Atypical presentation of placental abruption
Mounir Moukit1,&, Jaouad Kouach1,2
1Department of Obstetrics and Gynecology, Military Training Hospital Mohammed V, Hay Riyad, 10100, Rabat, Morocco, 2Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
Mounir Moukit, Department of Obstetrics and Gynecology, Military Training Hospital Mohammed V, Hay Riyad, 10100, Rabat, Morocco
A 25-year-old primigravida with no significant medical history was referred
to our department, at 30 weeks´ gestation, for threatened preterm labor.
On general examination, the patient was afebrile with normal vital signs.
Obstetrical examination revealed fundal height corresponding to gestational
age and regular uterine contractions without uterine rigidity. Fetal heart
rate was normal. On speculum, the cervix was macroscopically normal without
bleeding, amniotic fluid or vaginal discharge. Vaginal examination objectified
an open cervix (2cm). Ultrasound scan showed a single live intrauterine fetus
in cephalic presentation of 29-30 weeks with oligoamnios. Placenta was
anterior and thick with a hyper echoic basal area measuring 8cmx3cm suggestive
of placental abruption. Her blood investigations were normal. Under spinal
anesthesia, an emergent caesarean section was performed giving birth to a
male newborn, weighing 1200g with normal Apgar scores. Macroscopic examination
of the placenta confirmed the retro placental clot in maternal surface. The
postoperative period was uneventful for patient and the newborn was transferred
to neonatal intensive care unit. The highly variable presentation of placental
abruption makes the clinical diagnosis difficult. As was in the present case,
it should be suspected in any case of unexplained threatened preterm labor.
Ultrasound evaluation can play a role in the diagnosis of acute placental
abruption especially in those with atypical clinical presentation.
Figure 1: A) obstetrical ultrasound objectified the retroplacental hematomas (white arrows); B) macroscopic view of the adherent blood clot on maternal surface (white arrows)