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Clinical Obstetrics

Poster Session 3

(846) Obstetric and neonatal outcomes in clinically diagnosed placental abruption with and without placental histopathological confirmation

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Placental abruption (PA) is a severe obstetric complication. The diagnosis of PA is a clinical one, while placental histopathology (PH) is used to support the diagnosis. It is not yet clear whether PH findings consistent with PA are a marker of severity of abruption, and whether it correlates with maternal and neonatal outcomes.  Our aim was to compare obstetric and neonatal outcomes in clinically diagnosed PA cases with and without PH confirmation

Study Design: All clinically diagnosed PA cases between 2008-2020 were reviewed. Obstetrics and neonatal outcomes, and PH were compared between patients with a clinically diagnosed PA with and without PH of retroplacental hematoma. Placental lesions were classified according to the current “Amsterdam” criteria. Composite of neonatal morbidity included one or more of the following complications: seizures, IVH, HIE, PVL, blood transfusion, NEC, or neonatal death

Results:

A total of 305 clinically diagnosed PA cases were included for analysis, of them 95 (31.3%) had PH lesions consistent with PA and 210 (68.8%) did not.
The group with PH lesions was characterized by higher rates of vaginal bleeding at presentation (51.6% vs. 36.2%, p=0.012), a higher rate of prematurity (61% vs. 34.2%, p< 0.001), and a higher incidence of the composite neonatal outcomes (27.3% vs. 13.4%, p=0.005). The group with PH retroplacental hematoma had substantially higher rates of concurrent maternal vascular malperfusion (MVM) lesions (31.6% vs. 11.9%, p< 0.001)

Conclusion: Approximately 1/3 of PA cases were confirmed by histopathology and were associated with worse obstetric and neonatal outcomes as well as placental MVM lesions