What is the role of ultrasonography in the workup of abruptio placentae?

Updated: Nov 30, 2018
  • Author: Shad H Deering, MD; Chief Editor: Carl V Smith, MD  more...
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Answer

Ultrasonography is a readily available and important imaging modality for assessing bleeding in pregnancy.

The quality and sensitivity of ultrasonography in detecting placental abruptions has improved significantly; however, it is not a sensitive modality for this purpose—findings are positive in only 25% of cases confirmed at delivery, and the negative predictive value is low at around 50%.

In addition, there does not appear to be any clinical difference in presentation between women who have an abruption seen on ultrasonography and those who do not.

Ultrasonographic studies do help to quickly diagnose placenta previa as the etiology of bleeding, if present. [18]

Placental abruption shows as a retroplacental clot on an ultrasonographic image, but not all abruptions are ultrasonographically detectable.

In the acute phase, a hemorrhage is generally hyperechoic, or even isoechoic, compared with the placenta; a hemorrhage does not become hypoechoic for nearly a week.

Ultrasonography can help to exclude other causes of third-trimester bleeding. Possible findings consistent with an abruption include (1) retroplacental clot (ie, hyperechoic to isoechoic in the acute phase, changing to hypoechoic within a wk), (2) concealed hemorrhage, or (3) expanding hemorrhage.


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