Placental abruption recorded with real-time electrohysterography : case report

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Brief Introduction: A non-invasive technique based on real-time electrohysterography (EHG) is recently developed by our group and being tested at the labour ward (PUREtrace, Nemo Healthcare, Eindhoven, the Netherlands). We present a case of placental abruption and uterine hypertonia recorded with real-time EHG. Materials & Methods: Not applicable. Clinical Cases or Summary Results: A 33-year-old pregnant woman at 35 weeks of gestational age in her second pregnancy presented with vaginal blood loss. Her obstetric history revealed a uterus unicollis bicornis and an intrauterine fetal demise due to placental abruption at 26 weeks of gestational age. In the current pregnancy, prophylactic aspirin 80 mg was described from 12 up to 36 weeks. At admission there were no signs of fetal distress or retroplacental hematoma. The vaginal bleeding stopped, however several days later the pregnancy was complicated by preterm rupture of membranes followed by contractions and two centimetres of dilation. The fetal heart rate tracings showed a normal fetal condition, while monitoring uterine activity using external tocodynamometry was inconclusive. Therefore it was decided to use the EHG, by means of the Nemo Healthcare system consisting of a single abdominal electrode patch (Tocopatch, see Figure 1) and PUREtrace module connected to a Philips Avalon FM30 fetal monitor (Philips, Eindhoven, the Netherlands), which provided a cardiotocogram for real-time interpretation. Only half an hour later the pregnant woman presented acute onset of classical abruption signs such as severe abdominal pain, nausea, vomiting and fetal heart rate abnormality. The electrohysterogram showed a typical pattern of extreme uterine hypertonia (see Figure 2). Maternal vital signs were stable without vaginal blood loss. Within 15 minutes after the event an emergency caesarean delivery was performed, showing total detachment of the placenta. The neonate was born with a heart rate of 30 beats per minute and required neonatal resuscitation: Apgar score 0/6/8, umbilical artery pH 7.00, base deficit 17 mmol/L and neonatal body weight 2560 grams. During admission at the neonatal intensive care unit the newborn infant showed good clinical condition and no neurological sequels. Conclusions: This is the first report of real-time electrohysterography during placental abruption. The EHG showed a very typical pattern. Early recognition of this typical pattern might become important in patients with high risk of placental abruption. (Figure presented).
Originele taal-2Engels
Pagina's (van-tot)199-200
Aantal pagina's2
TijdschriftJournal of Maternal-Fetal and Neonatal Medicine
Nummer van het tijdschriftsuppl. 1
StatusGepubliceerd - 2014


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