5,27-31) The morphologic features include placental infarcts, decidual arteriopathy with foamy histiocytes, fibrinoid necrosis,
retroplacental hemorrhage (abruption clinically), accelerated (advanced) villous maturation with distal villous hypoplasia, and lack of physiologic remodeling of the spiral arterioles (Figures 13 and 14).
Ultrasound revealed a dead fetus of 18 weeks' gestation with a
retroplacental clot of 10 x 9 cm.
Previously, in various studies intraumbilical oxytocin given in intraumbilical vein directly places this oxytocic to
retroplacental myometrium and helps in its contraction, thereby preventing PPH and also helps in early separation of placenta.
The fetal heart was not heard, and ultrasound confirmed intrauterine death, severe growth impairment and a
retroplacental clot.
Sonographic findings suggestive of placenta accreta are as follows:[sup][5] (1) Loss of normal hypoechoic
retroplacental zone; (2) multiple vascular lacunae (irregular vascular spaces) within placenta, giving "Swiss cheese" appearance; (3) blood vessels or placental tissue bridging uterine-placental margin, myometrial-bladder interface, or crossing uterine serosa; (4)
retroplacental myometrial thickness of <1 mm; and (5) numerous coherent vessels visualized with three-dimensional power Doppler in basal view.
Retroplacental blood may penetrate through the thickness of the wall into the peritoneal cavity, a phenomenon known as Couvelaire uterus.
Clinical significance of subchorionic and
retroplacental hematomas detected in the first trimester of pregnancy.
loss of the hypoechoic
retroplacental myometrial zone
Ultrasonography revealed a normal 27 weeks fetus without
retroplacental hematoma.
In a previous study, the incidence of first-trimester subchorionic and
retroplacental hematomas was 3% in a general obstetric population (Obstet.
8) In conditions associated with maternal hypoperfusion the placenta may show perivillous fibrinoid deposition, subchorionic fibrinoid plaque, massive subchorial thrombosis, basal intervillous thrombus, intervillous lakes,
retroplacental haematomas, maternal surface chorionic villous infarction and syncytial knots.
A thinning or absence of
retroplacental myometrium is the most common sonographic finding.
