Research Article| Volume 171, ISSUE 2, P246-251, December 2013

Social disparity affects the incidence of placental abruption among multiparous but not nulliparous women: a register-based analysis of 1,162,126 singleton births

Published:September 26, 2013DOI:



      To identify risk factors for placental abruption and to evaluate associations between adverse perinatal outcomes and placental abruption stratified by parity among women with singleton births from 1991 to 2010 in Finland.

      Study design

      A retrospective population-based case–control study of singleton births in Finland from 1991 to 2010 (n = 1,162,126 from the Finnish Medical Birth Register). We modelled the group-specific risk factors for placental abruption in unadjusted and adjusted models.


      In total 3.5 and 3.7 per 1000 nulliparous and multiparous women, respectively, were affected by placental abruption. The recurrence rate was 8.6 per 1000 births. The adjusted risk for placental abruption increased in pregnancies characterised by advanced maternal age, low birth weight, smoking, major congenital anomaly, preeclampsia and male foetal sex in both parity groups. In vitro fertilisation increased the risk only in nulliparae whereas anaemia, a prior caesarean section and the lowest socioeconomic status increased the risk in multiparae. Births affected by placental abruption were associated with an increased admission for neonatal intensive care, preterm birth, low birth weight (<2500 g), small for gestational age infants, low Apgar scores, and low newborn umbilical vein pH (<7.15). Placental abruption resulted in increased risks of stillbirth and early neonatal death in both parity groups.


