title: Placental abruption: risk factors, management and maternal-fetal prognosis. Cohort study over 10 years.
abstract: OBJECTIVE
  To describe maternal and fetal risk factors, diagnosis, management and prognosis of placental abruption (PA).
  
  
  METHODS
  A retrospective cohort study between January 2003 and December 2012 within the three maternity units of a French university hospital. We included 55,926 deliveries after 24 weeks' gestation including 247 cases of PA (0.4%). We conducted univariate analyses to compare PA and control groups. Multivariate models were constructed in order to study PA risk factors and perinatal morbidity and mortality.
  
  
  RESULTS
  Independent risk factors for PA were preterm premature rupture of membranes (OR 9.5; 95% CI [6.9-13.1]), gestational hypertension (OR 7.4; 95% CI [5.1-10.8]), preeclampsia (OR 2.9; 95% CI [1.9-4.6]) and major multiparity (OR 1.6; 95% CI [1.1-2.4]). The classic clinical triad associating metrorrhagia, uterine hypertonia and abdominopelvic pains was present in only 9.7% of cases. Caesarean section rate was 90.3% with 51.8% being performed under general anesthesia. There was no case of maternal death, but maternal morbidity was considerable, with 7.7% of coagulation disorders and 16.6% of transfusion. After adjustment for the gestational age, we found an increased risk for pH≤7.0 (OR 14.9; 95% CI [9.2-23.9]) and neonatal resuscitation (OR 4.6; 95% CI [3.1-6.8]). Perinatal mortality was 15.8%, including 78% of fetal deaths.
  
  
  CONCLUSIONS
  Appropriate multidisciplinary management can limit maternal morbidity and mortality but perinatal mortality, which occurs essentially in utero, remains high.
authors: Department of Gynecology-Obstetrics, Strasbourg University Hospitals, Centre Médico-Chirurgical Obstétrique (CMCO), 1 Place de l'Hôpital - BP 426, 67091 Strasbourg Cedex, France; Department of Gynecology-Obstetrics, Strasbourg University Hospitals, Hôpital de Hautepierre, 1 Avenue Molière, 67098 Strasbourg Cedex, France. Electronic address: thomas.boisrame@chru-strasbourg.fr.
authors: T
authors: T
authors: Boisramé
authors: Department of Gynecology-Obstetrics, Strasbourg University Hospitals, Hôpital de Hautepierre, 1 Avenue Molière, 67098 Strasbourg Cedex, France; INSERM, UMR-S 1121, Biomatériaux et Bioingénierie, 11 rue Humann, F-67085 Strasbourg Cedex, France.
authors: N
authors: N
authors: Sananès
authors: Department of Gynecology-Obstetrics, Strasbourg University Hospitals, Hôpital de Hautepierre, 1 Avenue Molière, 67098 Strasbourg Cedex, France.
authors: G
authors: G
authors: Fritz
authors: Department of Gynecology-Obstetrics, Strasbourg University Hospitals, Hôpital de Hautepierre, 1 Avenue Molière, 67098 Strasbourg Cedex, France.
authors: E
authors: E
authors: Boudier
authors: Department of Gynecology-Obstetrics, Strasbourg University Hospitals, Centre Médico-Chirurgical Obstétrique (CMCO), 1 Place de l'Hôpital - BP 426, 67091 Strasbourg Cedex, France.
authors: G
authors: G
authors: Aissi
authors: Department of Gynecology-Obstetrics, Strasbourg University Hospitals, Centre Médico-Chirurgical Obstétrique (CMCO), 1 Place de l'Hôpital - BP 426, 67091 Strasbourg Cedex, France.
authors: R
authors: R
authors: Favre
authors: Department of Gynecology-Obstetrics, Strasbourg University Hospitals, Hôpital de Hautepierre, 1 Avenue Molière, 67098 Strasbourg Cedex, France.
authors: B
authors: B
authors: Langer
mesh_terms: D000037:Abruptio Placentae / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Maternal morbidity; Perinatal mortality; Placental abruption; Preeclampsia; Preterm PROM