A Case of Intra-Amniotic Maternal Hemorrhage in Term Pregnancy

Abstract

Introduction: Intra-amniotic maternal hemorrhage is a rare condition, hard to differentiate from some other conditions in pregnancy. We report an unusual case of intra-amniotic maternal hemorrhage in term pregnancy ending in urgent cesarean section, identified on ultrasound examination. Case Report: A 24-year-old female (gravida 3, para 2, abortion 0) was admitted to hospital at 40 weeks’ gestation for collapse and general weakness. Her blood pressure was 90/60 mm Hg, pulse 112 bpm, temperature 36°C. The fetal heart race tracings were stable and reactive. The cervix was opened 3 cm. Further examination revealed no vaginal bleeding and normal amnioscopic findings. An ultrasound examination confirmed singleton, head-presenting gestation without any visible congenital anomalies, amniotic fluid index was at the 50th percentile, anterior placenta without evidence of previa, abruption or retroplacental hematoma. An inhomogeneous echogenic mass, measuring 12 × 8 cm, was noted within the amniotic cavity, there was no evidence of pathological flow through the mass on color Doppler. After admittance to the hospital, the patient complained of regular pains, weakness and collapsed with signs of hemorrhagic shock. Repeated ultrasound evaluation showed no change in acoustic texture and size, but the amniotic fluid now had a hyperechoic appearance which revealed increasing intra-amniotic hemorrhage. Because of clinical signs of maternal hemorrhagic shock confirmed by laboratory findings of decreasing red blood parameters, an urgent cesarean section was performed. A female infant weighing 3,070 g, Apgar score 5/7, was delivered. After removal of the placenta there was no sign of abruption, which was confirmed at histopathology. Hemoglobin A was detected in the amniotic fluid by Abt’s test. The patient had an uncomplicated postoperative course. The infant developed normally. Conclusion: When there are signs of fetal distress or maternal hemorrhagic shock, an urgent cesarean section should be performed.

Total hemoglobin concentration in amniotic fluid is increased in intraamniotic infection/inflammation

“…A source for hemoglobin in amniotic fluid can be intra-amniotic bleeding prior to amniocentesis, although this condition is rare14;15 and may derived from the maternal15-17 or fetal18 circulation. Maternal intra-amniotic bleeding has been reported in association with placental abruption,19;20 circumvallated placenta,15 as well as PTL15;16 with clinical14 or histological chorioamnionitis 16.…”

Successful outcome after spontaneous first trimester intra-amniotic haematoma and early preterm premature rupture of membranes

“…She developed haemorrhagic shock and underwent immediate caesarean delivery. The placental histological examination was normal with no evidence of an abruption, but there was a 20 cm diameter 450 g blood clot detected 8…”

“…Placental histological analysis revealed chorioamnionitis 7. Finally, intra-amniotic haemorrhage has also presented with maternal collapse, tachycardia, hypotension and anaemia at 40 weeks of gestation 8. Ultrasound examination showed a live, well-grown fetus with a large intra-amniotic homogenous echogenic mass (120×80 mm).…”

A Case of Spontaneous Intra-Amniotic Hemorrhage in an Asymptomatic Patient at Near Term Pregnancy

“…There are only a few reports in the literature on intra-amniotic hemorrhages, which are not related to amniocentesis ( table 1 ). Sijanovic et al [2] reported on a woman whose presenting symptoms were weakness and tachycardia. Witter and Sanders [3] reported on maternal hemorrhage into the amniotic fluid associated with chorioamnionitis, and Kurata et al [4] described a case of a symptomatic anemic patient with 'pseudo polyhydramnios' and a clot identified by an ultrasound.…”