Placental hematoma occurring at the placental cord insertion site : a case report

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  • YANAI Sakika
    Departments of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine
  • NAKANO Akemi
    Premier Preventive Medicine, Osaka City University Graduate School of Medicine
  • KATAYAMA Hiroko
    Departments of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine
  • HAMURO Akihiro
    Departments of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine
  • TERADA Hiroyuki
    Departments of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine
  • TACHIBANA Daisuke
    Departments of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine
  • KOYAMA Masayasu
    Departments of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine

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Other Title
  • 臍帯付着部近傍に発生した胎盤血腫の1例
  • 症例報告 臍帯付着部近傍に発生した胎盤血腫の1例
  • ショウレイ ホウコク サイタイ フチャクブ キンボウ ニ ハッセイ シタ タイバン ケッシュ ノ 1レイ

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A placental hematoma is caused by the rupture of a placental vessel. The clinical symptoms vary depending upon the site of the hematoma. It has been reported that cystic tumors at the placental cord insertion site (PCIS) may lead to non-reassuring fetus status or fetal growth restriction. We report a case of a placental hematoma in which recurrent bleeding had occurred. Careful observation allowed the patient to progress to term. The 41-year-old gravida 3, para 2 was referred to our hospital at 25 gestational weeks (GWs) for evaluation of an enlargement of a cystic tumor on the placenta. At 31 GWs, she was hospitalized because of an acute increase in the size of the tumor; the fetal middle cerebral artery peak systolic velocity (MCA-PSV) was 66 cm/s (1.55 MoM). We suspected a subamniotic hematoma; therefore, we frequently assessed the fetal circulation, the tumor size, the amniotic fluid index, and the MCA-PSV. From 32 to 34 GWs, the MCA-PSV value was usually>1.8 MoM; thus, we suspected fetal anemia. However, the other indicators of fetal well-being were within normal limits. Beginning at 36 GWs, we intermittently performed a contraction stress test and confirmed fetal well-being. At 38 GWs, she delivered a 3380g female infant with Apgar scores of 8/9. The infant was not anemic and her postnatal course was uneventful. The pathologic diagnosis of the placental tumor was a subchorionic hematoma. In this case, we diagnosed a placental hematoma with ultrasound. Due to the high MCA-PSV, fetal anemia was suspected. Therefore, we carefully monitored fetal status and achieved a spontaneous vaginal delivery at term. [Adv Obstet Gynecol, 67 (2) : 120-125 , 2015 (H27.5)]

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