The Effect of Maternal Coagulation Parameters on Fetal Acidemia in Placental Abruption
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Subjects
2.2. Diagnosis of Placental Abruption
2.3. Biospecimen Collection and Processing
2.4. Diagnosis of Fetal Acidemia
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Downes, K.L.; Grantz, K.L.; Shenassa, E.D. Maternal, Labor, Delivery, and Perinatal Outcomes Associated with Placental Abruption: A Systematic Review. Am. J. Perinatol. 2017, 34, 935–957. [Google Scholar] [PubMed]
- Ananth, C.V.; Keyes, K.M.; Hamilton, A.; Gissler, M.; Wu, C.; Liu, S.; Luque-Fernandez, M.A.; Skjærven, R.; Williams, M.A.; Tikkanen, M.; et al. An International Contrast of Rates of Placental Abruption: An Age-Period-Cohort Analysis. PLoS ONE 2015, 10, e0125246. [Google Scholar] [CrossRef] [PubMed]
- Ananth, C.V.; Lavery, J.A.; Vintzileos, A.M.; Skupski, D.W.; Varner, M.; Saade, G.; Biggio, J.; Williams, M.A.; Wapner, R.J.; Wright, J.D. Severe placental abruption: Clinical definition and associations with maternal complications. Am. J. Obstet. Gynecol. 2016, 214, 272.e1–272.e9. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Boisramé, T.; Sananès, N.; Fritz, G.; Boudier, E.; Aissi, G.; Favre, R.; Langer, B. Placental abruption: Risk factors, management and maternal–fetal prognosis. Cohort study over 10 years. Eur. J. Obstet. Gynecol. Reprod. Biol. 2014, 179, 100–104. [Google Scholar] [CrossRef] [PubMed]
- Li, Y.; Tian, Y.; Liu, N.; Chen, Y.; Wu, F. Analysis of 62 placental abruption cases: Risk factors and clinical outcomes. Taiwan. J. Obstet. Gynecol. 2019, 58, 223–226. [Google Scholar] [CrossRef] [PubMed]
- Shinde, G.R.; Vaswani, B.P.; Patange, R.P.; Laddad, M.M.; Bhosale, R.B. Diagnostic Performance of Ultrasonography for Detection of Abruption and Its Clinical Correlation and Maternal and Foetal Outcome. J. Clin. Diagn. Res. 2016, 10, QC04-7. [Google Scholar] [CrossRef] [PubMed]
- Bond, A.L.; Edersheim, T.G.; Curry, L.; Druzin, M.L.; Hutson, J.M. Expectant management of abruptio placentae before 35 weeks gestation. Am. J. Perinatol. 1989, 6, 121–123. [Google Scholar] [CrossRef] [PubMed]
- Sabourin, J.N.; Lee, T.; Magee, L.A.; von Dadelszen, P.; Demianczuk, N. Indications for, timing of, and modes of delivery in a national cohort of women admitted with antepartum hemorrhage at 22 + 0 to 28 + 6 weeks’ gestation. J. Obstet. Gynaecol. Can. 2012, 34, 1043–1052. [Google Scholar] [CrossRef] [PubMed]
- Erez, O.; Othman, M.; Rabinovich, A.; Leron, E.; Gotsch, F.; Thachil, J. DIC in Pregnancy—Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments. J. Blood Med. 2022, 13, 21–44. [Google Scholar] [CrossRef] [PubMed]
- MacLennan, A.H.; Thompson, S.C.; Gecz, J. Cerebral palsy: Causes, pathways, and the role of genetic variants. Am. J. Obstet. Gynecol. 2015, 213, 779–788. [Google Scholar] [CrossRef] [PubMed]
