TY - JOUR
T1 - The histologic evolution of revealed, acute abruptions
AU - Chen, Athena L.
AU - Goldfarb, Ilona T.
AU - Scourtas, Aristana O.
AU - Roberts, Drucilla J.
N1 - Funding Information:
Funding/Support: This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center ( National Center for Research Resources and the National Center for Advancing Translational Sciences , National Institutes of Health Award UL1 TR001102 ) (Cambridge, MA) and financial contributions from Harvard University and its affiliated academic health care centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the National Institutes of Health.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/9
Y1 - 2017/9
N2 - There is considerable interest in using pathology to confirm acute abruptions. It has been suggested that pathologic findings can help to determine the timing of abruptions. Because of the dearth of evidence in the literature supporting this claim and its medicolegal implications, we undertook this study to explore further the possibility of timing abruptions by histopathology. We sought to correlate bleeding interval (duration from maternal presentation with vaginal bleeding [revealed abruption] to placental delivery) with placental histopathologic findings. We performed a retrospective review of clinical data and placental pathology from all cases of clinically diagnosed, acute, revealed abruptions at a single, large institution in New England between 2000 and 2015. Cases were identified based on clinical diagnoses, bleeding intervals were calculated from clinical notes, and histologic evaluations were performed by 2 pathologists blinded to the bleeding intervals. A total of 177 cases were analyzed. Of these, 103 (58%) had histologic findings corroborating the clinical diagnosis of abruption. The most frequent finding was maternal surface indentation (51 cases) followed by intravillous hemorrhage (50 cases). The former was also the earliest finding, with a minimum bleeding interval of 4 minutes. In multivariate modeling, plasma cell deciduitis was significantly associated with a longer bleeding interval (median 63 hours). If there were 2 pathologic findings, there was a trend toward a longer bleeding interval. There was modest sensitivity for the pathologic diagnosis of acute revealed abruption. Although there was not a clear, stepwise progression of histologic lesions; the presence of 2 or more findings tended to be seen with longer bleeding intervals. Our results suggest that histologic findings cannot be used to time acute revealed abruptions reliably, and any interpretation of such should be made with caution.
AB - There is considerable interest in using pathology to confirm acute abruptions. It has been suggested that pathologic findings can help to determine the timing of abruptions. Because of the dearth of evidence in the literature supporting this claim and its medicolegal implications, we undertook this study to explore further the possibility of timing abruptions by histopathology. We sought to correlate bleeding interval (duration from maternal presentation with vaginal bleeding [revealed abruption] to placental delivery) with placental histopathologic findings. We performed a retrospective review of clinical data and placental pathology from all cases of clinically diagnosed, acute, revealed abruptions at a single, large institution in New England between 2000 and 2015. Cases were identified based on clinical diagnoses, bleeding intervals were calculated from clinical notes, and histologic evaluations were performed by 2 pathologists blinded to the bleeding intervals. A total of 177 cases were analyzed. Of these, 103 (58%) had histologic findings corroborating the clinical diagnosis of abruption. The most frequent finding was maternal surface indentation (51 cases) followed by intravillous hemorrhage (50 cases). The former was also the earliest finding, with a minimum bleeding interval of 4 minutes. In multivariate modeling, plasma cell deciduitis was significantly associated with a longer bleeding interval (median 63 hours). If there were 2 pathologic findings, there was a trend toward a longer bleeding interval. There was modest sensitivity for the pathologic diagnosis of acute revealed abruption. Although there was not a clear, stepwise progression of histologic lesions; the presence of 2 or more findings tended to be seen with longer bleeding intervals. Our results suggest that histologic findings cannot be used to time acute revealed abruptions reliably, and any interpretation of such should be made with caution.
KW - Acute abruption
KW - Chorioamnionitis
KW - Decidual inflammation
KW - Placenta
KW - Retroplacental hematoma
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U2 - 10.1016/j.humpath.2017.08.007
DO - 10.1016/j.humpath.2017.08.007
M3 - Article
C2 - 28823573
AN - SCOPUS:85028940648
VL - 67
SP - 187
EP - 197
JO - Human Pathology
JF - Human Pathology
SN - 0046-8177
ER -