Diagnosis of placental abruption: relationship between clinical and histopathological findings

Abstract

Objective We evaluated the extent to which histologic lesions bearing a diagnosis of abruption conform to a diagnosis based on established clinical criteria. We further examined the profile of chronic and acute histologic lesions associated with clinical abruption. Methods Data from the New Jersey-Placental Abruption Study – a multi-center, case-control study – were utilized to compare the clinical and histologic criteria for abruption. The study was based on 162 women with clinically diagnosed abruption and 173 controls. We examined the concordance between clinical indicators for abruption with those of a histopathological diagnosis. The clinical criteria for a diagnosis of abruption included (i) evidence of retroplacental clot(s); (ii) abruption diagnosed on prenatal ultrasound; or (iii) vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity. The pathological criteria for abruption diagnosis included hematoma, fibrin deposition, compressed villi, and hemosiderin-laden histiocytes in cases with older hematomas. Acute lesions included chorioamnionitis, funisitis, acute deciduitis, meconium stained membranes, villous stromal hemorrhage, and villous edema. Chronic lesions included chronic deciduitis, decidual necrosis, decidual vasculopathy, placental infarctions, villous maldevelopment (delayed or accelerated maturation), hemosiderin deposition, intervillous thrombus, and chronic villitis. Results Of clinically diagnosed cases, the sensitivity and specificity for a histologic confirmation of abruption were 30.2% and 100%, respectively. Presence of retroplacental clots remained the single most common finding (77.1%) among clinically diagnosed cases. Among the acute lesions, chorioamnionitis and funisitis were associated with abruption. The only chronic histologic lesion associated with abruption was placental infarctions. Conclusions The concordance between clinical and pathologic criteria for abruption diagnosis is poor. The criteria for diagnosing a clinical abruption should include sonographic visualization of abruption, evidence of retroplacental clots, or vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity.

Correlation between Clinical, Placental Histology and Microbiological Findings in Spontaneous Preterm Births

“…Other explanations for this difference may be related to different populations and/or different definitions of placental abruption. Furthermore, only about one third of clinically diagnosed abruption cases were confirmed by histopathological examination in this study, similar to an incidence of 30.2% reported by Elsasser et al [11]. Examination of the placenta for conformational purposes has been reported as insensitive, and for that reason a number of reports recommend that the diagnosis of abruption be based on clinical and not histological criteria [10,22].…”

“…Several studies have shown a limited correlation between clinical chorioamnionitis and histological chorioamnionitis (HCA) [6,7,8,9]. In the case of placental abruption, several cases have been diagnosed based on histological markers with a clinically unremarkable obstetrical course and outcome and vice versa [10,11]. …”

Magnetic resonance imaging of clinically stable late pregnancy bleeding: beyond ultrasound

“…In 7 patients placental abruption was confirmed by the clinical evidence of adherent blood clots with fibrin deposits after the obstetricians, with more than 15 years of experience in operative obstetrics, performed a careful inspection of the placenta after delivery [18]. 4 abruptions were confirmed microscopically by an experienced (more than 25 years) pathologist, according to recognized criteria of diagnosis [19].…”

“…Nevertheless, Haste and True Fisp sequences also showed a very good diagnostic efficacy; this was probably due to the coexistence of phases of haemorrhage and ischemia in many cases of bleeding [18].…”

Circulating Levels of Pregnancy-Associated, Placenta-Specific microRNAs in Pregnant Women With Placental Abruption

“…The criteria for diagnosing a clinical abruption included one or more of the following: painful vaginal bleeding accompanied by nonreassuring fetal status and/or uterine hypertonicity, ultrasonographic visualization of abruption indicating retroplacental anechoicity and/or increased placental thickness (>5 cm), and evidence of retroplacental hemorrhage/clots. 38,39 Nonreassuring fetal status mainly indicated abnormal fetal heart rate patterns, for example, persistent late deceleration, prolonged deceleration, or fetal bradycardia (<110 beats per minute) for 3 minutes or more. Histopathological diagnosis of placental abruption, determined by a pathologist, included retroplacental hematoma and/or villous infarctions associated with decidual destruction.…”