EP17.68: A case report of a severe placental abruption as a first symptom of pre‐eclampsia

A 26 year-old Albanian girl at 38 weeks of gestation was presented in the emergency service with severe uterine bleeding and severe uterine tenderness with continued uterine contraction without any relaxation. Prior to presentation, the pregnancy had been completely uneventful. It was performed an ultrasonography immediately. Placenta was localised anteriorly and looks thicker than normally because of uterine tenderness and contractions. A hematoma with a hyperechogenic echotexture was visualised in the subchorionic area with these dimensions 6 cm×3 cm contributing in the thickness of placenta during this ultrasound examination. Fetal heart rate was 60 -70/min. So the diagnosis of a severe placental abruption was put and the decision for an emergency Caesarean section was taken immediately. The male fetus was delivered with weight 2280 gram with an APGAR of 3/7/8 and needed admission to the neonatal intensive care unit and CPAP ventilation. During the control of the placenta a big amount of blood clots were detected on it explaining severe placental abruption. The Couvelaire uterus was detected as a complication of placental abruption. After application of uterotonics the uterus was contracted stopping uterine hemorrhage. Later begun the hypertensive disorders. Arterial pressure was 190/100 mmHg, FC = 87/minute. Two days after Caesarean section all laboratory results were altered. LDH 1689 U/L, PLT 11000/uL, Reticulocit 3.5%, ALT 46U/L, AST 70 U/L, CR Proteina 10,17mg/dl, Creatinemia 1.47 mg/dl, Azotemia 56.99 mg/dl, Total bilirubin 1.0 mg/dl, D-dimer 5.87ug/ml, Fibrinogen 310 mg/dl, RBC 2.86 million/uL, HGB 8.2 g/dl and PT, INR, APTT normal. All these showed for a Hellp syndrome. So immediately the patient was sent to the intensive care unit for a better treatment and management. Seven days later the patient was recovered and discharged from the intensive care unit with these results: ALT 18U/L, AST 13.5 U/L, Total Bilirubin 0.32 mg/dl, LDH 632 U/L, RBC 2.92 million/uL, HGB 8.5 g/dl, PLT 158000/uL.