(1187) Placental abruption and antepartum hemorrhage delivery hospitalization trends, risk factors, and outcomes

Objective: Placental abruption is a serious condition involving early separation of the placenta. The objective of this study was to identify trends and adverse outcomes associated with placental abruption.

Study Design: The 2000-2020 National Inpatient Sample was used for this repeated cross-sectional study. Delivery hospitalizations to women age 15-54 years were identified. Temporal trends in abruption were analyzed with joinpoint regression to determine the average annual percentage change (AAPC) with 95% CIs. The association between hospital, demographic, and clinical factors and placental abruption was analyzed with logistic regression models. Logistic regression models were then used to assess odds of adverse outcomes associated with placental abruption accounting for demographic, hospital, and patient factors.

Results: Of 80.2 million deliveries from 2000 to 2022, 1.1 million had an abruption diagnosis. Placental abruption risk increased from 1.2% of deliveries in 2000 to 1.6% in 2020 (AAPC 0.5). Placental abruption was associated with multiple gestation, hypertensive diagnoses, diabetes, asthma, and Medicaid insurance. In unadjusted and adjusted analyses, placental abruption was associated with a range of adverse outcomes with adjusted odds highest for transfusion (aOR 6.9, 95% CI 6.7, 7.0) and preterm birth (aOR 8.4, 95% CI 8.2, 8.5) (Table). Risk for several adverse outcomes associated with abruption increased over the study period including postpartum hemorrhage (from 4.4% to 9.2%, AAPC 4.1%) and transfusion (3.9% to 6.2%, AAPC 2.7%).

Conclusion: Risk for placental abruption increased over the study period and was associated with several adverse outcomes. Among deliveries with abruption, risk for several complications increased significantly including transfusion and postpartum hemorrhage. Given trends in both increasing incidence and related complications, placental abruption is likely to continue to be a significant source of adverse obstetric outcomes.