Obstetric Emergencies

Answer 5 Abruptio placentae.Abruptio placentae, defined as a premature separation of the placenta from the uterine wall, is commonly seen with blunt abdominal trauma and can cause fetal distress. It occurs in 1% to 3% of pregnant women with minor trauma and in 40% to 50% with major life-threatening trauma.8,9 Abruption may present with vaginal bleeding, abdominal pain and tenderness, uterine contractions, or fetal distress; however, it may be occult with not vaginal bleeding in up to 20% of cases. Abruptio placentae may be missed on ultrasound examination. The gold standard for evaluation of placental abruption is cardiotocographic monitoring to detect uterine irritability and fetal distress. A cesarean section may be necessary to save the fetus in severe cases of placental abruption. Fetal malformations are not linked to trauma specifically. However, radiation exposure in early pregnancy may lead to fetal malformation. Placenta accreta, an obstetric complication involving an abnormal superficial attachment of the placenta to the myometrium, and placenta previa, an implantation of the placenta over the lower part of the uterus covering all of the internal cervical os, are not linked to trauma. Although premature labor may occur as a consequence of abdominal trauma, premature rapture of membranes is not specifically linked to trauma.8,9 REFERENCES 8. Fleming AD. Abruptio placentae. Crit Care Clin 1991;7:865–75. 9. Pearlman MD, Tintinalli JE. Evaluation and treatment of the gravida and fetus following trauma during pregnancy. Obstet Gynecol Clin North Am 1991;18:371–81. Click here to return to the questions

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