Unpredictable Placental Abruption: Case Series

Abstract

Background: The diagnosis of placental abruption is primarily clinical, but findings from imaging, laboratory, and postpartum pathologic studies can be used to support the clinical diagnosis. In patients with classic symptoms, fetal heart rate abnormalities, intrauterine fetal demise, and/or disseminated intravascular coagulation strongly support the clinical diagnosis and indicate extensive placental separation. In a few cases, placental separation has not been recognized and was only identified upon cesarean section as an inciden-tal finding. Objectives: To describe the clinical presentations and pregnancy outcomes of placental abruption cases that are not diagnosed before cesarean delivery, termed “unpredictable placental abruption” and also cases diag-nosed before cesarean delivery, termed “predictable placental abruption”. Methods: A retrospective analysis of 100 cases of placental abruption wasidentified by cesarean delivery at Tu Du hospital from September 2018 to May 2019. Clinical variables were compared between the unpredictable and predictable groups. The unpredictable group consists of cases that are not di-agnosed before cesarean delivery, while the predictable caseswere identified placental separation before cesarean delivery. The maternal and fetal out-comes were also studied. Results: In 100 cases of placental, abruption by gross clinical examination of the placenta at the time operation revealed that, 33% were unpredictable. Placental abruption attributed to maternal complications included one case of total hysterectomy (1%) with no cases of disseminated intravascular coagulation (DIC), shock or maternal death; specifically, this case of total hysterectomy appeared with predictable one. There were two cases of stillbirths. Among the 98 live neonates, 15 cases (14.7%) experienced severe birth asphyxia resulting in eight neonatal deaths; two of which were caused by heart disease and necrotizing enterocolitis. Sixty-three neonates were delivered prematurely (61.74%), with mean gestational age of 34.64 ± 3.32 weeks. Among the 33 unpredictable cases, there were no stillbirths but 60.6% and 12.1% experienced moderate and severe asphyxia, respectively. All unpredictable cases had obvious indications of cesarean section but the basic symptoms and signs of acute placental abruption included the onset of pre-term labor, unspecified intrapartum hemorrhage, hypertonic uterine contrac-tions and fetal distress for emergency caesarian section; however there were also cases where there were no symptoms and signs. Conclusions: Unpre-dictable placental abruption cases—not suspected of having abruption, termed—“concealed” or “chronic” placental abruption, may have variable clinical manifestations and better pregnancy outcomes.