) | |
Mother’s area of residence | |||
Rural | 61 (54.5) | 16,995 (42.6) | 0.01 |
Urban | 51 (45.5) | 22,886 (57.4) | |
Smoking in current pregnancy | 1.00 | ||
Yes | 0 (0) | 44 (0.1) | |
No | 112 (100) | 39,837 (99.9) | |
Alcohol use during pregnancy | 0.12 | ||
Yes | 44 (38.4) | 12,679 (31.8) | |
No | 68 (60.7) | 27,202 (68.2) | |
Mother’s educational (years) | 0.001 | ||
<12 | 87 (77.7) | 25,081 (62.9) | |
≥12 | 25 (22.3) | 14,800 (37.1) | |
Antenatal care (ANC) | 0.54 | ||
Yes | 111 (99.1) | 39,607 (99.3) | |
No | 1 (0.9) | 274 (0.7) | |
Gravidity | <0.001 | ||
1 | 22 (19.6) | 12,105 (30.4) | |
2–4 | 67 (59.8) | 24,618 (61.7) | |
≥5 | 23 (20.6) | 3158 (7.9) | |
Parity | <0.001 | ||
0 | 24 (21.4) | 13,056 (32.7) | |
1–4 | 76 (67.9) | 25,777 (64.6) | |
≥5 | 12 (10.7) | 1048 (2.6) |
Risk factors for abruptio placentae
Risk factors | Placental abruption (N = 112; 0.3 %) | No abruption (N =39,881; 99.7 %) | Unadjusted OR (95 % CI) | Adjusted OR (95 % CI)a |
---|---|---|---|---|
Chronic hypertension | 4.5 (1.6–13.2) | 4.1 (1.3–12.8) | ||
Yes | 3 (1.1) | 269 (98.9) | ||
No | 109 (0.3) | 39,612 (99.7) | ||
Preeclampsia/eclampsiab | 2.5 (1.6–5.2) | 2.1 (1.1–4.1) | ||
Yes | 9 (0.6) | 1622 (99.4) | ||
No | 103 (0.3) | 38,259 (99.7) | ||
Multiple gestations | ||||
Yes | 106 (0.28) | 37,664 (99.7) | 1.0 (0.5–2.3) | 0.8 (0.3–1.9) |
No | 6 (0.27) | 2217(99.7) | ||
Previous caesarean -section | 1.5 (1.2–4.8) | 1.3 (1.2–4.2) | ||
Yes | 22 (0.3) | 6947 (99.7) | ||
No | 90 (0.12) | 32,934 (99.8) | ||
Previous abruptio placentaec | 3.8 (2.3–6.4) | 2.3 (1.8–3.4) | ||
Yes | 49 (0.7) | 6658 (99.3) | ||
No | 63 (0.19) | 33,223 (99.8) | ||
Antenatal care visits | 1.6 (1.2–2.6) | 1.3 (1.1–2.4) | ||
<4 | 53 (0.4) | 13,315 (99.6) | ||
≥4 | 59 (0.2) | 26,566 (99.8) | ||
Gravidity | 2.2 (1.4–3.6) | 2.1 (1.2–3.5) | ||
Multigravida | 90 (0.3) | 27,766 (99.7) | ||
Primigravida | 22 (0.18) | 12,115 (99.8) | ||
Parity | 1.7 (1.4–10.5) | 1.4 (1.2–8.6) | ||
≥2 | 65 (0.36) | 17,836 (99.6) | ||
<2 | 47 (0.2) | 22,045 (99.8) | ||
Sex of the baby | ||||
Male | 62 (0.3) | 20,580 (99.7) | 1.2 (0.9–1.7) | 1.03(0.7–1.5) |
Female | 50 (0.25) | 19,301 (99.75) |
Maternal outcomes associated with abruptio placentae
Maternal outcomes | Abruption placental (n = 112) | No abruption (n =39,881) | Unadjusted OR (95 % CI) | Adjusted OR (95 % CI)a |
---|---|---|---|---|
Antepartum haemorrhage | ||||
Yes | 13(3.0) | 420 (97.0) | 11.9 (6.5–21.8) | 11.5 (6.3–21.2) |
No | 99 (0.3) | 39,461 (99.7) | 1.0 | 1.0 |
Postpartum haemorrhage | ||||