      The burden of placental abruption is equal in nulliparae and multiparae, but risk factors vary substantially. Social disparity only affects the incidence of placental abruption among multiparous women, indicating that factors related to lifestyle and health behaviour have different effects on the parity groups.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • Tikkanen M.
        Placental abruption: epidemiology, risk factors and consequences.
        Acta Obstet Gynecol Scand. 2011; 90: 140-149
        • Tikkanen M.
        • Riihimaki O.
        • Gissler M.
        • et al.
        Decreasing incidence of placental abruption in Finland during 1980-2005.
        Acta Obstet Gynecol Scand. 2012; 91: 1046-1052
        • Tikkanen M.
        • Nuutila M.
        • Hiilesmaa V.
        • Paavonen J.
        • Ylikorkala O.
        Clinical presentation and risk factors of placental abruption.
        Acta Obstet Gynecol Scand. 2006; 85: 700-705
        • Tikkanen M.
        • Luukkaala T.
        • Gissler M.
        • et al.
        Decreasing perinatal mortality in placental abruption.
        Acta Obstet Gynecol Scand. 2013; 92: 298-305
        • Ananth C.V.
        • Wilcox A.J.
        Placental abruption and perinatal mortality in the United States.
        Am J Epidemiol. 2001; 153: 332-337
        • Tikkanen M.
        • Gissler M.
        • Metsaranta M.
        • et al.
        Maternal deaths in Finland: focus on placental abruption.
        Acta Obstet Gynecol Scand. 2009; 88: 1124-1127
        • Pariente G.
        • Wiznitzer A.
        • Sergienko R.
        • Mazor M.
        • Holcberg G.
        • Sheiner E.
        Placental abruption: critical analysis of risk factors and perinatal outcomes.
        J Matern Fetal Neonatal Med. 2011; 4: 698-702
        • Ananth C.V.
        • Savitz D.A.
        • Williams M.A.
        Placental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis.
        Obstet Gynecol. 1996; 88: 309-318
        • Blumenshine P.
        • Egerter S.
        • Barclay C.J.
        • Cubbin C.
        • Braveman P.A.
        Socioeconomic disparities in adverse birth outcomes: a systematic review.
        Am J Prev Med. 2010; 39: 263-272
        • Niinimaki M.
        • Suhonen S.
        • Mentula M.
        • Hemminki E.
        • Heikinheimo O.
        • Gissler M.
        Comparison of rates of adverse events in adolescent and adult women undergoing medical abortion: population register based study.
        BMJ. 2011; 342: d2111
        • Gissler M.
        • Rahkonen O.
        • Arntzen A.
        • Cnattingius S.
        • Andersen A.M.
        • Hemminki E.
        Trends in socioeconomic differences in Finnish perinatal health 1991-2006.
        J Epidemiol Community Health. 2009; 63: 420-425
        • Sankilampi U.
        • Hannila M.L.
        • Saari A.
        • Gissler M.
        • Dunkel L.
        New population-based references for birth weight, length, and head circumference in singletons and twins from 23 to 43 gestation weeks.
        Ann Med. 2013; 45: 446-454
        • Hogberg V.
        • Rasmussen S.
        • Irgens L.M.
        The effect of smoking and hypertensive disorders on abruptio placentae in Norway 1999-2002.
        Acta Obstet Gynecol Scand. 2007; 86: 304-309
        • Rasmussen S.
        • Irgens L.M.
        • Albrechtsen S.
        • Dalaker K.
        Women with a history of placental abruption: when in a subsequent pregnancy should special surveillance for a recurrent placental abruption be initiated?.
        Acta Obstet Gynecol Scand. 2001; 80: 708-712
        • Ananth C.V.
        • Cnattingius S.
        Influence of maternal smoking on placental abruption in successive pregnancies: a population-based prospective cohort study in Sweden.
        Am J Epidemiol. 2007; 166: 289-295
        • Gissler M.
        • Shelley J.
        Quality of data on subsequent events in a routine medical birth register.
        Med Inform Internet Med. 2002; 27: 33-38
        • Gissler M.
        • Teperi J.
        • Hemminki E.
        • Merilainen J.
        Data quality after restructuring a national medical registry.
        Scand J Soc Med. 1995; 23: 75-80
        • Sund R.
        Quality of the Finnish Hospital Discharge Register: a systematic review.
        Scand J Public Health. 2012; 40: 505-515
        • Gissler M.
        • Merilainen J.
        • Vuori E.
        • Hemminki E.
        Register based monitoring shows decreasing socioeconomic differences in Finnish perinatal health.
        J Epidemiol Community Health. 2003; 57: 433-439
        • Mortensen L.H.
        • Lauridsen J.T.
        • Diderichsen F.
        • Kaplan G.A.
        • Gissler M.
        • Andersen A.M.
        Income-related and educational inequality in small-for-gestational age and preterm birth in Denmark and Finland 1987-2003.
        Scand J Public Health. 2010; 38: 40-45
        • Schieve L.A.
        • Cohen B.
        • Nannini A.
        • et al.
        A population-based study of maternal and perinatal outcomes associated with assisted reproductive technology in Massachusetts.
        Matern Child Health J. 2007; 11: 517-525
        • Matsuda Y.
        • Hayashi K.
        • Shiozaki A.
        • Kawamichi Y.
        • Satoh S.
        • Saito S.
        Comparison of risk factors for placental abruption and placenta previa: case-cohort study.
        J Obstet Gynaecol Res. 2011; 37: 538-546
        • Sun L.M.
        • Walker M.C.
        • Cao H.L.
        • Yang Q.
        • Duan T.
        • Kingdom J.C.
        Assisted reproductive technology and placenta-mediated adverse pregnancy outcomes.
        Obstet Gynecol. 2009; 114: 818-824
        • Grady R.
        • Alavi N.
        • Vale R.
        • Khandwala M.
        • McDonald S.D.
        Elective single embryo transfer and perinatal outcomes: a systematic review and meta-analysis.
        Fertil Steril. 2012; 97: 324-331
        • Yang Q.
        • Wen S.W.
        • Phillips K.
        • Oppenheimer L.
        • Black D.
        • Walker M.C.
        Comparison of maternal risk factors between placental abruption and placenta previa.
        Am J Perinatol. 2009; 26: 279-286
        • Tikkanen M.
        • Nuutila M.
        • Hiilesmaa V.
        • Paavonen J.
        • Ylikorkala O.
        Prepregnancy risk factors for placental abruption.
        Acta Obstet Gynecol Scand. 2006; 85: 40-44
        • Yang Q.
        • Wen S.W.
        • Oppenheimer L.
        • Chen X.K.
        • Black D.
        • Gao J.
        • et al.
        Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy.
        BJOG. 2007; 114: 609-613
        • Getahun D.
        • Oyelese Y.
        • Salihu H.M.
        • Ananth C.V.
        Previous cesarean delivery and risks of placenta previa and placental abruption.
        Obstet Gynecol. 2006; 107: 771-778
        • Kyrklund-Blomberg N.B.
        • Gennser G.
        • Cnattingius S.
        Placental abruption and perinatal death.
        Paediatr Perinat Epidemiol. 2001; 15: 290-297
        • Arnold D.L.
        • Williams M.A.
        • Miller R.S.
        • Qiu C.
        • Sorensen T.K.
        Iron deficiency anemia, cigarette smoking and risk of abruptio placentae.
        J Obstet Gynaecol Res. 2009; 35: 446-452