National trends in the incidence of abruptio placentae, 1979-1987

Article Abstract:

Abruptio placentae is an abnormality of pregnancy characterized by the premature separation of the placenta. It can result in severe bleeding and can result in the death of the mother, the fetus or the newborn. Perinatal mortality due to abruptio placentae has been reported to range between 19 and 87 percent, although more recent studies have indicated a rate of 20 to 40 percent. The incidence of abruptio placentae has been reported to occur in about one percent of all deliveries. Previous studies have identified a number of risk factors associated with this abnormality, including smoking and maternal age. None of the previous studies have examined a national population. This study assessed the national incidence of abruptio placentae and the risk factors associated with this condition. Data were obtained from the National Hospital Discharge Survey for the years 1979 to 1987 and described 319,600 deliveries nationwide. The rate of abruptio placentae was 8.2 cases per 1,000 deliveries in both the 1979 to 1980 and the 1981 to 1982 periods. It rose to 9.5 cases per 1,000 births for the 1983 to 1984 period, 10.1 cases from 1985 to 1986, and 11.5 cases during 1987. The increase was significant for all women and for non-white women. In white women, the rate increased for all but 20- to 24-year-old women. In nonwhite women, the rate increased for all age groups. In white women, age was associated with the rate of abruptio placenta, but age was not associated with it in nonwhite women. Unmarried women of all races had a significantly higher risk for abruptio placentae than married women. Blood coagulability abnormalities and still births were much more common in women who suffered from abruptio placentae. Other pregnancy complications were also associated with abruptio placentae. There were not enough data to examine other possible risk factors such as smoking. These findings indicate that the rate for abruptio placentae has increased significantly in the past few years. The exact cause of the increase is unknown, but the greatest increase occurred among poor women. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Abnormalities, Risk factors, Placenta, Abruptio placentae, Placental abruption

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Epidemiology of preeclampsia and eclampsia in the United States, 1979-1986

Article Abstract:

Preeclampsia is a complication of pregnancy that is characterized by increasing hypertension (high blood pressure), headaches, excretion of protein in the urine, and accumulation of body fluids in the lower limbs. If untreated, preeclampsia may develop into true eclampsia, which is characterized by coma and convulsive seizures occurring between the twentieth week of pregnancy and the end of the first week after birth. Eclampsia develops in one of 200 pregnant women with preeclampsia and is often fatal if untreated. Together, preeclampsia and eclampsia are the second leading cause of death in pregnant women; they increase the risk of abruptio placentae, or early detachment of the placenta; widespread blood clot formation; kidney failure; and bleeding within the brain. These conditions decrease the supply of blood to the fetus, which may lead to slowed growth of the fetus, early birth, and death shortly after birth. The incidence of disease and death due to preeclampsia and eclampsia can be reduced by providing appropriate medical care before birth. Factors which may contribute to the development of preeclampsia and eclampsia include hormones, nutrition, the immune system, and a family history of these conditions. The incidence of preeclampsia and eclampsia and factors that may increase the risk of developing these conditions were assessed. Data from the National Hospital Discharge Survey for the years 1979 to 1986 were analyzed. Twenty-six of 1,000 births were complicated by preeclampsia, whereas 0.56 per 1,000 births were complicated by eclampsia. The incidence of mild preeclampsia did not change over the study period, although the occurrence of severe preeclampsia increased markedly. The incidence of eclampsia declined by 36 percent. Maternal age of less than 20 years was the most important factor associated with an increased risk of preeclampsia and eclampsia. These findings suggest that prenatal care of teenagers must be improved. (Consumer Summary produced by Reliance Medical Information, Inc.)

Eclampsia, Preeclampsia, Teenage pregnancy

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Fatal pulmonary embolism during legal induced abortion in the United States from 1972 to 1985

Article Abstract:

Pulmonary embolism, which involves a blockage of the artery supplying the lungs, is life-threatening. Pulmonary embolism is the major cause of maternal death during pregnancy and during induced legal abortions. The causes of abortion-induced maternal death from pulmonary embolism are unknown. To determine the factors involved in pulmonary embolism, all abortion-related deaths reported to the Centers for Disease Control during 1972 and 1985 were analyzed. Of the 213 abortion-related deaths, a total of 45 cases were caused by air (4), a blood clot (19), or amniotic fluid (22) blocking a pulmonary artery. Deaths were grouped by abortion type: curettage, the scrapping of the uterus to remove the products of conception; instillation of fluid to induce an abortion; and hysterectomy. Death from pulmonary embolism occurred more often in minority and older women (34 to 44 years of age). Abortions performed by curettage before the 21st week of pregnancy and those before the 12th week of pregnancy regardless of procedure type offered the lowest risk of death due to embolism. The number of deaths caused by pulmonary embolisms decreased from 34 deaths (24 percent) between 1972 and 1978, to 11 (15 percent) deaths between 1979 and 1985, a 79 percent decrease in mortality. Since the amount of abortions performed by the curettage technique decreased by 58 percent after 1979, it is assumed that this type of procedure was associated with an increased risk for pulmonary embolism. Although the overall decrease in mortality was seen among all racial groups combined, the risk decreased more for white women. Blacks and minorities were four times more likely to experience a pulmonary embolism. (Consumer Summary produced by Reliance Medical Information, Inc.)

United States, Patient outcomes, Mortality, Pulmonary embolism, Mothers, Abortion, Maternal mortality, Amniotic fluid embolism

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