Unveiling the Enigma: Chronic Concealed Abruption Disguised as Placentomegaly

Here we present a case of Rh-negative Primigravida with 22 weeks gestation who presented to us with USG report of a live fetus with FGR, placentomegaly with oligohydramnios without any clinical symptoms and later diagnosed to be a case of chronic abruption oligohydramnios sequence (CAOS).Initially, all differentials of Placentomegaly like placental chorioangioma, placental mosaicism, chronic concealed abruptio placenta or placental tumours such as placental mesenchymal dysplasia were considered.Regular antenatal workup was carried out for the patient which revealed an incidental heart disease probably of rheumatic origin and the patient was managed accordingly.The patient was planned for termination of pregnancy in view of subsequent anhydramios in the midst of which the patient developed cardiac complications.The patient was stabilized and taken up for emergency hysterotomy which intraoperatively revealed retroplacental clots and altered blood as evidence of premature separation of placenta clinching the diagnosis of CAOS.Since CAOS can lead to fetal morbidity and mortality, decision-making has to be carried out regarding accelerating fetal lung maturity and neuroprotection or termination of pregnancy after carefully weighing out the fetomaternal outcomes.