Abstract
Here we present two cases of observed chronic abruption-oligohydramnios sequence (CAOS) with different infant outcomes. This report highlights the differences in placental pathology in cases of observed CAOS and the important role played by placental inflammation in the health and survival of the infant. In the first case, the patient presented to hospital complaining of persistent and abnormal vaginal bleeding and upon further investigation, subchorionic hematoma (SCH) was found at 14 weeks and four days of gestation. The patient was treated and sent home with instructions to check for worsening symptoms. At 23 weeks and four days of gestation, the patient returned to hospital with abdominal pain and abundant vaginal bleeding and was admitted. Due to the patient’s previous SCH, we observed the amniotic fluid index (AFI) for four days. During this time, there was evidence of oligohydramnios, and a diagnosis of CAOS was made. The patient was treated with antibiotics and tocolytic drugs. At 31 weeks and six days of gestation, the patient went into labor and gave birth vaginally to a normal infant. Placental pathology showed no signs of chorioamnionitis (CAM). In the second case, the patient first visited the hospital reporting persistent vaginal bleeding at 13 weeks and five days of gestation. She was treated and sent home with instructions to monitor for signs of worsening symptoms. The patient returned to the hospital a second time nine days later with evidence of SCH, and was again sent home after treatment. At 16 weeks and 1 day of gestation, the patient returned for the third time and was admitted for heavy vaginal bleeding and persistent uterine contractions. The AFI was monitored and a diagnosis of CAOS was made. In this case, the fetus showed a growth delay from 21 weeks and three days of gestation and the fetal heartbeat disappeared at 24 weeks and one day of gestation. At 24 weeks and six days of gestation, the infant was vaginally delivered. Placental histopathology found evidence of third degree CAM. It has been previously reported that long-term persistence of inflammation along with CAM is correlated with poor prognosis in infants. If cases of SCH present with evidence of oligohydramnios, perinatal management at a higher-level medical institution with a neonatal intensive care unit is recommended. [Adv Obstet Gynecol, 70 (2) : 134-142, 2018 (H30.5)]
