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Placental abruption in each hypertensive disorders of pregnancy phenotype: a retrospective cohort study using a national inpatient database in Japan

Hypertension Research volume 44, pages 232–238 (2021)Cite this article

A Comment to this article was published on 07 October 2020

Abstract

We designed a retrospective cohort study using the Diagnosis Procedure Combination database, a national inpatient database for acute-care inpatients in Japan, to examine whether recent global diagnostic criteria for preeclampsia, phenotypes of hypertensive disorders of pregnancy (HDP) and features of the disease are useful as predictors of placental abruption and whether other risk factors are associated with the onset of placental abruption. A total of 85,858 hospitalized patients with a diagnosis of HDP who gave birth during hospitalization between July 2010 and March 2018 were included in this study. We examined the associations between the occurrence of placental abruption after hospitalization and several factors, including gestational age (GA) at placental abruption onset, HDP subtypes, GA on admission, maternal age, body mass index, smoking, multiple pregnancy, prelabor rupture of membranes, diabetes mellitus, emergency admission by ambulance, and consciousness, using a multivariate logistic regression analysis. Placental abruption occurred in 541 patients (0.63%) after hospital admission, and the occurrence increased acutely after 32 weeks GA. A decrease in abruption was significantly associated with maternal BMI on admission (≥30 kg/m2; odds ratio [OR], 0.54; 95% confidence interval [CI], 0.41–0.70) and multiple pregnancy (OR, 0.29; 95% CI, 0.18–0.46). An increase in abruption was associated with earlier GA on admission (<34 weeks’ GA; OR, 3.77; 95% CI, 3.13–4.53) and emergency admission by ambulance (OR, 1.34; 95% CI, 1.09–1.65). Individual features of severe PE showed no significant associations with the occurrence of abruption. In conclusion, HDP at an earlier GA was suggested to be a risk factor for placental abruption, and we recommend hospitalization and careful management of such patients to improve their prognosis.

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References

  1. Hasegawa J, Toyokawa S, Ikenoue T, Asano Y, Satoh S, Ikeda T, et al. Relevant obstetric factors for cerebral palsy: from the Nationwide Obstetric Compensation System in Japan. PLoS ONE. 2016;11:e0148122.

    Article  Google Scholar 

  2. Ananth CV, Lavery JA, Vintzileos AM, Skupski DW, Varner M, Saade G, et al. Severe placental abruption: clinical definition and associations with maternal complications. Am J Obstet Gynecol. 2016;214:272.e1–272.e9.

    Article  Google Scholar 

  3. Ananth CV, Smulian JC, Demissie K, Vintzileos AM, Knuppel RA. Placental abruption among singleton and twin births in the United States: risk factor profiles. Am J Epidemiol. 2001;153:771–8.

    Article  CAS  Google Scholar 

  4. Ukah UV, De Silva DA, Payne B, Magee LA, Hutcheon JA, Brown H, et al. Prediction of adverse maternal outcomes from pre-eclampsia and other hypertensive disorders of pregnancy: a systematic review. Pregnancy Hypertens. 2018;11:115–23.

    Article  Google Scholar 

  5. Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018;72:24–43.

    Article  CAS  Google Scholar 

  6. Visintin C, Mugglestone MA, Almerie MQ, Nherera LM, James D, Walkinshaw S, et al. Management of hypertensive disorders during pregnancy: summary of NICE guidance. BMJ. 2010;341:c2207.

    Article  Google Scholar 

  7. Makino S, Takeda J, Takeda S, Watanabe K, Matsubara K, Nakamoto O, et al. New definition and classification of hypertensive disorders of pregnancy (HDP). Hypertens Res Pregnancy. 2019;7:1–5.

    Article  Google Scholar 

  8. Matsui H, Jo T, Fushimi K, Yasunaga H. Outcomes after early and delayed rehabilitation for exacerbation of chronic obstructive pulmonary disease: a nationwide retrospective cohort study in Japan. Respir Res. 2017;18:68.

    Article  Google Scholar 

  9. Yamana H, Moriwaki M, Horiguchi H, Kodan M, Fushimi K, Yasunaga H. Validity of diagnoses, procedures, and laboratory data in Japanese administrative data. J Epidemiol. 2017;27:476–82.

    Article  Google Scholar 

  10. Shigematsu K, Nakano H, Watanabe Y. The eye response test alone is sufficient to predict stroke outcome–reintroduction of Japan Coma Scale: a cohort study. BMJ Open. 2013;3:e002736.

    Article  Google Scholar 

  11. Ananth CV, Savitz DA, Williams MA. Placental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis. Obstet Gynecol. 1996;88:309–18.

    Article  CAS  Google Scholar 

  12. Buchbinder A, Sibai BM, Caritis S, Macpherson C, Hauth J, Lindheimer MD, et al. Adverse perinatal outcomes are significantly higher in severe gestational hypertension than in mild preeclampsia. Am J Obstet Gynecol. 2002;186:66–71.

    Article  Google Scholar 

  13. Guo Q, Feng P, Yu Q, Zhu W, Hu H, Chen X, et al. Associations of systolic blood pressure trajectories during pregnancy and risk of adverse perinatal outcomes. Hypertens Res. 2020;43:227–34.

    Article  CAS  Google Scholar 

  14. MacKay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol. 2001;97:533–8.

    CAS  PubMed  Google Scholar 

  15. von Dadelszen P, Menzies JM, Payne B, Magee LA, Group PS. Predicting adverse outcomes in women with severe pre-eclampsia. Semin Perinatol. 2009;33:152–7.

