Traumatic abruption secondary to physical violence in the setting of low fibrinogen; brief report and review of literature

Abstract

Trauma is not uncommon in pregnancy. Trauma and its complications in pregnancy include premature rupture of membranes, pelvic fractures, uterine rupture, placental abruption, direct fetal injury, fetal death, or maternal death. We present a case of placental tear and bleed secondary to physical trauma and domestic abuse with counter-coup injury. This case report highlights a unique case in which the patient endured physical abdominal trauma at 32 weeks, who presented for decreased fetal movement and pelvic pressure, but denied vaginal bleeding or decreased fetal movement. Findings were significant for hypofibrinogenemia and change in ultrasound placental findings in the setting of reassuring fetal monitoring consistent with concealed traumatic abruption. This unique presentation adds to the literature because it will increase provider awareness of the subtle signs of intra-placental abruption.