Sonographic Diagnosis of Intraplacental Hematoma in Preterm Pregnancy: A Case Report and Review of Literature.

Background

Intraplacental hematomas are uncommon placental lesions with potentially significant clinical implications, and their antenatal diagnosis remains challenging. This case report aims to present a rare case of a rapidly enlarging intraplacental hematoma diagnosed antenatally by serial ultrasonographic examinations and to highlight the potential role of ultrasonography in its diagnosis. Case Presentation: A 22-year-old gravida 2, para 2 woman presented at 34 weeks and 3 days of gestation for routine antenatal evaluation. Her pregnancy was complicated by intrahepatic cholestasis of pregnancy, treated with ursodeoxycholic acid, with subsequent improvement in biochemical parameters and symptoms. Although asymptomatic, she was noted to have intermittent hypertension. Ultrasonography revealed a well-circumscribed, hypoechoic intraplacental mass measuring 4.37 × 4.0 cm. Color Doppler demonstrated several apparent vascular channels extending through and around the lesion. Repeat ultrasonography 10 min later showed rapid enlargement, raising suspicion of an active intraplacental hematoma. In view of the rapidly progressive sonographic findings and maternal hypertension, emergency cesarean delivery was performed. A newborn was delivered with Apgar scores of 8 and 9 at 1 and 5 min, respectively. Histopathological examination confirmed extensive recent intraplacental hemorrhage, with erythrocyte extravasation into the intervillous spaces and compression of adjacent chorionic villi, without evidence of organization.

Conclusions

Meticulous placental assessment during prenatal ultrasonography is important, particularly in complicated pregnancies. Color Doppler and serial ultrasonographic examinations may help characterize intraplacental lesions and detect rapid interval changes, facilitating timely obstetric intervention. Histopathological examination remains essential for definitive diagnosis. Further research is needed to clarify the pathogenesis and clinical significance of intraplacental hematomas.