Maternal outcomes of placental abruption with intrauterine fetal death and delivery routes: A nationwide observational study
Abstract Introduction Placental abruption is a serious complication, especially when accompanied by intrauterine fetal death. The optimal delivery route for placental abruption with intrauterine fetal death for reducing maternal complications is still unclear. In this study we aimed to compare the m...
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Wiley
2023-06-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14569 |
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| author | Yoshimitsu Wada Hironori Takahashi Yusuke Sasabuchi Rie Usui Manabu Ogoyama Hirotada Suzuki Akihide Ohkuchi Hiroyuki Fujiwara |
| author_facet | Yoshimitsu Wada Hironori Takahashi Yusuke Sasabuchi Rie Usui Manabu Ogoyama Hirotada Suzuki Akihide Ohkuchi Hiroyuki Fujiwara |
| author_sort | Yoshimitsu Wada |
| collection | DOAJ |
| description | Abstract Introduction Placental abruption is a serious complication, especially when accompanied by intrauterine fetal death. The optimal delivery route for placental abruption with intrauterine fetal death for reducing maternal complications is still unclear. In this study we aimed to compare the maternal outcomes between cesarean delivery and vaginal delivery in women with placental abruption with intrauterine fetal death. Material and methods Using the Japan Society of Obstetrics and Gynecology nationwide perinatal registry database, we identified pregnant women with placental abruption with intrauterine fetal death between 2013 and 2019. The following women were excluded: those with multiple pregnancies, placenta previa, placenta accreta spectrum, amniotic fluid embolism, or whose delivery route was missing data. The association between delivery routes (cesarean delivery and vaginal delivery) and the maternal outcome was examined using a linear regression model with inverse probability weighting. The primary outcome was the amount of bleeding during delivery. Missing data were imputed using multiple imputation. Results The number of women with placental abruption with intrauterine fetal death was 1218/1601932 (0.076%). Of 1134 women analyzed, 608 (53.6%) underwent cesarean delivery. Bleeding during delivery (median [interquartile range]) was 1650.00 (950.00–2450.00) (mL) and 1171.00 (500.00–2196.50) (mL) in cesarean and vaginal delivery, respectively. Bleeding during delivery (mL) was significantly greater in cesarean delivery than in vaginal delivery (regression coefficient, 1086.39; 95% confidence interval, 130.96–2041.81; p = 0.026). Maternal death and uterine rupture occurred in four (0.4%) and five (0.4%) women, respectively. The four maternal deaths were noted in the vaginal delivery group. Conclusions Bleeding during delivery was significantly greater in cesarean delivery than that in vaginal delivery in women with placental abruption with intrauterine fetal death. However, severe complications, including maternal death and uterine rupture, occurred in vaginal delivery‐related cases. The management of women with placental abruption with intrauterine fetal death should be cautious regardless of the delivery route. |
| format | Article |
| id | doaj-art-4b3733fe1fb6436dbdd2216de9f2248b |
| institution | OA Journals |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2023-06-01 |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-4b3733fe1fb6436dbdd2216de9f2248b2025-08-20T02:09:34ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122023-06-01102670871510.1111/aogs.14569Maternal outcomes of placental abruption with intrauterine fetal death and delivery routes: A nationwide observational studyYoshimitsu Wada0Hironori Takahashi1Yusuke Sasabuchi2Rie Usui3Manabu Ogoyama4Hirotada Suzuki5Akihide Ohkuchi6Hiroyuki Fujiwara7Department of Obstetrics and Gynecology Jichi Medical University Tochigi JapanDepartment of Obstetrics and Gynecology Jichi Medical University Tochigi JapanData Science Center Jichi Medical University Tochigi JapanDepartment of Obstetrics and Gynecology Jichi Medical University Tochigi JapanDepartment of Obstetrics and Gynecology Jichi Medical University Tochigi JapanDepartment of Obstetrics and Gynecology Jichi Medical University Tochigi JapanDepartment of Obstetrics and Gynecology Jichi Medical University Tochigi JapanDepartment of Obstetrics and Gynecology Jichi Medical University Tochigi JapanAbstract Introduction Placental abruption is a serious complication, especially when accompanied by intrauterine fetal death. The optimal delivery route for placental abruption with intrauterine fetal death for reducing maternal complications is still unclear. In this study we aimed to compare the maternal outcomes between cesarean delivery and vaginal delivery in women with placental abruption with intrauterine fetal death. Material and methods Using the Japan Society of Obstetrics and Gynecology nationwide perinatal registry database, we identified pregnant women with placental abruption with intrauterine fetal death between 2013 and 2019. The following women were excluded: those with multiple pregnancies, placenta previa, placenta accreta spectrum, amniotic fluid embolism, or whose delivery route was missing data. The association between delivery routes (cesarean delivery and vaginal delivery) and the maternal outcome was examined using a linear regression model with inverse probability weighting. The primary outcome was the amount of bleeding during delivery. Missing data were imputed using multiple imputation. Results The number of women with placental abruption with intrauterine fetal death was 1218/1601932 (0.076%). Of 1134 women analyzed, 608 (53.6%) underwent cesarean delivery. Bleeding during delivery (median [interquartile range]) was 1650.00 (950.00–2450.00) (mL) and 1171.00 (500.00–2196.50) (mL) in cesarean and vaginal delivery, respectively. Bleeding during delivery (mL) was significantly greater in cesarean delivery than in vaginal delivery (regression coefficient, 1086.39; 95% confidence interval, 130.96–2041.81; p = 0.026). Maternal death and uterine rupture occurred in four (0.4%) and five (0.4%) women, respectively. The four maternal deaths were noted in the vaginal delivery group. Conclusions Bleeding during delivery was significantly greater in cesarean delivery than that in vaginal delivery in women with placental abruption with intrauterine fetal death. However, severe complications, including maternal death and uterine rupture, occurred in vaginal delivery‐related cases. The management of women with placental abruption with intrauterine fetal death should be cautious regardless of the delivery route.https://doi.org/10.1111/aogs.14569cesarean deliverydisseminated intravascular coagulationintrauterine fetal deathplacental abruptionpostpartum hemorrhage |
| spellingShingle | Yoshimitsu Wada Hironori Takahashi Yusuke Sasabuchi Rie Usui Manabu Ogoyama Hirotada Suzuki Akihide Ohkuchi Hiroyuki Fujiwara Maternal outcomes of placental abruption with intrauterine fetal death and delivery routes: A nationwide observational study Acta Obstetricia et Gynecologica Scandinavica cesarean delivery disseminated intravascular coagulation intrauterine fetal death placental abruption postpartum hemorrhage |
| title | Maternal outcomes of placental abruption with intrauterine fetal death and delivery routes: A nationwide observational study |
| title_full | Maternal outcomes of placental abruption with intrauterine fetal death and delivery routes: A nationwide observational study |
| title_fullStr | Maternal outcomes of placental abruption with intrauterine fetal death and delivery routes: A nationwide observational study |
| title_full_unstemmed | Maternal outcomes of placental abruption with intrauterine fetal death and delivery routes: A nationwide observational study |
| title_short | Maternal outcomes of placental abruption with intrauterine fetal death and delivery routes: A nationwide observational study |
| title_sort | maternal outcomes of placental abruption with intrauterine fetal death and delivery routes a nationwide observational study |
| topic | cesarean delivery disseminated intravascular coagulation intrauterine fetal death placental abruption postpartum hemorrhage |
| url | https://doi.org/10.1111/aogs.14569 |
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