- Wang, L.; Matsunaga, S.; Mikami, Y.; Takai, Y.; Terui, K.; Seki, H. Pre-delivery fibrinogen predicts adverse maternal or neonatal outcomes in patients with placental abruption. J. Obstet. Gynaecol. Res. 2016, 42, 796–802. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- ACOG. Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: Nomenclature, interpretation, and general management principles. Obstet. Gynecol. 2009, 114, 192–202. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Zhang, S.; Li, B.; Zhang, X.; Zhu, C.; Wang, X. Birth Asphyxia Is Associated with Increased Risk of Cerebral Palsy: A Meta-Analysis. Front. Neurol. 2020, 11, 704. [Google Scholar] [CrossRef] [PubMed]
- Matsuda, Y.; Ogawa, M.; Konno, J.; Mitani, M.; Matsui, H. Prediction of fetal acidemia in placental abruption. BMC Pregnancy Childbirth 2013, 13, 156. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kasai, M.; Aoki, S.; Ogawa, M.; Kurasawa, K.; Takahashi, T.; Hirahara, F. Prediction of perinatal outcomes based on primary symptoms in women with placental abruption. J. Obstet. Gynaecol. Res. 2015, 41, 850–856. [Google Scholar] [CrossRef] [PubMed]
- Su, J.; Yang, Y.; Cao, Y.; Yin, Z. The predictive value of pre-delivery laboratory test results for the severity of placental abruption and pregnancy outcome. Placenta 2021, 103, 220–225. [Google Scholar] [CrossRef] [PubMed]
Acidemia (n = 34) | No Acidemia (n = 57) | p-Value | |
---|---|---|---|
Maternal age * (years) | 31.9 ± 5.8 | 32.1 ± 5.1 | 0.803 |
<25 | 2 (5.9%) | 4 (7.0%) | 0.993 |
26–34 | 22 (64.7%) | 37 (64.9%) | |
35–39 | 8 (23.5%) | 15 (26.3%) | |
≥40 | 2 (5.9%) | 3 (5.3%) | |
Parity (n) | 0.399 | ||
Primiparous | 15 (41.2%) | 32 (56.1%) | |
Parity = 1 | 10 (29.4%) | 16 (28.1%) | |
Parity ≥ 2 | 9 (26.5%) | 9 (15.8%) | |
Pre-pregnancy BMI * | 20.8 ± 1.9 | 20.5 ± 2.5 | 0.526 |
HDP (n) | 6 (17.6%) | 6 (10.5%) | 0.331 |
Pre-eclampsia (n) | 5 (13.5%) | 6 (10.5%) | 0.554 |
Cesarean section (n) | 32 (94.1%) | 49 (86.0%) | 0.229 |
GA at delivery * (weeks) | 33.8 ± 4.3 | 34.4 ± 3.3 | 0.882 |
22–27 | 6 (17.6%) | 5 (8.8%) | 0.191 |
28–33 | 8 (23.5%) | 14 (24.6%) | |
≥34 | 20 (58.8%) | 38 (66.7%) | |
Birth weight * (g) | 1983 ± 749 | 2176 ± 711 | 0.111 |
Blood loss * (mL) | 1840 ± 1148 | 1032 ± 580 | 0.0001 |
Acidemia (n = 34) | No Acidemia (n = 57) | OR (95% CI) | |
---|---|---|---|
Vaginal bleeding | 26 (76.5%) | 48 (84.2%) | 0.61 (0.21–1.77) |
Abnormal ultrasonographic findings | 20 (58.8%) | 22 (38.6%) | 2.27 (0.97–5.41) |
Abnormal FHR patterns | 32 (94.1%) | 25 (43.9%) | 20.48 (4.47–93.77) |
Uterine spasm | 21 (61.8%) | 9 (15.8%) | 8.62 (3.19–23.25) |
Gestational age at delivery (<34 weeks) | 12 (35.3%) | 15 (26.3%) | 1.22 (0.75–1.98) |
Maternal coagulation parameters | |||
Fibrinogen (ng/dL) | 170.5 ± 120.0 | 334.2 ± 96.6 | 14.82 (5.22–42.03) |
FDP (µg/dL) | 186.2 ± 272.5 | 19.4 ± 37.9 | 10.20 (3.59–29.02) |
Platelet (×104/µL) | 16.0 ± 6.7 | 19.8 ± 6.0 | 3.33 (1.32–8.42) |
PT (second) | 16.2 ± 6.2 | 12.3 ± 1.8 | 4.73 (1.21–18.47) |
OR (95% CI) | p-Value | |
---|---|---|
Abnormal FHR patterns | 8.59 (1.08–67.99) | 0.0417 |
Uterine spasm | 5.68 (1.13–28.52) | 0.0351 |
Gestational age at delivery (<34 weeks) | 0.54 (0.06–6.53) | 0.6301 |
