Case history
Case history
A 42-year-old smoker presented to labor and delivery at 28 weeks' gestation with worsening abdominal pain of a few hours' duration. She had also had some vaginal bleeding within the past hour. She was found to have low-amplitude, high-frequency uterine contractions, and the fetal heart rate tracing showed recurrent late decelerations and reduced variability. Her uterus was tender and firm to palpation.
Other presentations
Although the most frequent symptom is abdominal pain, lower back pain may be the main symptom if the placenta is implanted posteriorly. Preterm labor is also common, especially with severe abruption.[2] In a concealed abruption, bleeding occurs from placental separation but the blood does not escape from the vagina, and accumulates in the uterus instead. Atypical presentations of a concealed abruption are a nonreassuring fetal heart tracing and DIC. Asymptomatic concealed abruption may occasionally be detected on routine sonography. In these cases, the abdomen is typically tender over the uterus, and the uterus may be rigid to palpation. Intrauterine growth restriction may also be associated with abruption.[2]
An abruption should be considered severe if it is accompanied by any of the following: fetal death, nonreassuring fetal status, preterm birth (regardless of severity of maternal symptoms), intrauterine growth restriction, disseminated intravascular coagulopathy (DIC), maternal death, renal failure, hypovolemic shock, or need for transfusion or hysterectomy.[2]
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