Association between coagulation function indicators and placental abruption among preeclampsia-eclampsia pregnant women / 中华预防医学杂志

Objective: To explore the association between coagulation function indicators and placental abruption (PA) in different trimesters of pregnancy among preeclampsia-eclampsia pregnant women. Methods: From February 2018 to December 2020, pregnant women who participated in the China birth cohort study and were diagnosed with preeclampsia, eclampsia and chronic hypertension with superimposed preeclampsia in Beijing Obstetrics and Gynecology Hospital were enrolled in this study. The baseline and follow-up information were collected by questionnaire survey, and the coagulation function indicators in the first and third trimesters were obtained through medical records. The Cox proportional hazards model was used to analyze the association between the coagulation function indicators and PA. A restrictive cubic spline curve was used to draw the dose-response curve between the relevant coagulation function indicators and PA. Results: A total of 1 340 participants were included in this study. The age was (32.50±4.24) and the incidence of PA was 4.4% (59/1 340). After adjusting for relevant factors, Cox proportional hazards model showed that compared with the high-level classification of fibrinogen (FIB), participants within the middle-(HR=3.28, 95%CI: 1.27-8.48) and low-level (HR=3.84, 95%CI: 1.40-10.53) classification during the first trimester and within the low-level classification (HR=4.18, 95%CI: 1.68-10.39) during the third trimester were more likely to experience PA. Compared with the middle-level classification of pro-thrombin time (PT), the risk of PA in the participants within the low-level classification (HR=2.67, 95%CI: 1.48-4.82) was significantly higher in the third trimester. The restrictive cubic spline analysis showed a linear negative association between FIB and PA in the first and third trimesters, while PT and PA showed an approximately L-shaped association . Conclusion: Among pregnant women diagnosed with preeclampsia-eclampsia, the middle-and low-level classification of FIB in the first and third trimesters and the low-level classification of PT in the third trimester could increase the risk of PA.

Perinatal risk factors for the occurrence of singleton apparently stillborn infants / 中国当代儿科杂志

OBJECTIVES@#To identify the perinatal risk factors for the occurrence of singleton apparently stillborn infants.@*METHODS@#This was a case-control study. A total of 154 singleton neonates with gestational age ≥28 weeks and Apgar score of 0-1 who were subsequently successfully resuscitated in the Obstetrics and Gynecology Hospital of Fudan University from January 2006 to December 2015 were enrolled as the case group (apparently stillborn group). A total of 616 singleton infants born from January 2006 to December 2015 (1-minute Apgar score >1) were randomly selected in a 1:4 ratio as the control group. Univariate analysis and multivariate logistic regression were used to analyze the perinatal risk factors for the occurrence of apparently stillborn infants.@*RESULTS@#The gestational age and birth weight in the apparently stillborn group were significantly lower than those in the control group (P<0.05). The incidences of fetal hydrops, cord prolapse, grade III meconium-stained amniotic fluid, placental abruption, breech presentation, severe pre-eclampsia, maternal general anesthesia at delivery, abnormal antenatal fetal heart monitoring and decreased fetal movement were significantly higher in the apparently stillborn group than those in the control group (P<0.05). The multivariate logistic analysis showed that the mother had general anesthesia at delivery (OR=34.520), decreased antenatal fetal movement (OR=28.168),placental abruption (OR=15.641), grade III meconium-stained amniotic fluid (OR=6.365), abnormal antenatal fetal heart monitoring (OR=5.739), and breech presentation (OR=2.614) were risk factors for the occurrence of apparently stillborn infants (P<0.05), while higher gestational age was a protective factor (OR=0.686, P<0.05).@*CONCLUSIONS@#Attention needs to be paid to mothers with abnormal prenatal fetal heart monitoring, decreased fetal movement, preterm labor, placental abruption, breech presentation, grade III meconium-stained amniotic fluid, and general anesthesia. Preparations for resuscitation should be done to rescue apparently stillborn infants.

