Multiple Placental Abruptions With Fetal Loss: A Case Report and Review of the Literature

The risk for negative outcomes in a pregnancy increases substantially when the placenta disconnects from the endometrial lining too soon before birth. This serious complication in obstetrics is known as placental abruption. Here, we describe a 39-year-old G5P4003 patient at 32 weeks of gestation who presented to the emergency department complaining of absent fetal movement and abdominal pain. Her medical history was notable for multiple high-risk factors, including a past placental abruption with fetal demise, requiring cesarean delivery at 39 weeks. She reported taking her antihypertensive medications consistently but admitted she had missed her most recent prenatal appointment. The emergency ultrasound confirmed a repeat abruption. The patient in this case had many risk factors for placental abruption, including gestational hypertension, preeclampsia and eclampsia, and advanced maternal age, as well as a previous pregnancy resulting in an abruption with fetal demise. High-risk patients such as these need to work closely with their medical team and follow the recommended guidelines to have the best chance of a healthy delivery. Still, this case exposes weaknesses in the current protocols for delivery timing and monitoring of high-risk pregnancies, as well as highlighting the importance of thorough patient education. Further research is needed to develop improved evidence-based recommendations for the best management practices, delivery schedules, and risk stratification in pregnancies at high risk of abruption.