- Umbilical vein varix
- Timing of Cranial Markers in Open NTD
- Real world experience Open Neural tube defect and Brain Signs
- Real world experience First Trimester Megacystis – Management
- Real world experience Fetal Megacystis
- Abnormal facial profile
- Azygous Vein & ARSA
- Blakes Pouch Cyst
- Absent nasal bone (ANB)
- Choroid plexus cysts
- Chronic placental abruption
- Fetal Alcohol Syndrome
- Placenta-First Risk Stratification
Chronic Placental Abruption
It is under-recognized, often ultrasound-subtle, and clinically important because it primarily causes uteroplacental insufficiency rather than hemorrhagic shock.
Definition
• Recurrent or ongoing small placental separations over time
• Usually retroplacental or marginal
• Bleeding is often concealed rather than external
Pathophysiology
• Repeated micro-hemorrhages at the decidual–placental interface
• Formation of organized hematoma, fibrin deposition, placental infarction
• Progressive reduction in functional placental surface area
• Leads to chronic hypoxia, not acute fetal compromise
Risk factors
• Previous placental abruption
• Chronic hypertension
• Preeclampsia
• Smoking, cocaine
• Thrombophilias (especially acquired)
• Trauma
• Uterine anomalies
• Advanced maternal age
• IUGR in prior pregnancy
Clinical presentation
Maternal
• Recurrent spotting or brownish discharge
• Intermittent abdominal pain or uterine irritability
• Often hemodynamically stable
• May have anemia over time
Fetal
• Fetal growth restriction (most common clue)
• Reduced fetal movements
• Oligohydramnios
• Non-reassuring fetal testing in advanced cases
MUltrasound findings (often subtle)
Placental features
• Retroplacental hypoechoic or heterogeneous area
• Thickened placenta
• Irregular placental–myometrial interface
• Placental lakes with echogenic margins (old bleed)
• Subchorionic or marginal hematoma
Amniotic fluid
• Oligohydramnios common
Doppler findings
• Elevated umbilical artery PI
• Abnormal uterine artery Doppler
• MCA brain-sparing in advanced disease
• Abnormal CPR
Differentiation from acute abruptiondisease
| Feature | Chronic abruption | Acute abruption |
|---|---|---|
| Onset | Gradual | Sudden |
| Bleeding | Minimal or concealed | Heavy, painful |
| Maternal shock | Rare | Common |
| Fetal effect | Chronic hypoxia, FGR | Acute distress or demise |
| Ultrasound | Subtle | Often normal |
Maternal and fetal risks
Fetal
• Fetal growth restriction
• Preterm birth
• Oligohydramnios
• Stillbirth (usually late and related to chronic hypoxia)
Maternal
• Recurrent bleeding
• Acute abruption superimposed on chronic
• Rarely DIC
Management (gestation-dependent)
Previable / early viable (<28 weeks)
• Expectant management if stable
• Close surveillance:
o Serial growth scans
o Dopplers
o AFI
• Corticosteroids if preterm risk
28–34 weeks
• Intensified fetal surveillance
• Admit if recurrent bleeding or Doppler deterioration
• Steroids ± magnesium sulfate
• Delivery if fetal compromise
≥34–36 weeks
• Low threshold for delivery
• Earlier if:
o Worsening Dopplers
o Reduced movements
o Recurrent bleeding
Counseling
• This is a placental function problem, not an infection or genetic issue
• The goal is timing delivery, not curing the placental disease
• Risk of sudden deterioration exists but is REMOTE
• Close follow-up improves outcomes significantly