title: The ability of computed tomography to diagnose placental abruption in the trauma patient.
abstract: BACKGROUND
  Fetal demise following trauma remains a devastating complication largely owing to placental injury and abruption. Our objective was to determine if abdominopelvic computed tomographic (CT) imaging can assess for placental abruption (PA) when obtained to exclude associated maternal injuries.
  
  
  METHODS
  Retrospective review of pregnant trauma patients of 20-week gestation or longer presenting to a trauma center during a 7-year period who underwent CT imaging as part of their initial evaluation. Radiographic images were reviewed by a radiologist for evidence of PA and classified based on percentage of visualized placental enhancement. Blinded to CT results, charts were reviewed by an obstetrician for clinical evidence of PA and classified as strongly positive, possibly positive, or no evidence.
  
  
  RESULTS
  A total of 176 patients met inclusion criteria. CT imaging revealed evidence of PA in 61 patients (35%). As the percentage of placental enhancement decreased, patients were more likely to have strong clinical manifestations of PA, reaching statistical significance when enhancement was less than 50%. CT imaging evidence of PA was apparent in all patients who required delivery for nonassuring fetal heart tones.
  
  
  CONCLUSIONS
  CT imaging evaluation of the placenta can accurately identify PA and therefore can help stratify patients at risk for fetal complications. The likelihood of requiring delivery increased as placental enhancement declined to less than 25%.
  
  
  METHODS
  Diagnostic study, level III.
authors.affiliation: Division of Burns, Trauma Surgery, and Surgical Critical Care, Maricopa Medical Center, Phoenix, Arizona 85008, USA. Tammy_Kopelman@dmgaz.org
authors.forename: Tammy R
authors.initials: TR
authors.lastname: Kopelman
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Berardoni
authors.forename: Maria
authors.initials: M
authors.lastname: Manriquez
authors.forename: Daniel
authors.initials: D
authors.lastname: Gridley
authors.forename: Sydney J
authors.initials: SJ
authors.lastname: Vail
authors.forename: Paola G
authors.initials: PG
authors.lastname: Pieri
authors.lastname: O'Neill
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Pressman
mesh_terms: D000037:Abruptio Placentae / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D011262:Pregnancy Trimester, Second; D014057:Tomography, X-Ray Computed; D014947:Wounds and Injuries / Q000150:complications* / Q000000981:diagnostic imaging