The ability of computed tomography to diagnose placental abruption in the trauma patient

Kopelman, Tammy R.; Berardoni, Nicole E.; Manriquez, Maria; Gridley, Daniel; Vail, Sydney J.; Pieri, Paola G.; O'Neill, .; Pressman, Melissa A.

doi:10.1097/ta.0b013e318278937b

Cited by 15 publications

(7 citation statements)

References 14 publications

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“…Our results are concordant with that of previous authors, who have demonstrated a high sensitivity of CT in detecting post-traumatic placental abruption (8, 9). A significant rate of false-positive interpretations points to lack of familiarity with the expected appearance of the placenta on contrast-enhanced CT, given its rarely performed in a gravid patient.…”

Section: Discussionsupporting

confidence: 93%

“…Major feature of abruption on CECT is placental non-enhancement (8, 9). Larger degrees of placental non-enhancement are associated with greater risk of fetal demise (9).…”

Section: Introductionmentioning

confidence: 99%

“…Saphier et al proposed a grading for placental evaluation on CECT to risk stratify pregnant patients undergoing evaluation post trauma (9). They also highlighted the normal variants in an effort to educate radiologists and improve accuracy of placental evaluation on CT (8, 9). Both these studies state the suboptimal ultrasound evaluation of the placenta in pregnant patients in the setting of trauma.…”

Section: Introductionmentioning

confidence: 99%

“…Both these studies state the suboptimal ultrasound evaluation of the placenta in pregnant patients in the setting of trauma. Placental evaluation with CT has multiple limitations particularly due to lack of adequate literature elaborating the spectrum of normal imaging findings and expected findings with trauma (8, 9). Utilization of CT in pregnant patients is also a rare occurrence due to concerns for irradiating the developing fetus with detrimental outcomes including birth defects and childhood malignancy (10, 11).…”

Section: Introductionmentioning

confidence: 99%

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Trauma in pregnant women: assessing detection of post-traumatic placental abruption on contrast-enhanced CT versus ultrasound

et al. 2016

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Objectives To evaluate detection of post-traumatic placental abruption with contrast-enhanced CT (CECT) and comparison with Ultrasound (US). Methods Picture Archive and Date System (PACS) database at a level-1 trauma center was retrospectively reviewed using keywords pregnancy, trauma, and/or placental abruption over 10 years. CT was compared to US, if performed within 24 hours. 2 subspecialty-trained radiologists blindly reviewed the studies. Placental features on delivery and pregnancy outcomes were used as reference standard. Lack of adverse pregnancy/fetal outcome was treated as the absence of abruption. Results CECT was performed in 36 patients, with 27 US within 24 hours. There were 3 complete and 8 partial abruptions. Reader sensitivity for CT was 100% for both reviewers; however, specificity was 54.5% and 56.7%. No sonographic abnormality was noted in both partial and complete abruption. Using kappa statistics, inter-observer agreement was low for both CT (0.169) and US (0.078). False-positive reads were from misinterpretation of normal placental structures like cotyledons, age-related infarcts, and marginal sinus of the placenta. Conclusions CECT identifies post-traumatic placental abruption with high sensitivity but low specificity for clinically significant abruptions, and performs better than US. Pitfalls from normal placental structures mimicking abruption should be avoided. US markedly underdiagnoses abruption.

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Section: Discussionsupporting

confidence: 93%

“…Major feature of abruption on CECT is placental non-enhancement (8, 9). Larger degrees of placental non-enhancement are associated with greater risk of fetal demise (9).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Trauma in pregnant women: assessing detection of post-traumatic placental abruption on contrast-enhanced CT versus ultrasound

et al. 2016

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“…In the presence of diagnostic uncertainty of injuries, ultrasound is possible, as is CT if available and clinically indicated. It is generally accepted that the radiation exposure risk of CT is outweighed by the diagnostic benefit 15 16…”

Section: Discussionmentioning

confidence: 99%

Obstetric complications on deployed operations: a guide for the military surgeon

Faulconer¹,

Irani

Dufty

et al. 2015

J R Army Med Corps

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Modern military general surgeons tend to train and then practice in 'conventional' surgical specialties in their home nation; however, the reality of deployed surgical practice, either in a combat zone or on a humanitarian mission, is that they are likely to have to manage patients with a broad range of ages, conditions and pathologies. Obstetric complications of war injury include injury to the uterus and fetus as well as the mother and both placental abruption and uterine rupture are complications that military surgeons may have little experience of recognising and managing. On humanitarian deployments, fetomaternal complications are a common reason for surgical intervention. We report a recent patient's story to highlight the obstetric training needs of military surgeons.

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Cardiopulmonary Resuscitation of Pregnant Women

Briller

2019

Cardiac Problems in Pregnancy, 4th Edition

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The ability of computed tomography to diagnose placental abruption in the trauma patient

Abstract: Diagnostic study, level III.

Cited by 15 publications

References 14 publications

Trauma in pregnant women: assessing detection of post-traumatic placental abruption on contrast-enhanced CT versus ultrasound

Trauma in pregnant women: assessing detection of post-traumatic placental abruption on contrast-enhanced CT versus ultrasound

Obstetric complications on deployed operations: a guide for the military surgeon

Cardiopulmonary Resuscitation of Pregnant Women

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