1. Could be abruptio placentae

2. • Digital examination contraindicated Abruptio Placentae Definition

3. Rates are calculated for all abruptio placentae cases and for those abruptio placentae cases ending in stillbirth (abruptio-stillbirth).

4. Rates of abruptio placentae and abruptio placentae ending in stillbirth were examined by calendar year, province, maternal age and urban/rural status.

5. • Antepartum complications (e.g., preeclampsia, gestational diabetes, abruptio placentae)

6. • Placental abnormalities: placenta previa, abruptio placentae or cord compression

7. The occurrence of abruptio placentae in Canada: 1990 to 1997.

8. Key words: abruptio placentae; Canada; epidemiology; placenta diseases; pregnancy complications

9. This would under-estimate the abruptio placentae rate reported in our study.

10. Abruptio placentae is a possible complication of acute changes in blood pressure.

11. This would underestimate the abruptio placentae rate reported in our study.

12. This NCLEX review will discuss abruptio placentae, which is also called placental Abruption

13. These results provide a baseline reference for rates of abruptio placentae in Canada.

14. Patients with abruptio placentae, also called placental Abruption, typically present with bleeding,

15. The accurate identification of abruptio placentae cases is the primary limitation in this study.

16. This abruptio placentae rate is comparable to rates found in other population-based studies.

17. The primary etiology for abruptio placentae is still unknown, but several risk factors have been identified, including pre-eclampsia, pre-pregnancy hypertension, previous history of placental abruption, increased maternal age, cigarette smoking, and cocaine use.1,3,9-11 It has also been hypothesized that the etiology for a marginal or partial abruptio placentae may differ from that of a complete abruptio placentae.4 Despite the potential severity of abruptio placentae, particularly in the case of stillbirth and maternal death, no data have been reported on the geographic and temporal distribution of abruptio placentae cases in Canada.

18. Factors that could account for associations between abruptio placentae rates and increased maternal age may include increased parity and prior abruptio placentae.9 Pre-pregnancy hypertension, another risk factor for abruptio placentae,10 also increases with age.19 The high proportion of cases ending in a stillbirth among the youngest maternal age groups could be related to underutilization of prenatal health care services in this age group.21 Findings on the association between maternal age and abruptio placentae have

19. No literature was found that reported regional variations of abruptio placentae rates within a population.

20. Despite this, there is little information on the occurrence of abruptio placentae in Canada.

21. Natural disasters (eg, abruptio placentae, cord prolapse, fetal hypoxemia) occur in rural maternity practice.

22. The sickle cell anemia (HbS/S) was diagnosed only after the abruptio placentae had been performed.

23. Table 4 presents rates by urban and rural status for abruptio placentae cases and abruptio-stillbirth.

24. Causes The two most common causes are placenta previa and abruptio placentae, described in Table 6.

25. Table 1 presents the rate of abruptio placentae and abruptiostillbirth for singleton deliveries by year.

26. Objective Respiratory chain enzymes defect can be found in placentae of some patients with preeclampsia.

27. Studies have shown that cocaine usage during pregnancy triggers premature labor and may lead to abruptio placentae.

28. As well, the results indicated that the risk was especially high among stillbirths due to abruptio placentae.

29. Patients with abruptio placentae, also called placental Abruption, typically present with bleeding, uterine contractions, and fetal distress.

30. CAUSES The two most common causes are placenta previa and abruptio placentae, described in Table 6.

31. Table 1 presents the rate of abruptio placentae and abruptio-stillbirth for singleton deliveries by year.

32. Abstract Abruptio placentae is a serious obstetric condition associated with an increased incidence of perinatal mortality and morbidity.

33. The ultrastructure of the mucous Areolae in placentae from 18th to 113th day post coitum was investigated.

34. The Canadian Perinatal Health Report - 2000, prepared by Health Canada's Bureau of Reproductive and Child Health and the Canadian Perinatal Surveillance System Steering Committee, provides information on numerous reproductive indicators.12 Abruptio placentae, and other placental conditions such as placentae previa, are not monitored, however.

35. Over the entire period of observation, the abruptio placentae rate was 11.25 (95% CI 11.1-11.4) per 1,000 singleton births.

36. Descriptive information on abruptio placentae is important in order to gain a better understanding of the event across the country.

