HEMODYNAMIC-CHANGES WITH PARADOXICAL BLOOD-FLOW IN EXPECTANT MANAGEMENT OF ABRUPTIO PLACENTAE

Background: Because the early diagnosis of abruption often is missed o r misinterpreted, emergency situations frequently do not permit adequa te management. Case: A woman of 26-weeks' gestation was transferred wi th symptoms and laboratory findings typical for abruption. Ultrasound, including Doppler, revealed a subchorionic hematoma, pathologic blood flow in the uterine arteries, low pulsatility index values in the fet al cerebral and umbilical arteries (paradoxical blood flow), and high maximal velocities in the fetal aorta. Repeated Doppler and laboratory examinations revealed a gradual restoration to normal of the arterial uterine blood flow pattern, of paradoxical blood flow aortic maximal velocities, and laboratory values. Conclusion: Serial Doppler measurem ents considering the paradoxical pattern illustrate pathophysiologic m echanisms of abruption that may assist in deciding whether to deliver immediately or to continue intense surveillance. (C) 1998 by The Ameri can College of Obstetricians and Gynecologists.