The effect of maternal thrombophilia on placental abruption: Histologic correlates

• Published in: The journal of maternal-fetal & neonatal medicine 2009-01, Vol.22 (3), p.243-248
• Main Authors: Kinzler, Wendy L., Prasad, Vinay, Ananth, Cande V., For The New Jersey-Placental Abruption Study Investigators
• Format: Article
• Language: English
• Subjects: Abruptio Placentae - etiology; Abruptio Placentae - pathology; Adult; Case-Control Studies; Female; Humans; ischaemic placental disease; Placenta - pathology; Placental abruption; placental histology; Pregnancy; thrombophilia; Thrombophilia - complications; Thrombophilia - pathology; Young Adult
• ISSN: 1476-7058; 1476-4954
• DOI: 10.1080/14767050802551795

Objective. To determine if the histology of placental abruption differs by maternal thrombophilia status. Study design. This was a multicentre, case-control study of women with abruption and delivering at ≥20 weeks' gestation, collected as part of the ongoing New Jersey-placental abruption study. Women were identified by clinical criteria of abruption. Maternal blood was collected postpartum and tested for anticardiolipin antibodies, and mutations in the Factor V Leiden and prothrombin genes. Cases were comprised of women with an abruption and a positive thrombophilia screen. Controls were comprised of women with an abruption and a negative thrombophilia screen. All placental histology was systematically reviewed by two perinatal pathologists, blinded to the abruption status. Results. A total of 135 women with placental abruption were identified, of which 63.0% (n = 85) had at least one diagnosed maternal thrombophilia. There were increases in the rates of meconium-stained membranes (7.9%vs. 2.1%, p = 0.015) and decidual necrosis (4.5%vs. 2.1%, p = 0.023) when a maternal thrombophilia was diagnosed. Although there was no difference in the overall presence of infarcts between the two groups (27.0%vs. 38.3%, p = 0.064), the presence of an old infarct was more common among women with a positive thrombophilia screen (83.3%vs. 44.4%, p = 0.003). Conclusion. Placental abruption with a positive maternal thrombophilia screen is associated with higher rates of old placental infarcts and decidual necrosis compared with abruption when thrombophilia is not diagnosed. These lesions suggest a chronic etiology of placental abruption in the presence of a maternal thrombophilia.