37. Women who had a live birth and a diagnosis of abruptio placentae were added as a second case group.

38. A 20-year-old clinically inconspicuous female from Togo, underwent an abruptio placentae while under general anesthesia during the sixth week of pregnancy.

39. The prevalence report in previous studies1,4,9,10,17–19 of a number of the risk factors associated with abruptio placentae have been on the decline.

40. The prevalence report in previous studies1,4,9,10,17-19 of a number of the risk factors associated with abruptio placentae have been on the decline.

41. Because abruptio placentae is related not only to stillbirth but also to perinatal death and sequelae from perinatal asphyxia, inclusion of abruptio placentae as an indicator in the Canadian Perinatal Surveillance System should be considered to better understand the distribution of this event and to facilitate future observational investigations on the condition.

42. Introduction Abruptio placentae, the premature separation of a normally implanted placenta before delivery, can be a serious pregnancy complication to both mother and infant.

43. Methods The Discharge Abstract Database, maintained by the Canadian Institute for Health Information (CIHI), was the source of abruptio placentae cases in this descriptive study.

44. The abruptio placentae rate was highest in mothers over 40 years of age and the case-fatality rate highest in those under 20.

45. Contraindications – – – – – Evidence of fetal distress Fetal anomalies Abruptio placentae Placenta previa with heavy bleeding Severe maternal disease such as cardiac disease, toxemia, hypertension, diabetes mellitus

46. Thus, these study results provide a baseline reference for rates of abruptio placentae in Canada as well as those that specifically end in stillbirth.

47. It occurs after various birth complications (abruptio placentae, placenta praevia, abnormal positions of the fetus, prolonged labor, twin pregnancies, diabetes mellitus of the mother and others).

48. For early diagnosis of an abruptio placentae after blunt trauma to the abdomen, continuous monitoring of the fetal heart rate and uterine contractions is very useful.

49. Plural abruptio placentarum \- ˌplas- ᵊn- ˈtar- əm , - ˈtär- \ or Abruptiones placentarum \- shē- ˌō- (ˌ)nēz- , - tē- ˌō- ˌnās- \ Medical Definition of abruptio placentae : …

50. Abruptio placentae The premature separation of the placenta from its site of implantation in the endometrium before the delivery of the foetus, commonly known as placental Abruption.

51. Low birth weight, small for gestational age, premature birth, congenital defects, abruptio placentae, spontaneous abortion, ectopic pregnancy, and perinatal mortality have been linked to prenatal smoking (1,3,5).

52. The rate of abruptio placentae is highest for mothers in the two older age groups, aged 35–39 years and aged 40 years and over (Table 3).

53. The significant variation that was identified in abruptio placentae rates and case-fatality rates according to time and maternal age underline the need for further investigation into this condition.

54. This provincial pattern of rates was similar for abruptio-stillbirth, with the exception of Saskatchewan, which had a high rate of abruptio placentae and a moderate rate ending in stillbirth.

55. Abruptio placentae, placenta praevia, maternal eclampsia, abnormal positions of the fetus, prolonged labor, twin pregnancy, and maternal diabetes mellitus can induce disseminated intravascular coagulation in the fetal or neonatal organism.

56. The number of abruptio placentae cases is influenced by potential under-reporting of mild cases that may be less likely to be recorded in the administrative database utilized in this study.

57. The rates of abruptio placentae varied across provinces (Table 2), with rates below 8/1,000 in Newfoundland and Prince Edward Island and rates above 13/1,000 in Nova Scotia, Saskatchewan, and Yukon/ North West Territories.

58. The most frequent obstetrical causes of death were partual bleedings due to abruptio placentae and placenta praevia (38%), followed by EPH-gestosis (15%), complications of the umbilical cord (13%) and abnormal course of labor (11%).

59. Bleeding problems in late pregnancy are still among the most dangerous complications in pregnancy requiring immediate admission to hospital; this applies especially for life-threatening bleeding complications as abruptio placentae, placenta previa and uterine rupture.

60. In addition, the definitive diagnosis of abruptio placentae may occur after delivery when the placenta is sent to the pathology laboratory, so information on the final diagnosis may not be available when data abstracting is conducted.

61. Battledore insertion of cord was also found to have increased association with placenta previa, abruptio placentae, preeclampsia, preterm delivery, cord prolapse, foetal distress, increased incidence of emergency LSCS, low Apgar score, NICU admission, low birth weight and congenital malformations (8, …

62. He found that many such infants suffer from hypoxia (oxygen deficiency), and this “could help to explain studies which have correlated the use of cigarettes by the mother with spontaneous abortion, abruptio placentae [detachment of the placenta] and premature labor.”