Prevalencia de preeclampsia en embarazadas en el servicio de ginecología y obstetricia del Hospital Central del Instituto de Previsión Social, 2017 / Prevalence of preeclampsia in pregnant women in the gynecology and obstetrics service of the Central Hospital of the Social Security Institute, 2017

Introducción: Los trastornos hipertensivos son la primera causa de muerte materna en los países desarrollados y la tercera causa de muerte materna en los países en vías de desarrollo. La preeclampsia es una enfermedad de origen desconocido y multifactorial cuyo tratamiento definitivo es el parto, además de ser causal de repercusiones sobre la madre y el recién nacido. Objetivo: El objetivo general del estudio fue determinar la Prevalencia de preeclampsia en embarazadas en el servicio de ginecología y obstetricia del hospital central del instituto de previsión social, 2017. Materiales y métodos: Estudio observacional descriptivo retrospectivo de corte transversal, con muestreo no probabilístico de casos consecutivos. Fueron incluidas todas las embarazadas con preeclampsia que acudieron al Servicio de Ginecología y Obstetricia del Hospital Central de Instituto de Previsión Social en el periodo comprendido entre los meses de enero a diciembre del año 2017. Resultados: Se realizó un estudio observacional descriptivo retrospectivo en 375 pacientes que acudieron al Hospital Central del Instituto de Previsión Social en el año 2017. Los resultados arrojaron que el 38,4% presentó preeclampsia de las cuales 63,2% presentaba en preeclampsia leve y 36,8% presentaba preeclampsia severa Entre los factores de riesgo el que apareció en mayor cantidad fue la Hipertensión Arterial Crónica. En cuanto a las complicaciones maternas se presentan en mayoría Hepáticas, Neurológicas y Renales. Conclusión: Los resultados de este estudio realizado en un centro de referencia nacional y de alta complejidad coinciden con estudio previo, determina datos importantes acerca de la prevalencia de preeclampsia.

Grandmultiparas; frequency of hypertension placental abruption and postpartum haemorrhage in

Intrapartum complications that are classically associated with grandmultiparas include fetal malpresentation, dysfunctional labour, chronic hypertension, abruptio placentae, postpartum haemorrhage and macrosomic babies. Excellent maternal and fetal outcome is possible in grandmultiparas with improvement in health care system and free provision of health facilities to all pregnant women. The objective of the study was: to find the frequency of hypertension, placental abruption and primary postpartum hemorrhage in grandmultiparas. It was a prospective study with descriptive pattern. Gynaecology and Obstetric unit-I of Allied Hospital, Punjab Medical College Faisalabad. January to June 2006. Eighty patients were included in the study. Eighty grandmultiparas were randomly selected for the study. Detailed evaluation of all patients was done by thorough history, examination and investigation. Patients were analyzed for complications during pregnancy, labour and delivery, especially hypertension, placental abruption and primary post partum haemorrhage. Hypertensive disorders found to be in 32 [33.8%], placental abruption in 7[8.8%] and postpartum hemorrhage in 19[23.8%] of grandmultiparas. It was concluded from the result of my study that grandmultiparity is still a major obstetric hazard in developing countries like Pakistan with higher incidence of complications. Safe maternal and perinatal outcome is possible in grandmultiparas with improvement in health care system and free provision of health care facilities to all pregnant women

Óbitos fetais e neonatais entre casos de near miss materno / Fetal and neonatal deaths among cases of maternal near miss

OBJETIVO: Determinar a prevalência dos óbitos fetais e neonatais entre as pacientes com near miss materno e os fatores associados a esse desfecho fatal. MÉTODOS: Realizou-seumestudo descritivo, tipo corte transversal, analisando-se prontuários das pacientes admitidas na UTI obstétrica de um hospital terciário do Recife (Brasil), entre janeiro de 2007 e dezembro de 2010, que apresentavam pelo menos um critério de near miss definido pela OMS. A análise estatística foi realizada com o programa Epi-Info 3.3.2, usando os testes Qui-quadrado de associação e exato de Fisher, considerando-se o nível de significância de 5%. Para análise multivariada foi construído um modelo hierarquizado tendo como variável resposta os óbitos fetais e neonatais. RESULTADOS: Foram incluídos 246 casos de near miss. Entre as mulheres do estudo, os distúrbios hipertensivos ocorreram em 62,7%, a síndrome HELLP em 41,2% e os critérios laboratoriais de near miss em 59,6%. Ocorreram 48 (19,5%) óbitos fetais e 19 (7,7%) óbitos neonatais. Após a análise estatística as variáveis que permaneceram associadas aos óbitos fetais e neonatais foram: pré-eclâmpsia grave, DPP, endometrite, cesariana, prematuridade e os critérios laboratoriais de near miss materno. CONCLUSÃO: É elevada a ocorrência de óbitos fetais e neonatais entre as pacientes com near miss materno. Entre essas mulheres há uma sobreposição de fatores que contribuem para esse desfecho fatal, em nosso estudo aquelas que apresentaram pré-eclâmpsia grave, DPP, endometrite, parto prematuro ou critérios laboratoriais apresentam associação positiva com os óbitos.

