Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2017 Apr;42(4):1062-1067.
doi: 10.1007/s00261-016-0970-x.

Trauma in pregnant women: assessing detection of post-traumatic placental abruption on contrast-enhanced CT versus ultrasound

Priyanka Jha  1   2 , Giselle Melendres  3 , Bijan Bijan  3 , Eleanor Ormsby  3 , Lisa Chu  4   3 , Chin-Shang Li  5 , John McGahan  3
Affiliations
Comparative Study

Trauma in pregnant women: assessing detection of post-traumatic placental abruption on contrast-enhanced CT versus ultrasound

Priyanka Jha et al. Abdom Radiol (NY). 2017 Apr.

Abstract

Objectives: To evaluate detection of post-traumatic placental abruption with contrast-enhanced CT (CECT) and comparison with Ultrasound (US).

Methods: Picture Archive and Date System database at a level-1 trauma center was retrospectively reviewed using keywords pregnancy, trauma, and/or placental abruption over 10 years. CT was compared to US, if performed within 24 h. Two subspecialty-trained radiologists blindly reviewed the studies. Placental features on delivery and pregnancy outcomes were used as reference standard. Lack of adverse pregnancy/fetal outcome was treated as the absence of abruption.

Results: CECT was performed in 36 patients, with 27 US within 24 h. There were three complete and eight partial abruptions. Reader sensitivity for CT was 100% for both reviewers; however, specificity was 54.5% and 56.7%. No sonographic abnormality was noted in both partial and complete abruption. Using kappa statistics, inter-observer agreement was low for both CT (0.169) and US (0.078). False-positive reads were from misinterpretation of normal placental structures like cotyledons, age-related infarcts, and marginal sinus of the placenta.

Conclusions: CECT identifies post-traumatic placental abruption with high sensitivity but low specificity for clinically significant abruptions, and performs better than US. Pitfalls from normal placental structures mimicking abruption should be avoided. US markedly underdiagnoses abruption.

Keywords: CT; Computed tomography; Placental abruption; Trauma; US; Ultrasound.

PubMed Disclaimer

Conflict of interest statement

All the authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A 36-year-old 32 weeks pregnant woman status post motor vehicle accident. a) Contrast-enhanced CT demonstrated full thickness non-enhancement of the anteriorly located placenta (asterisk), involving more than 50% of the placenta, consistent with partial abruption. b) Coronal reformats from the contrast-enhanced CT redemonstrate the placental findings (asterisk). Fetus had a femur fracture in utero as well (arrow).
Figure 2
Figure 2
A 25-year-old female at 29 weeks gestation ejected from the vehicle after an accident. a) Contrast-enhanced CT demonstrated complete non-enhancement of the anteriorly located placenta (asterisk), consistent with complete abruption. Surrounding myometrium demonstrates enhancing vessels. b) No fetal heart rate noted on US consistent with fetal demise. No focal placental abnormality was present.
Figure 3
Figure 3
A 28-year-old female at 36 weeks of gestation status post motor vehicle accident. a and b) Contrast-enhanced CT demonstrate rounded hypodense structures present throughout the placenta, representing placental cotyledons (arrows). This was misinterpreted as partial abruption.
See this image and copyright information in PMC

References

    1. Mattox KL, Goetzl L. Trauma in pregnancy. Critical care medicine. 2005;33(10 Suppl):S385–9. - PubMed
    1. Chibber R, Al-Harmi J, Fouda M, El-Saleh E. Motor-vehicle injury in pregnancy and subsequent feto-maternal outcomes: of grave concern. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2015;28(4):399–402. - PubMed
    1. Raptis CA, Mellnick VM, Raptis DA, et al. Imaging of trauma in the pregnant patient. Radiographics: a review publication of the Radiological Society of North America, Inc. 2014;34(3):748–63. - PubMed
    1. Sadro C, Bernstein MP, Kanal KM. Imaging of trauma: Part 2, Abdominal trauma and pregnancy–a radiologist’s guide to doing what is best for the mother and baby. AJR American journal of roentgenology. 2012;199(6):1207–19. - PubMed
    1. Nyberg DA, Cyr DR, Mack LA, Wilson DA, Shuman WP. Sonographic spectrum of placental abruption. AJR American journal of roentgenology. 1987;148(1):161–4. - PubMed

Publication types