Chorioamniotic Separation Found on Obstetric Ultrasound and Perinatal Outcome

Abstract

Objective This study aims to evaluate pregnancy outcomes in patients with spontaneous and iatrogenic chorioamniotic separation diagnosed by ultrasound after 17 weeks.

Methods This is a retrospective cohort study of women with a singleton pregnancy who were diagnosed with chorioamniotic separation (n = 106) after 17 weeks' gestation from January 2000 to January 2013. Patients with chorioamniotic separation were compared with a group of patients who had obstetric ultrasounds without a diagnosis of chorioamniotic separation. Those without chorioamniotic separation were matched (1:1) on gestational age on the date of the ultrasound ( ± 2 weeks) (n = 106). The primary outcome was preterm delivery (< 37 weeks). Secondary outcomes included intrauterine growth restriction, stillbirth, and neonatal morbidity.

Results The rate of preterm delivery was significantly higher for those with chorioamniotic separation than for those without (57.5 vs. 17.1%, p < 0.0001). There were no significant differences in the rate of aneuploidy, intrauterine growth restriction, stillbirth, or neonatal demise. The rate of stillbirth was significantly higher among those with chorioamniotic separation diagnosed before 24 weeks as compared with those diagnosed after 24 weeks (9.7 vs. 0%, p = 0.03).

Conclusions Chorioamniotic separation is associated with preterm delivery. If diagnosed before 24 weeks, the rate of stillbirth is significantly higher.

Keywords

chorioamniotic separation - preterm delivery rate - stillbirth - aneuploidy

Note

The study is original research that was performed at the Brigham and Women's Hospital, Boston, MA. The authors report no conflict of interest and there was no financial support provided for this project.

• References

• 1 Kim YN, Jeong DH, Jeong SJ, Sung MS, Kang MS, Kim KT. Complete chorioamniotic membrane separation with fetal restrictive dermopathy in two consecutive pregnancies. Prenat Diagn 2007; 27 (4) 352-355
• 2 Bromley B, Shipp TD, Benacerraf BR. Amnion-chorion separation after 17 weeks' gestation. Obstet Gynecol 1999; 94 (6) 1024-1026
• 3 Levine D, Callen PW, Pender SG , et al. Chorioamniotic separation after second-trimester genetic amniocentesis: importance and frequency. Radiology 1998; 209 (1) 175-181
• 4 Benacerraf BR, Frigoletto Jr FD. Sonographic observation of amniotic rupture without amniotic band syndrome. J Ultrasound Med 1992; 11 (2) 109-111
• 5 Graf JL, Bealer JF, Gibbs DL, Adzick NS, Harrison MR. Chorioamniotic membrane separation: a potentially lethal finding. Fetal Diagn Ther 1997; 12 (2) 81-84
• 6 Sydorak RM, Hirose S, Sandberg PL , et al. Chorioamniotic membrane separation following fetal surgery. J Perinatol 2002; 22 (5) 407-410
• 7 Ulm B, Ulm MR, Bernaschek G. Unfused amnion and chorion after 14 weeks of gestation: associated fetal structural and chromosomal abnormalities. Ultrasound Obstet Gynecol 1999; 13 (6) 392-395
• 8 Lewi L, Hanssens M, Spitz B, Deprest J. Complete chorioamniotic membrane separation. Case report and review of the literature. Fetal Diagn Ther 2004; 19 (1) 78-82
• 9 Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2013. Natl Vital Stat Rep 2015; 64 (1) 1-65
• 10 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (2) 377-381