OBJECTIVE: To determine the prevalence of fetal and neonatal deaths among patients with maternal near miss and the factors associated with this fatal outcome. METHODS: The authors conducted a descriptive, cross-sectional, analyzing medical records of patients admitted to the ICU of a tertiary obstetric Recife (Brazil), between January 2007 and December 2010, who had at least one criterion of near miss defined by WHO. Statistical analysis was performed with Epi-Info 3.3.2, using chi-square and Fisher's exact test, considering a significance level of 5%. For multivariate analysis was constructed as a hierarchical model with the response variable fetal and neonatal deaths. RESULTS: We included 246 cases of maternal near miss. Among women in the study, hypertensive disorders occurred in 62.7% to 41.2% in HELLP syndrome and the laboratory criteria for near miss in 59.6%. There were 48 (19.5%) stillbirths and 19 (7.7%) neonatal deaths. After analyzing the variables that remained statistically associated with fetal and neonatal deaths were: severe preeclampsia, placental abruption, endometritis, cesarean delivery, prematurity and the laboratory criteria for maternal near miss. CONCLUSION: The high incidence of fetal and neonatal deaths among patients with maternal near miss. Among these women there is an overlap of factors contributing to this fatal outcome, in our study, those who had severe preeclampsia, placental abruption, endometritis, premature birth or laboratory criteria positively associated with deaths.

Associação entre via de parto e complicações maternas em hospital público da Grande São Paulo, Brasil / Association between mode of delivery and maternal complications in a public hospital in Greater Metropolitan São Paulo, Brazil

O estudo objetivou avaliar associação entre via de parto e complicações maternas. Realizou-se coorte retrospectiva com partos ocorridos durante o ano de 2003, em um hospital público. As complicações avaliadas foram: infecção, hemorragia, histerectomia, rotura uterina, lesão de órgão contíguo, trombose venosa profunda e embolia pulmonar. Utilizou-se a odds ratio (OR) e os testes de qui-quadrado de Pearson e de Fisher, além da regressão logística. Estabeleceu-se o nível de 0,05 como significante. Foram encontradas 15 complicações. Tomando-se o parto vaginal como referência, encontrou-se associação entre cesárea e as complicações tomadas em conjunto. Analisando-se variáveis confundidoras, encontrou-se associação das complicações com hipertensão, soropositividade para HIV, placenta prévia e descolamento prematuro de placenta. Após controle para estas quatro variáveis, manteve-se a associação entre cesárea e complicações (OR = 9,7; p = 0,04). Encontrou-se também associação entre complicações e cesárea eletiva comparada ao parto vaginal (OR = 4,7; p = 0,02), e maior proporção de complicações, no limite da significância estatística, nas cesáreas eletivas comparadas à "tentativa de parto vaginal" (OR = 3; p = 0,058). Conclui-se que a cesárea associa-se a complicações maternas, mesmo após a realização de vários ajustes.

The purpose of this study was to assess the relationship between mode of delivery and maternal complications, based on a retrospective cohort of all births at a public hospital in 2003. Complications included: infection, hemorrhage, hysterectomy, uterine rupture, lesions in adjacent organs, deep venous thrombosis, and pulmonary embolism. The analysis used odds ratio (OR), chi-squared test, and Fisher's exact test, besides logistic regression. Fifteen complications were identified. Taking vaginal delivery as the reference, an association was found between cesarean section and overall complications. Analysis of confounding showed an association between hypertension, HIV, placenta previa, and abruptio placentae. After controlling for these variables, an association remained between overall complications and cesarean section (OR = 9.7; p = 0.04). Another analysis comparing elective cesareans and vaginal deliveries also showed an increased risk for cesarean (OR = 4.7; p = 0.02). Finally, comparing elective cesareans with trial of labor, we found an increased proportion of complications in elective cesareans, with borderline significance (OR = 3; p = 0.058). We concluded that cesarean section is associated with maternal morbidity, even after controlling for confounders.

