Sonolucency of a fresh hematoma in a case of marginal placental abruption

Abstract

A 33-year-old primigravid woman was referred at 37 weeks of gestation for an unexpected vaginal bleeding with continuous weak uterine contractions. The antenatal course was uneventful until presentation. The amniotic membrane was intact, and vaginal discharge was blood-stained on vaginal examination. The fetal heart rate was reactive. An initial sonographic examination at that stage showed that the placenta was attached to the anterior uterine wall, but no previa or abruption was noted. Approximately 10min after the initial examination, a small wedge shaped sonolucent area appeared at the highest placental margin (Fig. 1). The lesion gradually increased in size. The diagnosis of marginal placental abruption was made. Cesarean section conducted immediately showed a couvelaire uterus. A female infant weighing 2.592g was born with Apgar scores of 1 and 5 at 1and 5min, respectively. A hen egg-sized retroplacental hematoma was located at the margin of the removed placenta. The patient and her infant had uneventful postoperative course.