Chronic Abruption Oligohydramnios Sequence

Abstract

Abruption is a significant cause of both maternal morbidity and neonatal morbidity and mortality, particularly when it occurs preterm. Women with chronic abruption experience relatively light, chronic, intermittent bleeding. They are at risk of developing clinical manifestations of ischemic placental disease over time, such as oligohydramnios (termed chronic abruption-oligohydramnios sequence [CAOS]), fetal growth restriction, and preeclampsia. They are also at risk of preterm prelabor rupture of membranes. CAOS is manifested by chronic bleeding, placental insufficiency, and oligohydramnios. Oligohydramnios is presumably due to hypoxic fetal response and decreased urine output. At 22 weeks, 3 days gestation, the patient was seen in our maternal fetal medicine (MFM) clinic as a consultation from another hospital about an hour away. Her personal life had been very difficult: She was going through a divorce, had two other children whose father was not involved, had an unplanned pregnancy, her brother had just committed suicide, and her father was missing for more than 3 months. Not only was she at risk for having a severely premature newborn to care for, but she had many personal obstacles that our team had to consider to make a prolonged hospital stay work for her and her family. Our MFM clinic discussed the plan with the patient: hospitalization at 23 weeks with bedrest until the planned birth at 34 weeks. Our multidisciplinary team (MFM, neonatology, NICU nurses, labor nurses, a social worker, a psychiatrist, dietary, family patient experience specialist) developed a comprehensive, holistic care plan that enabled us to not only provide quality maternal and fetal care but also provide her family with care during her 10-week stay at our facility. Her baby was born at 33 weeks, 1 day gestation, just a little more than 10 weeks after arriving on our unit. A multidisciplinary team provided this patient with the best possible outcome. Our unit also did our best to provide this long-term patient with continuity of care by assigning a group of nurses who knew her well and could provide consistent and supportive care related to her specific needs.