Óbito fetal no descolamento prematuro da placenta: comparação entre dois períodos / Fetal death in placental abruption: comparison of two different time periods

OBJETIVOS: Comparar a incidência de descolamento prematuro da placenta (DPP), de óbito fetal e o perfil dos fatores maternos associados ao óbito fetal em casos acometidos por DPP em dois períodos, num mesmo serviço médico terciário. MÉTODOS: Avaliação retrospectiva dos casos de DPP ocorridos entre 1º de janeiro de 1994 a 31 de dezembro de 1997 (período 94-97) e 1º de abril de 2001 a 31 de março de 2005 (período 01-05), em gestações únicas com peso do recém-nascido superior a 500g e idade gestacional acima da 20ª semana. Foram analisados os fatores: idade materna, cor, antecedentes obstétricos, ocorrência de hipertensão arterial ou ruptura prematura de membranas ovulares, presença de sangramento genital, hemoâmnio, características do tônus uterino, ocorrência de CIVD, insuficiência renal, anemia puerperal, bem como a idade gestacional e peso do RN no parto. RESULTADOS: No período 94-97, foram realizados 7.692 partos e o DPP ocorreu em 0,78 por cento (60 casos), e no período 01-05 foram 8.644 partos com 0,59 por cento (51 casos) de DPP, sem diferença significativa. No período 94-97, a proporção de casos sem sangramento genital foi significativamente maior no grupo que evoluiu com óbito fetal quando comparado aos casos cujo feto nasceu vivo (57,9 por cento vs 22,0 por cento; p=0,01). No período 01-05, a proporção de casos com hipertonia uterina foi significativamente maior no grupo que evoluiu com óbito fetal quando comparado aos casos com recém-nascido nativivo (66,7 por cento vs 29,3 por cento; p=0,04). As complicações maternas no pós-parto foram mais freqüentes nos casos de óbito fetal, em ambos os períodos 94-97 e 01-05 (31,6 por cento vs 4,9 por cento, p=0,009, e, 50,0 por cento vs 5,1 por cento, p=0,001, respectivamente). CONCLUSÃO: O DPP permanece grave problema obstétrico com conseqüências potencialmente fatais, principalmente nos casos com maior área de descolamento da placenta. Maior gravidade do quadro clínico materno é observada...

OBJECTIVE: To compare the incidence of placental abruption (PA), fetal death and the profile of maternal factors associated with fetal death in pregnancies affected by placental abruption during two different time periods in the same hospital. METHODS: retrospective study between January 1, 1994 and December 31, 1997 and April 1, 2001 and March 31, 2005, including singleton pregnancies with a birth weight higher than 500g and gestational age of more than 20 weeks. Factors analyzed were maternal age, race, obstetric history, presence of arterial hypertension or premature rupture of membranes, presence of genital bleeding, presence of amniotic fluid contaminated with blood, characteristics of uterine tonus, occurrence of renal insufficiency, postpartum coagulopathy, puerperal anemia, gestational age and weight at birth. RESULTS: there were7692 births in the 1994-1997 period, placental abruption incidence of 0.78 percent (60 cases); 8644 births occurred in the 2001-2005 period, placental abruption incidence of 0.59 percent (51 cases), with no statistical difference. During the 1994-1997 period, proportion of cases without genital bleeding was significantly higher in the group whose fetuses died compared to cases of live born fetuses (57.9 percent vs 22.0 percent; p=0.01). During the 2001-2005 period, proportion of cases with uterine hypertonia was significantly higher in the group whose fetuses died compared to cases of live born fetuses (66.7 percent vs 29.3 percent; p=0.04). Postpartum maternal complications were more frequent in cases of fetal death during both periods (31.6 percent vs 4.9 percent; p=0.009; and 50 percent vs 5.1 percent; p=0.001, respectively). CONCLUSION: Placental abruption continues to be a serious obstetric problem, with fatal consequences, especially when the placental abruption area is large. Maternal clinical symptoms are more severe in cases of fetal death.

Pregnancy outcomes in placental abruption.

