IS ACUTE PLACENTAL ABRUPTION A CHRONIC PROCESS

Objective: Abruptio placentae is an important cause of antepartum feta l death, and believed to be nonpreventable. We tested the hypothesis t hat intensive fetal surveillance is associated with a decrease in abru ptio placentae-related antepartum fetal death. Methods: Retrospective comparison was made of 4727 high-risk pregnancies that were subjected to intensive fetal surveillance, and 10,276 control, low-risk pregnanc ies that received routine prenatal care. Intensive fetal surveillance consisted of nonstress testing, sonographic examination, and Doppler v elocimetry. The outcome variable studied was the incidence of abruptio placentae-related antepartum fetal death. Results: The incidence of a bruptio-related antepartum fetal death in the control, low-risk popula tion was 1.8/1000 births. The incidence of abruptio-related antepartum fetal death in the high-risk population followed with intensive surve illance was 0.2/1000 births. The odds ratio of abruptio-related fetal death occurring in patients subjected to intensive fetal surveillance was 0.12 (95% confidence interval 0.02-0.85). Intensive fetal surveill ance of pregnancies at elevated risk of abruptio placentae was associa ted with a significant decrease in the incidence of abruptio-related f etal death (p < 0.05). Conclusions: Institution of a regimen of intens ive fetal surveillance may be associated with a decreased incidence of abruptio-related antepartum fetal death. These data lend support to t he hypothesis that acute placental abruption may be the result of a ch ronic disturbance in the maternal-fetal relationship.