Association between hypertensive disorders of pregnancy and third stage of labor placental complications

Objective: To examine the association between hypertensive disorders of pregnancy and third stage placental complications. Methods: A retrospective cohort study based on Soroka Medical Center institutional computerized database. All vaginal deliveries of women between the years 1998-2013 were included. Rates of third placental complications and other adverse pregnancy outcomes were compared between parturients with and without hypertensive disorders of pregnancy. Multivariate analysis models as well as generalized equations models (GEE) controlling for potential confounders were constructed. Results: Of 263,053 deliveries included, 14,754 (5.6%) were complicated by hypertensive disorders of pregnancy. Hypertensive parturients were older, had higher rates of: diabetes, previous cesarean section and induction of labor. Rates of third stage placental complications were significantly higher among hypertensive parturients (4.7% versus 4.0%, p value < 0.001). Preeclampsia was found independently associated with third placental complication in the logistic regression and the GEE models constructed. Adjusted odds ratio, 95% confidence interval, respectively: 1.11 (1.00-1.24); 1.11 (1.00-1.25). Conclusion: Our study was the first to demonstrate that an association between hypertensive disorders of pregnancy and third stage placental complications exists, suggesting a common pathological pathway. Further larger studies are needed in order to reinforce these findings.