OBJECTIVES: To determine the outcomes of pregnancies with placental abruption and to investigate the relationship between clinical maternal characteristics and poor perinatal outcomes. MATERIAL AND METHOD: A retrospective descriptive study was conducted to evaluate 103 cases of placental abruption delivered at King Chulalongkorn Memorial Hospital from 1995 to 2004. RESULTS: There were 111,375 singleton deliveries with 103 cases (0.92 in 1,000) complicated by placental abruption during the study period. Placental abruption attributed to maternal complications including hemorrhagic shock (19.4%), Couvelaire uterus (16.5%) and DIC (5.8%). The perinatal outcomes included low birth weight (65.0%), preterm (56.3%), severe birth asphyxia (16.5%) and perinatal death (16.5%). Placental abruption with pregnancy induced hypertension (PIH), DIC and blood transfusion had a significantly higher incidence of perinatal mortality than the remainder (odds ratio [OR] 4.16, 95% confidence interval [CI] 1.41-12.24; OR 12.92, 95%CI 2.15-77.80 and OR 3.93, 95%CI 1.27-12.19, respectively). Placental abruption with Couvelaire uterus had a significantly higher incidence of severe birth asphyxia than the remainder (OR 3.72, 95%CI 1.14-2.09). CONCLUSION: Placental abruption had a profound impact on both maternal and perinatal complications including DIC, Couvelaire uterus, severe birth asphyxia and perinatal death. The relationship between PIH, DIC, blood transfusion and Couvelaire uterus with poor perinatal outcomes were found Therefore, placental abruption with these clinical characteristics should be closely monitored and prompt delivery should be carried out at tertiary care centers with adequate maternal-neonatal intensive care facilities.

Risk factors predisposing to abruption placentae. Maternal and Fetal outcome

Abruptio placentae is one of the leading causes of perinatal deaths. Abruptio placentae increase the neonatal morbidity and mortality. It is one of the recognized causes of low birth weight. The purpose of this study was to examine the risk factors for abruptio placentae together with the maternal and fetal outcome in a large population based data set. All cases of abruptio placentae presented to the Department of Obstetrics, Wad Medani Teaching Hospital, Sudan during the period January 1997 through to December 2002 were collected. All infants born to those cases were also collected and analyzed as live birth or stillbirth. The live born infants were followed for one month to detect the neonatal deaths. The study also aimed to determine the predisposing factors for abruptio placentae. The study was designed as a case control study from live, singleton births and singleton fetal death. The total number of abruptio placentae collected during this period was 1028, while the total number of births during the same period was 15620 giving and incidence of 1028/15620 [6.5%] for abruptio placentae. The combined stillbirths and first month deaths were 20.2%. Abruptio placentae was associated with pre-eclampsia, diabetes, polyhydramnios and hypertension. Parity and maternal age were not associated with an increased incidence of abruption placentae. This study had the advantage of complete ascertainment of all reported cases of abruptio placentae during a period of 6-years. We found an increased risk for abruptio placentae associated with maternal diabetes, hypertension, pre-eclampsia and polyhydramnios. We found that infants born after abruptio placentae were small for gestational age and had lower Apgar scores than the control infants. The possibility of abruptio placentae should be considered by the clinician when managing pregnant women with any of those characteristics. Abruptio placentae should be managed in centers were there is advanced maternal and neonatal facilities

Descolamento prematuro da placenta: estudo comparativo / Abruptio placentae: comparative study

Esta investigaçao embasa-se em 103 casosEsta investigaçao embasa-se em 103 casos de DPP que foram assistidos na Maternidade da Encruzilhada, Recife, de 1( de agosto de 1992 a 31 de julho de 1994. Elegeu-se como grupo-controle igual número de parturientes que foram atendidas na mesma instituiçao e na mesma época. As seguintes variáveis foram consideradas: idade, paridade, tipo de parto, hipertensao arterial e transfusao de sangue. No que compete ao nascituro, levaram-se em consideraçao: baixo peso ao nascer, Apgar e óbito fetal. A idade avançada, grande multiparidade, operaçao cesariana, transfusao de sangue e hipertensao arterial foram mais freqüentes nas portadoras de DPP do que no grupo-controle. Os resultados neonatais foram piores nas portadoras de abruptio placentae do que no grupo-controle.