Yes | 10 (7.6) | 145 (92.4) | 25.6 (12.4–52.8) | 17.9 (8.8–36.4) |
No | 100 (0.3) | 39,736 (99.7) | 1.0 | 1.0 |
Model of delivery | ||||
Caesarean delivery | 85 (0.7) | 12,914 (99.3) | 6.6 (4.3–10.1) | 5.6 (3.6–8.8) |
Vaginal delivery | 27 (0.1) | 26,967 (99.9) | 1.0 | 1.0 |
Acute renal failure | ||||
Yes | 1 (0.6) | 153 (99.4) | 2.4 (0.6–16.3) | 2.2 (0.3–15.5) |
No | 111 (0.3) | 39,728 (99.7) | 1.0 | 1.0 |
Need for blood transfusion | ||||
Yes | 43 (1.9) | 2248 (98.1) | 10.1 (6.9–14.8) | 9.6 (6.5–14.1) |
No | 69 (0.2) | 37,633 (99.7) | 1.0 | 1.0 |
Duration of hospitalization | ||||
>4 days | 18 (1.3) | 1415 (98.7) | 5.2 (2.3–15.4) | 3.5 (1.8–9.6) |
≤4 days | 94 (0.2) | 38,466(99.7) | 1.0 | 1.0 |
Referred for delivery | ||||
Yes | 46 (0.5) | 8841 (99.5) | 2.3 (1.6–9.5) | 2.1 (1.5–8.2) |
No | 66 (0.2) | 31,040 (99.8) | 1.0 | 1.0 |
Altered liver function test | ||||
2 (1.5) | 128 (98.5) | 5.6 (1.4–22.9) | 5.3 (1.3–21.6) | |
110 (0.3) | 39,753 (99.7) | 1.0 | 1.0 | |
Admission to NICU | ||||
Yes | 23 (0.4) | 5667 (99.6) | 1.6 (1.2–2.5) | 1.5 (0.9–2.4) |
No | 89 (0.3) | 34,214 (99.7) | 1.0 | 1.0 |
Fetal outcomes associated with abruptio placentae
Fetal outcomes | Abruption placenta | Non abruption | Unadjusted OR (95 % CI) | Adjusted OR (95 % CI)a | P value |
---|---|---|---|---|---|
Low birth weight | |||||
Yes | 56 (1.1) | 5269 (98.9) | 6.9 (4.7–10.1) | 5.9 (3.9–8.7) | <0.001 |
No | 56 (0.2) | 34,612(99.8) | 1.0 | 1.0 | |
Perinatal death | |||||
Yes | 63 (3.5) | 1762(96.5) | 28.9 (19.8–42.1) | 17.6 (11.3–27.3) | <0.001 |
No | 49 (0.1) | 38,119(99.9) | 1.0 | 1.0 | |
Early neonatal death | |||||
Yes | 5 (1.5) | 315 (98.5) | 5.5 (2.1–15.2) | 4.3 (1.8–9.9) | 0.001 |
No | 107 (0..3) | 39,566(99.8) | 1.0 | 1.0 | |
Stillbirthb | |||||
Yes | 58 (3.8) | 1473 (96.2) | 28.0 (19.3–40.7) | 23.7 (15.6–35.9) | <0.001 |
No | 54 (0.1) | 38,408(99.9) | 1.0 | 1.0 | |
Stillborn conditionc | |||||
Fresh | 37 (7.2) | 475 (92.8) | 4.6 (2.2–9.7) | 2.5 (1.5–4.2) | <0.001 |
Macerated | 9 (1.9) | 534 (98.3) | 1.0 | 1.0 | |
Preterm birth | |||||
Yes | 30 (0.2) | 4473 (99.8) | 2.9 (1.1–7.4) | 0.4 (0.1–7.1) | 0.97 |
No | 82 (0.3) | 35,408(99.7) | 1.0 | 1.0 | |
Fetal distress | |||||
Yes | 22 (0.3) | 6947 (99.7) | 1.2 (0.5–3.6) | 0.8 (0.2–3.1) | 0.69 |
No | 90 (0.1) | 32,934 (99.9) | 1.0 | 1.0 | |
Apgar score at 1 min | |||||
<7 | 41 (1.1) | 3810 (98.9) | 5.4 (3.6–12.3) | 5.3(2.7–10.1) | <0.001 |
≥7 | 71 (0.2) | 36,071(99.8) | 1.0 | 1.0 | |
Apgar score at 5 min | |||||
<7 | 18 (0.7) | 2292 (97.1) | 2.9 (1.2–5.3) | 2.2 (0.9–4.8) | 0.054 |
≥7 | 94 (0.2) | 37,589 (99.9) | 1.0 | 1.0 |