Maternal coagulation parameters | ||
Fibrinogen (<288 ng/dL) | 21.83 (1.77–269.72) | 0.0162 |
FDP (>31.0 µg/dL) | 1.15 (0.13–9.93) | 0.9000 |
Platelet (<13.4 × 104/µL) | 3.34 (0.4–28.01) | 0.2655 |
PT (>13.4 s) | 0.72 (0.51–1.02) | 0.0680 |
OR (95% CI) | p-Value | |
---|---|---|
Abnormal FHR patterns | 9.46 (1.71–52.28) | 0.0100 |
Uterine spasm | 4.23 (1.07–16.73) | 0.0399 |
Maternal coagulation parameters | ||
Fibrinogen (<288 ng/dL) | 7.82 (2.09–29.30) | 0.0023 |
Acidemia (n = 8) | No Acidemia (n = 22) | p-Value | |
---|---|---|---|
Maternal age * (years) | 33.9 ± 3.9 | 32.0 ± 4.8 | 0.331 |
<25 | 0 (0%) | 1 (4.5%) | 0.119 |
26–34 | 3 (37.5%) | 15 (68.2%) | |
35–39 | 5 (62.5%) | 4 (18.2%) | |
≥40 | 0 (0%) | 2 (9.1%) | |
Parity (n) | 0.932 | ||
Primiparous | 4 (50.0%) | 10 (45.4%) | |
Parity = 1 | 3 (37.5%) | 8 (36.4%) | |
Parity ≥ 2 | 1 (12.5%) | 4 (18.2%) | |
Pre-pregnancy BMI * | 21.6 ± 2.6 | 21.2 ± 2.4 | 0.688 |
HDP (n) | 2 (25.0%) | 2 (9.1%) | 0.257 |
Pre-eclampsia (n) | 2 (25.0%) | 0 (0%) | 0.015 |
Cesarean section (n) | 8 (100%) | 22 (100%) | |
GA at delivery * (weeks) | 32.1 ± 4.1 | 33.3 ± 4.2 | 0.507 |
22–27 | 1 (12.5%) | 2 (9.1%) | 0.711 |
28–33 | 4 (50.0%) | 8 (36.4%) | |
≥34 | 3 (37.5%) | 12 (54.5%) | |
Birth weight * (g) | 1612 ± 608 | 1972 ± 765 | 0.242 |
Blood loss * (mL) | 1008 ± 314 | 887 ± 383 | 0.434 |
Acidemia | Sensitivity, % | Specificity, % | PPV, % | NPV, % | |||||
---|---|---|---|---|---|---|---|---|---|
+ | − | (95% CI) | (95% CI) | (95% CI) | (95% CI) | LR + | LR − | ||
PFAAS ≥ 3 | + | 8 | 7 | 100.0 | 68.2 | 53.3 | 100.0 | 3.1 | 0.0 |
− | 0 | 15 | (51.8–100.0) | (45.1–86.1) | (26.6–78.7) | (69.8–100.0) |
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Sugimoto, A.; Tanaka, T.; Ashihara, K.; Daimon, A.; Nunode, M.; Nagayasu, Y.; Fujita, D.; Tanabe, A.; Kamegai, H.; Taniguchi, K.; et al. The Effect of Maternal Coagulation Parameters on Fetal Acidemia in Placental Abruption. J. Clin. Med. 2022, 11, 7504. https://doi.org/10.3390/jcm11247504
Sugimoto A, Tanaka T, Ashihara K, Daimon A, Nunode M, Nagayasu Y, Fujita D, Tanabe A, Kamegai H, Taniguchi K, et al. The Effect of Maternal Coagulation Parameters on Fetal Acidemia in Placental Abruption. Journal of Clinical Medicine. 2022; 11(24):7504. https://doi.org/10.3390/jcm11247504
Chicago/Turabian StyleSugimoto, Atsuko, Tomohito Tanaka, Keisuke Ashihara, Atsushi Daimon, Misa Nunode, Yoko Nagayasu, Daisuke Fujita, Akiko Tanabe, Hideki Kamegai, Kohei Taniguchi, and et al. 2022. "The Effect of Maternal Coagulation Parameters on Fetal Acidemia in Placental Abruption" Journal of Clinical Medicine 11, no. 24: 7504. https://doi.org/10.3390/jcm11247504
APA StyleSugimoto, A., Tanaka, T., Ashihara, K., Daimon, A., Nunode, M., Nagayasu, Y., Fujita, D., Tanabe, A., Kamegai, H., Taniguchi, K., Komura, K., & Ohmichi, M. (2022). The Effect of Maternal Coagulation Parameters on Fetal Acidemia in Placental Abruption. Journal of Clinical Medicine, 11(24), 7504. https://doi.org/10.3390/jcm11247504