Preterm premature rupture of membranes and abruptio placentae: Is there an association between these pregnancy complications?

• Published in: American journal of obstetrics and gynecology Vol. 172; no. 2; pp. 672 - 676
• Main Authors: Major, Carol A., de Veciana, Margarita, Lewis, David F., Morgan, Mark A.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-02-1995; Elsevier
• Subjects: Abruptio placentae; Abruptio Placentae - epidemiology; Abruptio Placentae - etiology; Adult; Biological and medical sciences; Cohort Studies; Diseases of mother, fetus and pregnancy; Female; Fetal Membranes, Premature Rupture - complications; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; Incidence; Infant, Newborn; Infant, Premature; Medical sciences; Obstetric Labor, Premature - complications; Pregnancy; Pregnancy. Fetus. Placenta; preterm rupture of membranes; Retrospective Studies; preterm rupture of membranes; Abruptio placentae; Human; Concomitant disease; Pregnancy disorders; Etiopathogenesis; Premature rupture of membrane; Delivery disorders; Female; Placenta diseases
• DOI: 10.1016/0002-9378(95)90591-X
• EISSN: 1097-6868
• ISSN: 0002-9378

OBJECTIVE: Our purpose was to determine whether the incidence of abruptio placentae is increased in pregnancies with preterm premature rupture of membranes and to assess whether certain clinical risk factors in this group predispose them to have abruptio placentae.
STUDY DESIGN: A retrospective cohort study over a 2.5-year period was performed. The study group consisted at 756 singleton pregnancies between 20 and 36 weeks' gestation complicated by preterm premature rupture of membranes and managed expectantly. The control group consisted of 11,240 pregnancies not complicated by preterm premature rupture of membranes and delivered during the same time period. The incidence of abruptio placentae was compared between the two groups. The study group of patients with preterm premature rupture of membranes wa further subdivided into cases with (
n = 38) and without abruptio placentae (
n = 718) and compared. Clinical factors such as admission amniotic fluid index, history of bleeding before or after rupture of membranes, incidence of intrapartum fetal distress, and low 5-minute Apgar scores (<6), latency-to-delivery interval, gestational ago and weight at delivery, and incidence of amnionitis and endometritis were compared.
RESULTS: The incidence of abruptio placentae in the study grouop (
387
756
, 5%) was significantly higher than that in the control group (
97
11
, 240, 0.9%) (
p < 0.001, odds ratio = confidence interval). Comparison of cases with preterm premature rupture of membranes with and without abruptio placentae demonstrated both groups to have a similar gestational age at delivery, birth weight, latency-to-delivery interval, amniotic fluid index, and infectious morbidity. The group with abruptio placentae had a significantly higher incidence of bleeding before rupture of membrane (six of 38, 15% vs eight of 718, 1%;
p < 0.005) and of intrapartum fetal distress (
18
38
, 46% vs
49
718
7%,
p < 0.0009).
CONCLUSIONS: Pregnancies complicated by preterm premature rupture of membranes that are managed expectantly are at significant risk for abruptio placentae. Preterm premature rupture of membranes n such cases is more often preceded by bleeding. These abruptions may predispose the patient to intrapartum fetal distress.