Hemodynamic changes with paradoxical blood flow in expectant management of abruptio placentae.
BACKGROUND
Because the early diagnosis of abruption often is missed or misinterpreted, emergency situations frequently do not permit adequate management.


METHODS
A woman of 26-weeks' gestation was transferred with symptoms and laboratory findings typical for abruption. Ultrasound, including Doppler, revealed a subchorionic hematoma, pathologic blood flow in the uterine arteries, low pulsatility index values in the fetal cerebral and umbilical arteries (paradoxical blood flow), and high maximal velocities in the fetal aorta. Repeated Doppler and laboratory examinations revealed a gradual restoration to normal of the arterial uterine blood flow pattern, of paradoxical blood flow, aortic maximal velocities, and laboratory values.


CONCLUSIONS
Serial Doppler measurements considering the paradoxical pattern illustrate pathophysiologic mechanisms of abruption that may assist in deciding whether to deliver immediately or to continue intense surveillance.
Arabin
B
B
Department of Perinatal Medicine, Sophia Ziekenhuis, Zwolle, The Netherlands. clara-angela@pi.net
van Eyck
J
J
Laurini
R N
RN
D000037:Abruptio Placentae / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D000328:Adult; D001011:Aorta / Q000000981:diagnostic imaging / Q000502:physiology; D001783:Blood Flow Velocity; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D005260:Female; D006406:Hematoma / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D010922:Placenta Diseases / Q000150:complications / Q000000981:diagnostic imaging; D011247:Pregnancy; D011673:Pulsatile Flow; D012039:Regional Blood Flow; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014599:Uterus / Q000098:blood supply