Presentation
Fourth pregnancy, with three previous first-trimester miscarriages requiring curettage. Currently, at 33 weeks and 6 days of gestation, cervical cerclage was performed during this pregnancy. The patient had been under outpatient follow-up at our hospital, with close monitoring due to oligohydramnios and previous pregnancy losses. During a routine evaluation, fetal bradycardia was evident, prompting an obstetric ultrasound. The patient had no obstetric complaints.
Patient Data
At the ultrasound, the priority was to check fetal vitality and the status of maternal-fetal circulation. Thus, the selected images show in sequence the spectral Doppler study of normal fetal heart rate, umbilical artery, and middle cerebral artery.
A comprehensive obstetric examination was conducted; however, additional images will be omitted from this publication to keep this presentation concise.
While scanning the placenta, something caught our attention in the retroplacental region. The placenta had an anterior implantation, and the umbilical scar cast an acoustic shadow over a point that drew attention. We carefully applied ultrasound gel over the umbilical scar, and the image became clearer, revealing an elongated hypoechoic area retroplacentally, measuring 3.8 x 1.0 x 8.5 cm, which could correspond to the region of detachment or retroplacental hematoma.
The surgical specimen clearly shows an area of detachment with retroplacental hematoma, consistent with the ultrasonographic image.
Case Discussion
The patient had no obstetric complaints. She was without pain, bleeding, or vaginal fluid loss. She attended a routine medical appointment due to oligohydramnios in this pregnancy and previous pregnancy losses. Following fetal bradycardia observed in the office, an obstetric ultrasound was indicated, revealing an image compatible with placental abruption. The patient underwent an emergency cesarean section, which proceeded without complications, and her baby showed good vitality. Both were discharged from the hospital 48 hours after delivery.
Acknowledgements: Special thanks to Dr Giovanni B. P. Lima, Radiologist and staff physician at HC-UFTM.
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