Unveiling the Enigma: Chronic Concealed Abruption Disguised as Placentomegaly
Abstract:
Here we present a case of
Rh-negative Primigravida with 22 weeks gestation who presented to us with USG
report of a live fetus with FGR, placentomegaly with oligohydramnios without
any clinical symptoms and later diagnosed to be a case of chronic abruption
oligohydramnios sequence (CAOS). Initially, all differentials of Placentomegaly
like placental chorioangioma, placental mosaicism, chronic concealed abruptio
placenta or placental tumours such as placental mesenchymal dysplasia were
considered. Regular antenatal workup was carried out for the patient which
revealed an incidental heart disease probably of rheumatic origin and the
patient was managed accordingly. The patient was planned for termination of
pregnancy in view of subsequent anhydramios in the midst of which the patient
developed cardiac complications. The patient was stabilized and taken up for
emergency hysterotomy which intraoperatively revealed retroplacental clots and
altered blood as evidence of premature separation of placenta clinching the
diagnosis of CAOS. Since CAOS can lead to fetal morbidity and mortality,
decision-making has to be carried out regarding accelerating fetal lung
maturity and neuroprotection or termination of pregnancy after carefully
weighing out the fetomaternal outcomes.
References:
[1]. Weerakkody Y., 2024, Placentomegaly Radiology Reference Article Radiopaedia.org. In: Radiopaedia [Internet], Doi:10.53347/rID-13573.
[2]. Rohilla M, Siwatch S, Jain V, Nijhawan R., 2024, Placentomegaly and Placental Mesenchymal Dysplasia. BMJ Case Rep. 2012, bcr2012007777. Doi:10.1136/bcr-2012-007777.
[3]. Yonai NB, Mandel R, Shteel S, Lavie O, Goldberg Y. VP38.02: Severe Placentomegaly and Intrauterine Growth Restriction In A Persistently Hypoxemic Pregnant Woman with a Single Cardiac Ventricle. Ultrasound in Obstetrics & Gynecology. 2020;56: 222–223. Doi:10.1002/uog.22921.
[4]. Chigusa Y, Mogami H, Minamiguchi S, Kido A, Ishida A, Kurata Y, et al., 2022, Chronic abruption-oligohydramnios sequence (CAOS) revisited: possible implication of premature rupture of membranes. J Matern Fetal Neonatal Med;35: 6894–6900. Doi:10.1080/14767058.2021.1929159.
[5]. Tikkanen M, Nuutila M, Hiilesmaa V, Paavonen J, Ylikorkala O., 2006, Clinical presentation and risk factors of placental abruption. Acta Obstet Gynecol Scand. 85: 700–705. Doi:10.1080/00016340500449915.
[6]. Fleming AD., 1991, Abruptio placentae. Crit Care Clin. 7: 865–875.
[7]. Mohanty GS, Katoch T, Siwatch S, Lamba DS, Sharma RR., 2023, Chronic Abruptio Placentae with Multiple Alloantibodies: An Obstetrician’s Challenge. Cureus. 15: e47762. Doi:10.7759/cureus.47762.
[8]. Nyberg DA, Cyr DR, Mack LA, Wilson DA, Shuman WP., 1987, Sonographic spectrum of placental abruption. AJR Am J Roentgenol.148: 161–164. Doi:10.2214/ajr.148.1.161.
[9]. Harris BAJ, Gore H, Flowers CEJ., 1985, Peripheral Placental Separation: A Possible Relationship to Premature Labor. Obstetrics & Gynecology. 66: 774.
[10]. Redline RW, Wilson-Costello D., 1991, Chronic peripheral separation of placenta. The significance of diffuse chorioamnionic hemosiderosis. Am J Clin Pathol. 111: 804–810. Doi:10.1093/ajcp/111.6.804.
[11]. Jain P, Yadav R, Jaiswal N, Agarwal K., 2021, Live Pregnancy with Chronic Abruption-oligohydramnios Sequence: A Case Report. JCDR. Doi:10.7860/JCDR/2021/50455.15773.
[12]. Braun P, Kazmi K, Nogués-Meléndez P, Mas-Estellés F, Aparici-Robles F., 2007, MRI findings in spinal subdural and epidural hematomas. Eur J Radiol. 64: 119–125. Doi:10.1016/j.ejrad.2007.02.014.
