Preterm placental abruption: Tocolytic therapy regarded as a poor neonatal prognostic factor

Aim: To elucidate factors associated with a poor neonatal prognosis in preterm placental abruption. Methods: A multicenter retrospective study was conducted. A total of 247 cases with preterm placental abruption during 2009, derived from an electronic database constructed by the Japan Society of Obstetrics and Gynecology, were investigated as the subjects of this study, and were divided into three groups: very preterm (VPT, n=66) was delivered at 28 to 31 gestational weeks, preterm (n=56) was at 32 and 33 weeks, and late preterm (LPT, n=125) was at 34 to 36 weeks. Risk factors, clinical course, and neonatal/infantile outcomes were compared. Poor neonatal outcome was defined as stillbirth, or neonatal and infantile death, or cases with neurological disability at 2 years of age. Results: The number of subjects who received tocolytic therapy was significantly higher in the VPT group as compared with the LPT group. It was higher in the VPT group even after excluding the 57 stillbirths. Multiple logistic regression analysis revealed that poor prognostic factors were umbilical arterial pH (Δ=0.1) (0.17 [0.069-0.417], p<0.0001) and tocolytic therapy (28.5 [2.014-403.9], p<0.0132). Conclusion: Administration of tocolytic agents is a possible factor in a poor neonatal prognosis in preterm placental abruption. This finding may suggest that differential diagnosis could improve the prognosis. Correspondence to: Masaki Ogawa, M.D. and Ph.D. Perinatal Medical Center, Tokyo Women’s Medical University Hospital, Tokyo, Japan, Kawadacho 8-1, Shinjuku Tokyo, 162-8666, Japan, Tel: +81-3-3353-8111, Fax: +81-3-5269-7350; E-mail: [email protected]