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    Abruptio Placenta Case Scenario

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    JR Rolf Neuqelet
    A 25-year-old woman at 33 weeks of gestation presented to the hospital with severe abdominal pain that had started 3 hours prior. Ultrasound showed signs of abruptio placentae including a large subchorionic hematoma and thickened placenta. She underwent an emergency c-section which found approximately 100mL of blood in the peritoneal cavity and a fresh clot in the uterus, confirming abruptio placentae. The newborn had very low Apgar scores, was diagnosed with cerebral hemorrhage, and died 60 days later.

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    Abruptio Placenta Case Scenario

    Uploaded by

    JR Rolf Neuqelet
    7 views2 pages
    A 25-year-old woman at 33 weeks of gestation presented to the hospital with severe abdominal pain that had started 3 hours prior. Ultrasound showed signs of abruptio placentae including a large subchorionic hematoma and thickened placenta. She underwent an emergency c-section which found approximately 100mL of blood in the peritoneal cavity and a fresh clot in the uterus, confirming abruptio placentae. The newborn had very low Apgar scores, was diagnosed with cerebral hemorrhage, and died 60 days later.

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    ABRUPTIO-PLACENTA-CASE-SCENARIO

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    A 25-year-old woman at 33 weeks of gestation presented to the hospital with severe abdominal pain that had started 3 hours prior. Ultrasound showed signs of abruptio placentae including a large subchorionic hematoma and thickened placenta. She underwent an emergency c-section which found approximately 100mL of blood in the peritoneal cavity and a fresh clot in the uterus, confirming abruptio placentae. The newborn had very low Apgar scores, was diagnosed with cerebral hemorrhage, and died 60 days later.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    7 views2 pages

    Abruptio Placenta Case Scenario

    Uploaded by

    JR Rolf Neuqelet
    A 25-year-old woman at 33 weeks of gestation presented to the hospital with severe abdominal pain that had started 3 hours prior. Ultrasound showed signs of abruptio placentae including a large subchorionic hematoma and thickened placenta. She underwent an emergency c-section which found approximately 100mL of blood in the peritoneal cavity and a fresh clot in the uterus, confirming abruptio placentae. The newborn had very low Apgar scores, was diagnosed with cerebral hemorrhage, and died 60 days later.

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    © All Rights Reserved
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    ABRUPTIO PLACENTA

    CASE SCENARIO
    A 25-year-old woman, gravida 2, para 1, reported to the hospital at 33 weeks of gestation
    with severe abdominal pain. She had a BMI of 24 and no previous history of unfavorable
    pregnancy. The abdominal pain had started three hours prior to admission, like a vague
    posterior abdominal colicky pain. The patient and her husband did not relate physical efforts
    prior the onset of the pain. She did not have abdominal surgery in the past. The course of
    pregnancy was regular including fetal growth.

    At the admission in the hospital the patient appeared pale, exhausted, unable to walk, and
    maintaining an upright position. She had nausea and episodes of vomiting. At triage blood
    pressure was 90–60 mmHg, heart rate was 120 beats per minute, and temperature was
    37.1°C. Abdominal pain was deep, diffuse, with no signs of peritonitis or lateral renal colic.
    Uterine growth was appropriate for gestational age and the organ was tender on palpation. On
    vaginal examination cervix was closed and there was no vaginal bleeding or abnormal
    vaginal discharges.

    Ultrasonography showed a single fetus in transverse lie, with a normal amniotic fluid.
    Placental location was clearly “anterior” with vast subchorionic hypoechogenic area
    interpreted as a sign of abruptio placentae. Placental tissue was hyperechogenic and thicker
    than normal. Fetal heart rate at ultrasound examination was 90 beats per minute. It was not
    possible to visualize and interrogate uterine arteries in their typical anatomical sites by Color
    Doppler and Pulsed Wave Doppler.

    An emergency caesarean section under general anesthesia was performed. Abdomen was
    opened by vertical incision. Peritoneal cavity contained approximately 100 milliliters of
    coagulated blood. Hysterotomy was done on “the lower uterine segment.” At rupture of
    membranes the amniotic fluid was clear. A male fetus in transverse lie was delivered by
    breech extraction. The fetus was alive but pale and hypotonic. A large quantity of fresh clots
    leaked from the uterus during the afterbirth. The placenta showed a large subchorionic
    haematoma. The uterus was ischemic and extremely floppy. A superficial bleeding laceration
    of the left part of the posterior wall that probably was the cause of the hemoperitoneum was
    also observed. There were no myomas or uterine malformations. The posterior uterine
    incision was closed by a standard two-layer suture. The uterus, after the administration of
    uterotonic, was properly contracted and it was then replaced into the abdomen. The estimated
    loss of blood was 1100 milliliters. The placenta was sent for pathologic examination that
    confirmed the clinical diagnosis of abruptio.

    Maternal conditions were stable after two hours. Haemoglobin concentration decreased from
    10.8 g/dL at admission to 8.5 g/dL. White blood cell count was 19.000/milliliter, almost
    halved from admission values (31.000/milliliter). C-reactive protein had always been
    negative. Analysing the previous reports and ultrasound images in the patient’s pregnancy
    record, it was confirmed that a posterior placental position had been observed at 22 weeks’
    scan, exactly the opposite of the anterior position that has been seen by ultrasound at the time
    of hospital admission.
    The newborn at birth weighted 2200 grams, Apgar score was 1, 3, and 5 at 1, 5, and 10
    minutes. A severe acute cerebral haemorrhage was diagnosed. The newborn was admitted at
    Neonatal Intensive Care Unit (NICU), never recovered his vital functions, and died sixty days
    after birth.

    The woman was discharged three days after caesarian section.

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