Placental Abruption: Temporal Trends, Risk Factors, and Associated Adverse Maternal Outcomes

Gillian L. Wright; Alexander Friedman; Cande V. Ananth; Timothy Wen

doi:10.1055/a-2699-9371

American Journal of Perinatology, Table of Contents

Am J Perinatol
DOI: 10.1055/a-2699-9371

Original Article

Placental Abruption: Temporal Trends, Risk Factors, and Associated Adverse Maternal Outcomes

Authors

Gillian L. Wright

¹Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, United States
Alexander Friedman

²Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, United States
Cande V. Ananth

³Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States

⁴Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States

⁵Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, United States

⁶Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
Timothy Wen

⁷Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Diego, San Diego, California, United States

⁸Division of Biomedical Informatics, Department of Medicine, University of California-San Diego, San Diego, California, United States

Abstract

Objective

This study aimed to evaluate trends in placental abruption during delivery hospitalizations and associated risk factors and adverse outcomes.

Study Design

Delivery hospitalizations with and without placental abruption were identified using billing codes in the 2000 to 2020 National Inpatient Sample for this serial cross-sectional study. Temporal trends in abruption were analyzed with Joinpoint regression to determine the average annual percentage change (AAPC) in abruption. The association between hospital, demographic, and clinical factors and abruption was analyzed with adjusted logistic regression models with adjusted odds ratios (ORs) with 95% confidence interval (CI) as measures of association. Logistic regression models were then performed to assess the odds of adverse outcomes, including transfusion and severe maternal morbidity associated with abruption, accounting for demographic, hospital, and patient factors. Associations between changes in abruption and trends in the risk for adverse outcomes were then analyzed.

Results

Of 80.2 million deliveries from 2000 to 2020, 1.1 million had an abruption diagnosis. Placental abruption risk increased from 1.2% of deliveries in 2000 to 1.6% in 2020 (AAPC: 1.6%, 95% CI: 1.3%, 2.0%). Abruption was associated with multiple gestations, hypertensive diagnoses, diabetes, asthma, and Medicaid insurance. In adjusted analyses, abruption was associated with a range of adverse outcomes including transfusion (OR = 6.86, 95% CI: 6.70, 7.03), non-transfusion severe maternal morbidity (OR = 4.05, 95% CI: 3.93, 4.17), postpartum hemorrhage (OR = 1.76, 95% CI: 1.72, 1.80), disseminated intravascular coagulation (OR = 6.30, 95% CI: 6.00, 6.61), and critical care procedures (OR = 4.76, 95% CI: 4.26, 5.32). The increase in abruption accounted for 1.1% of the population change in transfusion risk over the study period.

Conclusion

The risk for abruption increased over the study period and was associated with several adverse outcomes. Abruption accounted for a modest increase in population-level adverse outcomes. Given the increasing incidence, placental abruption will likely continue to be a significant source of adverse obstetric outcomes.

Key Points

Abruption risk increased over the study period and was associated with several adverse outcomes.
Abruption accounted for a modest increase in population-level adverse outcomes.
Placental abruption will likely continue to be a significant source of adverse obstetric outcomes.

Keywords

placental abruption - severe maternal morbidity - maternal outcomes

Full Text

References

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