    Article  Google Scholar 

  16. Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de Paco Matallana C, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med. 2017;377:613–22.

    Article  CAS  Google Scholar 

  17. Turner JM, Robertson NT, Hartel G, Kumar S. Impact of low-dose aspirin on adverse perinatal outcome: meta-analysis and meta-regression. Ultrasound Obstet Gynecol. 2020;55:157–69.

    Article  CAS  Google Scholar 

  18. Haddad B, Sibai BM. Expectant management in pregnancies with severe pre-eclampsia. Semin Perinatol. 2009;33:143–51.

    Article  Google Scholar 

  19. Churchill D, Duley L, Thornton JG, Moussa M, Ali HS, Walker KF. Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks’ gestation. Cochrane Database Syst Rev. 2018;10:CD003106.

    PubMed  Google Scholar 

  20. Tokumasu H, Tokumasu S, Kawakami K. Impact of pre-eclampsia in extremely premature infants: population-based study. Pediatr Int. 2016;58:578–83.

    Article  Google Scholar 

  21. Meher S, Abalos E, Carroli G. Bed rest with or without hospitalisation for hypertension during pregnancy. Cochrane Database Syst Rev. 2005;4:CD003514.

    Google Scholar 

  22. Minakami H, Maeda T, Fujii T, Hamada H, Iitsuka Y, Itakura A, et al. Guidelines for Obstetrical Practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2014 Edition. J Obstet Gynaecol Res. 2014;40:1469–99.

    Article  Google Scholar 

  23. Adane AA, Shepherd CCJ, Lim FJ, White SW, Farrant BM, Bailey HD. The impact of pre-pregnancy body mass index and gestational weight gain on placental abruption risk: a systematic review and meta-analysis. Arch Gynecol Obstet. 2019;300:1201–10.

    Article  Google Scholar 

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Acknowledgements

This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and 20AA2005) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (20H03907).

Members for the Advanced Life Support in Obstetrics (ALSO)-Japan Research Group

Ichiro Yasuhi6, Yasuhiko Ozaki7, Akiko Sakajo8, Atsushi Tajima9, Seiji Tsutsumi10, Satoru Nakayama11, Teruyuki Yamasaki12, Satoshi Nakago13, Yuji Hiramatsu14, Junko Mochizuki15, Mikio Hashiguchi16, Katsuhiko Naruse17, Takanari Arai18

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan

    Katsuhiko Naruse

  2. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan

    Daisuke Shigemi & Hideo Yasunaga

  3. Department of Obstetrics and Gynecology, Okinawa Prefectural Chubu Hospital, Uruma, Okinawa, Japan

    Mikio Hashiguchi

  4. Ikoma City Hospital, Ikoma, Nara, Japan

    Masatoshi Imamura

  5. Department of Obstetrics and Gynecology, Keiju Medical Center, Nanao, Ishikawa, Japan

    Takanari Arai

  6. Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan

    Ichiro Yasuhi

  7. Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan

    Yasuhiko Ozaki

  8. Department of Nursing, Musashino University, Tokyo, Japan

    Akiko Sakajo

  9. Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan

    Atsushi Tajima

  10. Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan

    Seiji Tsutsumi

  11. Department of Obstetrics and Gynecology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan

    Satoru Nakayama

  12. Department of Obstetrics and Gynecology, Iida Municipal Hospital, Iida, Nagano, Japan

    Teruyuki Yamasaki

  13. Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Osaka, Japan

    Satoshi Nakago

  14. Department of Obstetrics and Gynecology, Okayama City General Medical Center, Okayama, Japan

    Yuji Hiramatsu

  15. Department of Obstetrics and Gynecology, Kitasato University Hospital, Sagamihara, Kanagawa, Japan

    Junko Mochizuki

  16. Department of Obstetrics and Gynecology, Okinawa Prefectural Chubu Hospital, Uruma, Okinawa, Japan

    Mikio Hashiguchi

  17. Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan

    Katsuhiko Naruse

  18. Department of Obstetrics and Gynecology, Keiju Medical Center, Nanao, Ishikawa, Japan

    Takanari Arai

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  1. Katsuhiko Naruse
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  2. Daisuke Shigemi
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  5. Hideo Yasunaga
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Consortia

for the Advanced Life Support in Obstetrics (ALSO)-Japan Research Group

  • Ichiro Yasuhi
  • , Yasuhiko Ozaki
  • , Akiko Sakajo
  • , Atsushi Tajima
  • , Seiji Tsutsumi
  • , Satoru Nakayama
  • , Teruyuki Yamasaki
  • , Satoshi Nakago
  • , Yuji Hiramatsu
  • , Junko Mochizuki
  • , Mikio Hashiguchi
  • , Katsuhiko Naruse
  •  & Takanari Arai

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Correspondence to Katsuhiko Naruse.

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Members for the Advanced Life Support in Obstetrics (ALSO)-Japan Research Group are listed below Acknowledgements.

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Naruse, K., Shigemi, D., Hashiguchi, M. et al. Placental abruption in each hypertensive disorders of pregnancy phenotype: a retrospective cohort study using a national inpatient database in Japan. Hypertens Res 44, 232–238 (2021). https://doi.org/10.1038/s41440-020-00537-6

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  • DOI: https://doi.org/10.1038/s41440-020-00537-6

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