Presentation
Trauma. 37 weeks pregnant.
Patient Data
Chest
No traumatic aortic injury or mediastinal hematoma. The lungs and pleural spaces are clear. Midshaft fracture of the right clavicle. Undisplaced fracture of the lower sternum. No rib, or scapula fractures.
Abdomen and pelvis
Single fetus with a cephalic presentation, size appropriate for a third-trimester pregnancy. Anterior placenta. Lack of enhancement of the inferolateral (left) aspect of the placenta with some undermining of the placenta inferiorly is suspicious for traumatic placental abruption, involving less than 25% of the placental volume. The liver, spleen, pancreas, kidneys and adrenal glands are normal. Bowel and mesentery are normal. No free fluid or gas. No pelvic fracture.
Thoracic and lumbar spine
Alignment is normal. No fracture is seen.
IMPRESSION
- Right clavicular and sternal fracture.
- Probable placental abruption involving < 25 % of placental volume.
Case Discussion
US (not available) was also concerning for placental abruption. The patient proceeded to emergency cesarean delivery which delivered a normal, healthy neonate. Surgical notes indicated fresh blood clots upon entering the uterine cavity and at the placental edge, consistent with abruption.