Concealed Placental Abruption Complicating Hypertensive Disorders of Pregnancy: Exploring the Role of Point-of-Care Ultrasound

TL;DR

This paper discusses how point-of-care ultrasound can help detect hidden placental abruption in women with pregnancy-related hypertension, improving delivery decisions in low-resource areas.

Contribution

The study highlights the potential of point-of-care ultrasound in managing concealed placental abruption in hypertensive pregnancies.

Findings

Point-of-care ultrasound identified placental abruption in two cases of severe hypertensive disorders.

Cesarean section was promptly performed, confirming placental abruption in both cases.

One case resulted in stillbirth and postpartum hemorrhage, while the other had a healthy outcome.

Abstract

Placental abruption (PA) without vaginal bleeding is known to be associated with severe outcomes when compared to symptomatic cases; the presence of hypertensive disorders of pregnancy (HDP) is an additional negative prognostic factor. According to guidelines, severe HDP are indications for prompt delivery after maternal–fetal stabilization. Considering gestational age, parity and clinical obstetric examination, the induction of labor should be prioritized to avoid additional risks associated with cesarean section. However, since only a minority of cases of PA may be detected by ultrasonography (US), findings consistent with this suspicion should contribute to the establishment of an appropriate mode of delivery. We present two cases affected by severe HDP, eclampsia and HELLP syndrome, admitted to St. Luke Catholic Hospital, Wolisso, Ethiopia. In both cases, obstetric point-of-care (POC) US revealed a live premature fetus and a solid heterogeneous placental mass, raising the suspicion of concealed placental abruption. To expedite delivery, cesarean section was promptly offered. PA was confirmed in both cases; the first had stillbirth and postpartum hemorrhage, while the second ended up with healthy mother and newborn. In conclusion, POC-US imaging could play a role in optimizing delivery mode and timing for patients with HDP in low-resourced settings. Additional research is warranted to determine the impact of this technique in the management of obstetric emergencies.

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