Objective Although retroplacental hemorrhage is a major cause of fetal death, its etiology often remains obscure. In some reports, cocaine use by pregnant women has been associated with retroplacental hemorrhage and clinical abruptio placentae. This study was designed to assess the occurrence of chorionic villus hemorrhage, an entity shown recently to be associated with retroplacental hemorrhage, in the placentas of cocaine users.
Methods Twenty-nine placentas from cocaine users and 15 placentas from drug-free controls, as determined by questionnaire and urine toxicology screen, were examined prospectively, and pathological findings documented. The prevalence of retroplacental hemorrhage, chorionic villus hemorrhage, edema, chorioamnionitis, funisitis, infarction, fetal vessel thrombosis, and intervillus hemorrhage was examined in the two groups.
Results Chorioamnionitis was the most frequent finding in both groups (58% of cocaine users, 66% of controls). Edema of moderate severity or greater was found only in the cocaine-using group (17%). The prevalence of chorionic villus hemorrhage among women using cocaine also was 17%.
Conclusion Cocaine use during pregnancy may be associated with chorionic villus hemorrhage and villus edema, even in the absence of clinical abruptio placentae. The relationship between abnormal placental morphology and adverse perinatal outcomes remains to be determined.
Address reprint requests to: Eoghan E. Mooney, MB, MRCpath, Armed Forces Institute of Pathology, Department of Gynecologic and Breast Pathology, Bldg 54, Rm 1070, 14th & Alaska Avenue NW, Washington, DC 20306-6000.
© 1998 The American College of Obstetricians and Gynecologists
In cocaine users with no clinical evidence for abruptio placentae, the prevalence of chorionic villous hemorrhage is 17% and of villous edema 17%.