Fatores de risco para descolamento prematuro de placenta: estudo caso-controle / Risk factors for abruptio placentae: a case control study

O objetivo principal deste estudo foi identificar alguns fatores de risco associados ao DPP entre mulheres grávidas de baixa renda em Campinas, Brasil. Num estudo caso-controle, 159 gestantes foram escolhidas como casos por apresentarem DPP entre 1986 e 1992. Quatro controles hospitalares foram selecionados randomicamente para cada caso, num total de 636 gestantes sem DPP e que deram à luz no mesmo hospital. Para cada potencial fator de risco considerado, calcularam se o risco relativo estimado (RRE) e o seu respectivo IC 95 por cento. Usou-se também análise de regressao múltipla para o controle de fatores confundidores. Para cada fator de risco significativo na análise univariada, calculou-se ainda a fraçao de risco atribuível populacional. A incidência global da patologia foi de 9,1 por 1.000 partos institucionais. Dentre os potenciais fatores de risco estudados, os que mostraram estar significativamente associados ao DPP foram: idade materna, paridade, história de hipertensao arterial crônica e gestacional, hemorragia em gestaçoes anteriores, antecedente de aborto e natimorto, número de consultas pré-natal, e hipertensao arterial crônica ou gestacional atuais. A regressao logística mostrou serem a hipertensao gestacional e o menor número de consultas de pré-natal os fatores de risco mais importantes associados ao DPP nessa populaçao. Existem diversos fatores de risco significativamente associados ao DPP entre mulheres de baixa renda. Estes fatores de risco poderiam ser rastreados durante a assistência pré-natal e o planejamento familiar para diminuir a incidência desta importante patologia e suas conseqüências.

Evaluación del Desprendimiento Prematuro de Placenta en la Altura / Evaluation of Abruptio Placentae in high altitude

De 4467 partos ocurridos en el lapso de 15 años en el Hospital II IPSS de la Oroya (3750 mts. sobre el nivel del mar),fueron seleccionados para el presente estudio, 75 casos con diagnóstico de desprendimiento prematuro de placenta normo inserta, con una incidencia de 1.6 por ciento.En esta patología la incidencia se se elevó 3.3 veces en gestantes mayores de 35 años, dos veces cuando tenían más de 4 hijos y 4.3 veces cuando el feto se encontraba en presentación transvera. Sangrado oculto o exterior leve con gran desprendimiento placentario fue hallado en 45.33 por ciento de los casos. En 82.7 por ciento de los caso se practicó cesárea de emergencia, y de ellas, en 70.97 por ciento se utilizó anestesia general. La incidencia de neonatos con apgar menor de 4 por DPP llegó al 18.02 por ciento (63.64 por ciento de los casos). 14.40 por ciento de los recién nacidos de bajo peso en estos 15 años, corresponden a DPP, así como 12.50 por ciento de los neonatos con menos de 35 semanas; siendo DPP la principal causa de muerte neonatal temprana intrahospitalaria. En 50.67 por ciento del total de casos de DPP, lo valores de hemoglobina materna fueron menores de 10 gr por ciento lo que correspomde a anemia aguda severa y hasta pre shock en nuestro medio. El comportamiento de la DPP en altura es más aparatosa que a nivel del mar. Su incidencia y morbimortalidad es superior a la reportada por la literatura y su etiología se deberá a que la hipoxia condiciona fragilidad capilar a nivel velloso, y al mayor volumen y viscosidad sanguínea que aumenta la resistencia vascular del lecho placentario. También influyen patrones culturales aún no desterrados que preconizan la versión externa para "acomodar" una mala presentación fetal.

Desprendimiento prematuro de la placenta: Hospital Universitario de Caracas; 1985-1990 / Placental abruption: Universitary Hospital of Caracas; 1985-1990

Se presenta un análisis retrospectivo de 36 casos de desprendimiento prematuro de placenta (DPP), sintomáticos o no, que fueron clasificados en leve, moderado o severo de acuerdo al área de desprendimiento (<25%, 25-50%,> 50% respectivamente). La incidencia de DPP encontrada fue de 0.25%, con una morbilidad fetal del 55.5%. Las complicaciones más frecuentes fueron la anemia y la coagulación intravascular diseminada, diagnosticadas por laboratorio. Con respecto al momento de presentarse el DPP el 66.67% no se encontraba en trabajo de parto activo. El sangrado genital como signo y síntoma se reportó en el 67.11%, seguido por el dolor abdominal en el 56% de los casos. La enfermedad más frecuentemente asociada al accidente placentario fue la hipertención inducida por el embarazo en 9 pacientes (25%), con 2 casos de eclampsia (22.22%). Se revisa la literatura nacional e internacional