Portal de Periódicos da CAPES

Risk factors of abruptio placentae among Peruvian women

2007; Elsevier BV; Volume: 196; Issue: 3 Linguagem: Inglês

10.1016/j.ajog.2006.09.034

1097-6868

Olivia Fiori, Lieve Verstraete, Nadia Berkane,

Maternal and fetal healthcare

We read with interest the article by Sanchez et al,1Sanchez S.E. Pacora P.N. Farfan J.H. et al.Risk factors of abruptio placentae among Peruvian women.Am J Obstet Gynecol. 2006; 194: 225-230Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar examining potential risk factors for abruptio placentae (AP) in Peruvian women. Their study involved 255 cases and 258 controls. Most previous reports describe large retrospective epidemiologic studies. These generally failed to examine all clinical and biologic features of pregnancy, or the time interval between the onset of pathologic modifications and placental abruption. The study by Sanchez et al1Sanchez S.E. Pacora P.N. Farfan J.H. et al.Risk factors of abruptio placentae among Peruvian women.Am J Obstet Gynecol. 2006; 194: 225-230Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar is one of the first medium-sized studies to include a thorough data analysis. However, we are disappointed that Sanchez et al1Sanchez S.E. Pacora P.N. Farfan J.H. et al.Risk factors of abruptio placentae among Peruvian women.Am J Obstet Gynecol. 2006; 194: 225-230Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar did not consider biologic data such as the plasma α-fetoprotein level, which has been linked to the risk of AP.2Chandra S. Scott H. Dodds L. Watts C. Blight C. Van Den Hof M. Unexplained elevated maternal serum alpha-fetoprotein and/or human chorionic gonadotropin and the risk of adverse outcomes.Am J Obstet Gynecol. 2003; 189: 775-781Abstract Full Text Full Text PDF PubMed Scopus (92) Google Scholar Likewise, no mention is made of uterine artery Doppler waveforms,3Harrington K. Carpenter R.G. Goldfrad C. Campbell S. Transvaginal Doppler ultrasound of the uteroplacental circulation in the early prediction of pre-eclampsia and intrauterine growth retardation.BJOG. 1997; 104: 674-681Crossref Scopus (104) Google Scholar which are markers of vascular disease in pregnancy. These explorations may not be used routinely for pregnancy management in Peru, but their value must be underlined. The control group of the study by Sanchez et al was very different from white populations, with rates of cesarean section, prematurity, and neonatal intensive care of 56.2%, 20.2%, and 11.3 %, respectively. The rate of preclampsia/eclampsia among the control subjects was 11.6%, a value 10 times higher than generally reported, possibly influencing the calculated odds ratio. Smoking,4Ananth C.V. Smulian J.C. Vintzileos A.M. Incidence of placental abruption in relation to cigarette smoking and hypertensive disorders during pregnancy: a meta-analysis of observational studies.Obstet Gynecol. 1999; 93: 622-628Crossref PubMed Scopus (140) Google Scholar which has been forwarded as an etiologic factor in AP, did not emerge as a risk factor in the Peruvian study, possibly because only 3.1% of the 513 subjects smoked. As pointed out by the authors, this is an unusually small proportion. The work of Sanchez et al has the merit of being one of very few clinical studies of AP, but their conclusions may not be applicable to other populations. Further studies are needed to identify factors predictive of AP in non-Peruvian populations.