Category: Clinical Obstetrics
Poster Session I
Clinical outcomes in expectantly managed placental abruption are poorly described with few published data to guide management in cases that do not warrant immediate delivery. Our primary objective was to describe the incidence of severe abruption, defined as maternal or fetal instability requiring immediate delivery, in patients with placental abruption who were stable at admission (mild abruption). We also sought to determine factors associated with progression to severe abruption.
Study Design:
Retrospective cohort study of hospitalized patients between 20 weeks and 36 weeks 6 days with mild placental abruption at a single institution between 2015-2021. Clinical information and delivery/neonatal outcomes were collected by chart abstraction. Patients with continued mild abruption were compared to those with progression to severe abruption with t-test for continuous and chi-squared test for categorical variables.
Results:
Included 78 patients with expectantly managed abruption; 28 (35%) progressed to severe abruption. Mean gestational age at diagnosis was 29 weeks. The average length of time from diagnosis to delivery in those progressing to severe was 9 + 13.5 days vs 18.7 + 23.9 days in those with continued mild abruption (p=0.024). (Fig 1) The only finding associated with developing a severe abruption was oligohydramnios on initial presentation (p=0.005), despite similar rates of PPROM in both groups. Those with severe abruption were most commonly delivered for non-reassuring FHR tracing and were more likely to deliver by cesarean section with increased severe maternal morbidity. Neonatal morbidity was common in all patients. (Table 1)
Conclusion:
Progression of abruption from mild to severe is common. Many clinical and demographic factors were investigated but not associated with progression after initial presentation with mild abruption. Even in persistently mild abruption, rates of preterm birth and NICU admission were high, suggesting all patients with mild abruption warrant increased clinical surveillance.
Sarah Heerboth, MD (she/her/hers)
Resident Physician
University of Utah Health
Salt Lake City, Utah, United States
Amanda A. Allshouse, MS
Perinatal Biostatistician
University of Utah
Salt Lake City, Utah, United States
Kellyn Maves, MD
Resident Physician
University of Utah Health
Salt Lake City, Utah, United States
Heather Campbell, MD
University of Utah Health
Salt Lake City, Utah, United States