Teenage pregnancy as a risk factor for placental abruption: Findings from the prospective Japan environment

and children’s study

Kyozuka, H., et al.

I. Summary
Placental abruption, a significant obstetric complication, affects both maternal and neonate mortality
and morbidity. It can lead to maternal consequences such as excessive blood loss, hypovolemic shock,
multiorgan failure, peripartum hysterectomy, and death. Neonatal consequences include preterm birth
and related hypoxia or asphyxia. Several risk factors, such as advanced and younger maternal age; number
of previous deliveries; hypertension before pregnancy; maternal smoking; ethnicity and pregnancy related
complications such as preeclampsia, chorioamnionitis, and preterm rupture of membrane, a complication
resulting in preterm birth, have been reported for placental abruption. Advanced maternal age has been
a focus in studies, but few have comprehensively assessed both teenage and advanced maternal age.
This study evaluated the effect of maternal age on placental abruption in Japan's largest prospective birth
cohort study between 2011 and 2014.

II. Reflection to the Journal

In the Japanese general population, besides advanced maternal age, teenage pregnancy was
associated with placental abruption. Recently, the mean maternal age has been changing in Japan.
Therefore, it is important for obstetric care providers to provide proper counseling to young women based
on up-to-date evidence. The incidence of placental abruption varies by area. In several countries, the
prevalence has risen over the last decade, presumably as a result of changes in risk variables such as
growing maternal age, BMI, and increased use of assisted reproductive technology (ART). According to the
data, the average mother age is rising, implying that maternal age may be a major risk factor for obstetric
problems in Japan.

III. Nursing Implications

A. To Nursing Practice
In this study, it is important to know what are the Clinical profiles, risk factors and in hospital outcomes
of patients who are at risk for abruptio placenta in order to perform an appropriate nursing practice for
the patients in the ward. Nurses are responsible for educating patients and family members/cares
about their care, including the pathogenesis of hemorrhage, usual treatment provided, personal risk
factors, medications, signs and symptoms, use of emergency medical services and procedures, and
strategies to reduce further risks.
B. To Nursing Education
This journal will help the nursing education in which it can provide information that will enhance the
knowledge regarding awareness of medications for abruptio placenta. This journal could help raise
teaching standards for clinical and community health workers. This will supply updates within the body
of knowledge needed to be learned by the nursing students, students will be implementing knowledge
dissemination and care to patient that is timely, with high standard and quality.
C. To Nursing Research
There will be a continuity of knowledge and goal project advancement within the nursing
healthcare practice for there would be baseline data like this journal that would pacify the need of
continuously having to do researches, literature review and journal readings because these are the
very foundation of reliability, standard, effective and efficient patient care.

This study also has a few limitations. First, this study lacked the definition of placental
abruption and the data for type (occurred during antepartum or intrapartum) and severity.
The severity of placental abruption could have been graded based on the maternal (disseminated
intravascular coagulation, hypovolemic shock, renal failure), fetal (non-reassuring fetal
status, intrauterine fetal growth restriction, intrauterine fetal death), or neonatal (preterm
delivery, small for gestational age, or neonatal death) complications [28]. The severity usually
causes premature placental separation. Therefore, the higher occurrence of abruption-related
complications such as the rate of CS; pH<7.20, <7.10, and <7.00; IUFD; and maternal transfusion could
minimize this limitation. Second, the specific ART methods (in vitro fertilization
and/or intracytoplasmic sperm injection; cryopreserved, frozen, or blastocyst embryo transfer)
were not classified in this study. Third, this study included individuals of the same ethnicity,
therefore whether these results can be applied to other ethnic groups is unknown.