Traumatic placental abruption and intra-uterine fetal death

Case contributed by Assoc Prof Craig Hacking

Presentation

High speed motor vehicle accident.

Patient Data

Age: 30 years
Gender: Female

No fetal heart activity or color Doppler flow demonstrated. No color Doppler flow within middle cerebral arteries, aorta or umbilical arteries. 

Extensive isoechoic layering appears to extend across the entire placenta, without superimposed Doppler flow.

Impression

Large acute placental abruption which appears to extend across the entire placenta with subsequent intrauterine fetal death.

Single intrauterine fetus with a cephalic presentation. The uterus has an irregular contour at the right mid and inferior lateral edge and there is adjacent hyperattenuating fluid. Right anterolateral placenta has active contrast blush on angiogram with pooling of blood on PV phase imaging, in keeping with active placental bleeding. A 3cm focus of acute hemorrhage is adjacent to the inferior left uterus. 

Hyperattenuating fluid representing with hemorrhage is also demonstrated adjacent to the inferior liver and splenic edges. Liver and spleen otherwise appear normal with no parenchymal injury evident. 

Duplex left kidney. Both kidneys otherwise normal. Gallbladder, adrenal glands and pancreas have a normal appearance. 

Small bowel loops are adjacent to the inferior right aspect of the uterus where this is hemorrhage, however no discrete bowel injury is demonstrated. No free gas. 

Aorta, IVC and portal vein have a normal appearance. 

No pelvic or hip fractures. Normal lumbosacral spine.

Impression

  • Active placenta hemorrhage and irregular uterine wall as described with free intraperitoneal blood is concerning for uterine wall injury.
  • Small amount hemorrhage at the inferior liver and splenic edges without discrete injury demonstrated, most likely tracking up from uterine injury.
  • Small bowel loops are adjacent to the hemorrhage at the right inferior uterus, however no discrete bowel injury is demonstrated.

Case Discussion

Traumatic placental abruption is an unfortunate consequence of trauma to the gravid abdomen. Ultrasound, although the initial investigation in the pregnant trauma patient, is not as sensitive or specific for abruption as CT, but it nevertheless has to be performed initially to assess fetal wellbeing as well as for a maternal FAST.

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Case information

rID: 60496
Published: 22nd May 2018
Last edited: 13th Feb 2020
Inclusion in quiz mode: Included