63. The Canadian Perinatal Surveillance System lists recognized risk factors for preterm deliveries to include genital tract infection, cigarette smoking, pre-eclampsia, incompetent cervix, prior preterm birth and abruptio placentae as well as psychological factors, such as stress, anxiety and depression (McLaughlin et al.

64. The primary etiology for abruptio placentae is still unknown, but several risk factors have been identified, including pre-eclampsia, pre-pregnancy hypertension, previous history of placental abruption, increased maternal age, cigarette smoking, and cocaine use.1,3,9–11 It has also been hypothesized that the

65. Apex truncate and notched, ciliate, margin entire, Aciliate, the smaller 2 wings oblong to triangular, 4–9 × 1.5–2.6, margin entire, Aciliate; placentae axile, bilamellate, ovuliferous all over; styles 3, deciduous in fruit, 5–6 mm long, irregularly multifid 1 mm from base, branches spreading, spirally twisted.

66. It is associated with an increased incidence of preterm delivery as well as maternal and perinatal mortality, causing between 15% and 25% of all perinatal deaths.1-3 The rate of abruptio placentae in North America is approximately 0.1-0.2 per 1,000 pregnancies,4-7 but reported rates can range from 0.04-0.35/1,000.1,3,8,9 This wide range in reported incidence rates may be explained partly by the differing criteria for diagnosing abruptio placentae as well as the increased recognition of milder forms of the event, i.e., the separation of the placenta from the uterine wall can be complete, partial, or marginal (involving only the placental margin).

67. Research has found that prenatal exposure is associated with a higher risk of spontaneous abortion, abruptio placentae, premature birth weight, length and head circumference at birth, poor sleep patterns, and long-term behavioural problems (Gingras et al., 1995; Howard et al., 1995; Kenner and D'Apolito, 1997; Mayes et al., 1995; Regalado et al., 1996; Vogel, 1997).

68. History of Maternal Perinatal Complications – Preterm labor – Placental abnormalities: placenta previa, abruptio placentae or cord compression – Amniotic fluid abnormalities: polyhydramnios or oligohydramnios – Infectious process: maternal fever – Infectious agents (maternal source): group B Streptococcus, gram-negative bacteria, viruses (e.g., HSV, toxoplasmosis, CMV, HIV) – Maternal abnormalities: diabetes mellitus, size of pelvic outlet – Neonatal abnormalities: genetic, anatomic or cardiac – Maternal drugs: prescription or illicit

69. Although the highest case-fatality rate was observed in Prince Edward Island, this was based on a small number of events and was not statistically different from the case-fatality rate for the rest of Canada (p=0.17). The rate of abruptio placentae is highest for mothers in the two older age groups, aged 35-39 years and aged 40 years and over (Table 3).

70. For example, smoking rates have decreased in Canada over the past decade.20 Live birth rates have also declined among women of reproductive age in Canada, from 61.1 per 1,000 in 1981 to 51.1 per 1,000 in 1997.12 Although these factors were not available for analysis in our data, we speculate that the observed increased rates of abruptio placentae are attributable to other factors, including changes in ascertainment and reporting.

71. Wen et al. examined the CIHI database used in this study and found that the number of illogical and out-of-range values were few.14 Furthermore, for most adverse pregnancy conditions and outcomes, including abruptio placentae, Wen et al. found the prevalence to be within a reasonable range of that reported in the literature.14 An additional strength of the study is the very large number of births that were analyzed (n = 2,162,815) over the 1990–1997 time period, using quality data.

72. Five diseases of pregnancy are analyzed which are at least partly characterized by impaired transplacental transport: a) abruptio placentae, resulting in acute respiratory insufficiency; b) intrauterine growth restriction combined with absent or reverse flow in the umbilical arteries, resulting in severe chronic nutritional insufficiency, with the risk of acute respiratory decompensation; c) intrauterine growth restriction combined with preserved flow in the umbilical arteries, resulting in chronic nutritional insufficiency, d) premature delivery following maturitas praecox of the placenta, in a subset of cases complicated by chronic nutritional insufficiency; and e) postterm delivery following persistent immaturity of the placenta, bearing the risk of acute respiratory decompensation.