Co-existence of spontaneous rupture of uterine artery and placental abruption

Abstract

vaginal bleeding with no evidence of prelabour rupture of the membranes. No cause was found to explain her presenting symptoms. Her antenatal period was otherwise uneventful. Her blood group was O Rhesus positive with no antibodies detected at her booking antenatal visit. On admission, she was comfortable without palpable uterine activity. Her abdomen was soft and non-tender. Her blood pressure was 138/77 mmHg with a pulse rate of 103 beats per minute, regular with good volume. A small amount of altered blood was noted on her sanitary towel. An abdominal ultrasound scan showed that the placenta was posterior, not low lying with no evidence of placental separation. A 10◊6◊4 cm intrauterine haematoma described as mixed echogenocity was noted anteriorly and separate from the placenta. Cardiotocogram showed a reactive trace, and the Kleihauer test was negative. Her coagulation screen, platelet count and haemoglobin were normal. On the third day after her admission she suddenly became unwell, appeared clammy and complained of abdominal pain. Her blood pressure was 90/45 mmHg with a pulse rate of 90 beats per minute. Abdominal examination revealed a hard, tender and tense uterus. Cardiotocography showed a baseline fetal heart rate of 120 beats per minute with a baseline variability of less than 5 beats per minute. There was a deceleration to 90 beats per minute lasting for a minute. A clinical diagnosis of placental abruption was made. A cardiotocogram performed 2 hours before her collapse showed a baseline fetal heart rate of 150 beats per minute with baseline variability between 10 and 15 beats per minute. Accelerations were noted throughout the hour-long trace, with no decelerations. Her haemoglobin was 10´6 g/dl, white cell count of 15´9◊10 9 /l,