146 Early placental abruption – Case report in a tertiary service in Western Amazon

Abstract

Abruptio Placentae (AP) is the premature separation of the normal inserted placenta and constitutes an important cause of maternal and perinatal morbidity and mortality in the third trimester. The AP is associated with a set of morphological, molecular or functional alterations of the placenta and hypertension works as a considerable risk factor. The direct cause of detachment is the breakdown of maternal blood vessels in the decidua basalis. To report a case of hypovolemic shock associated with placental abruption and stillbirth involving a teenager pregnant. This is a case report regarding a pregnant 17-years-old, Gesta 2 Para 1, admitted to the Dr. Ary Pinheiro Base Hospital in Porto Velho – Brazil. Patient presented abdominal pain and heavy bleeding for more than three hours. Antenatal care had not been initiated yet and no information was given about the last menstrual period. Patient presented hemodynamic instability, pallor (3+/4+) and blood pressure 80 × 60 mmHg. Obstetric evaluation demonstrated moderate vaginal bleeding and 4 cm of cervical dilation. Laboratory parameters were: hemoglobin: 4.2 g/dL; hematocrit: 12.5%; leukocyte count 19,580/mm3, platelet count: 75.000/mm3, prothrombin time: 22.7 s activated thromboplastin time: 45/2, ultrasound scan showed placental abruption and fetal demise. The patient underwent to immediate cesarean section which evidenced premature single and macerated fetus and complete detached placenta. Uterine wall was infiltrated in approximately 70–80% of whole uterus (Courvelaire Uterus). After intervention patient received 4 packs of plasma and 3 packs of red blood cells. Triple antibiotic therapy was also prescribed. Patient had satisfactory recovery, with good general condition, with normally contracted uterus below the umbilical scar and physiological lochia. Surgical wound was clean and dry, with no signs of inflammation. Perinatal outcomes in the presence of placental abruption are usually unfavorable, but immediate diagnosis and delivery are crucial in order to improve these outcomes. In addition, emergency caesarean section may be indicated either by maternal or fetal indication.