Is 'acute placental abruption' a chronic process?

Objective: Abruptio placentae is an important cause of antepartum fetal death, and believed to be nonpreventable. We tested the hypothesis that intensive fetal surveillance is associated with a decrease in abruptio 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 pregnancies that received routine prenatal care. Intensive fetal surveillance consisted of nonstress testing, sonographic examination, and Doppler velocimetry. The outcome variable studied was the incidence of abruptio placentae-related antepartum fetal death. Results: The incidence of abruptio-related antepartum fetal death in the control, low-risk population was 1.8/1000 births. The incidence of abruptio-related antepartum fetal death in the high-risk population followed with intensive surveillance 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 surveillance of pregnancies at elevated risk of abruptio placentae was associated with a significant decrease in the incidence of abruptio-related fetal death (p<0.05) . Conclusions: Institution of a regimen of intensive fetal surveillance may be associated with a decreased incidence of abruptio-related antepartum fetal death. These data lend support to the hypothesis that acute placental abruption may be the result of a chronic disturbance in the maternal-fetal relationship.