Placental abruption and child mortality

Abstract

BACKGROUND AND OBJECTIVES: Placental abruption causes asphyxia and leads to high perinatal mortality. Our objective was to study the overall mortality and causes of death among children born after placental abruption. METHODS: Data on children born from singleton pregnancies complicated by placental abruption between 1987 and 2005 were collected from the Finnish Medical Birth Register, the Hospital Discharge Register, and the Cause-of-Death Register. A reference group consisted of children born from pregnancies without placental abruption. After excluding stillbirths, the final study sample comprised 3888 children born after placental abruption (index children) and 12530 referent children. The main outcome measure was overall mortality. RESULTS: By the end of 2013, there were 280 deaths among the index children and 107 deaths among the referent children. Compared with the referent children, the overall mortality among the index children was significantly increased (hazard ratio: 8.70; 95% confidence interval 6.96–10.90). During the neonatal period (0–27 days) the mortality was nearly 15-fold (14.8; 10.9–20.0), birth-related asphyxia being the leading cause of death (108; 34–341). The mortality remained high during days 28 to 365 (10.3; 4.83–21.8) and beyond 365 days (1.70; 1.03–2.79). Furthermore, the overall mortality was increased among the index children born at 32 to 36 + 6 gestational weeks (2.77; 1.54–4.98) and at ≥37 weeks (4.98; 3.54–6.99) and among children with a birth weight of 2500 g or more (5.94; 4.33–8.14). CONCLUSIONS: The impact of abruption on offspring mortality extends far beyond the perinatal period. This is mainly due to birth-related asphyxia and prematurity-related consequences.