Intra-Amniotic Hemorrhage Imitating Gastroschisis: A Case Report and Review of the Literature

Abstract

Patient: Female, 33Final Diagnosis: Intramamniotic hemorrhageSymptoms: Abdominal pain • uterine contractions • vaginal bleedingMedication: —Clinical Procedure: Cesarean deliverySpecialty: Obstetrics and GynecologyObjective:Unusual clinical courseBackground:A spontaneous intra-amniotic hemorrhage is rarely encountered during pregnancy. The correct diagnosis and management are problematic because of the infrequency of this condition and the high likelihood of a misdiagnosis.Case Report:A primigravida with an uncomplicated pregnancy and a normal targeted ultrasound presented late in the second trimester of pregnancy with antepartum bleeding of unknown origin. A repeat ultrasound was suggestive of an abdominal wall defect (gastroschisis). The patient continued to have antepartum bleeding and developed uterine contractions and abdominal pain necessitating frequent visits to labor and delivery. An MRI ruled out gastroschisis and diagnosed intra-amniotic hematoma. The patient presented with acute abdominal pain and was clinically considered to be having an abruption, and was delivered by cesarean. Old blood was noted in the abdominal cavity and within the uterine cavity. At the time of the cesarean, an area of intra-amniotic hematoma was identified, as well as a retroplacental blood clot.Conclusions:An intra-amniotic hematoma is unusual and may be misdiagnosed. MRI may be helpful in determining the correct diagnosis and subsequent management.

Fetal abdominal wall defects in an Australian tertiary setting: contemporary characteristics, ultrasound accuracy, and outcome

“…Gastroschisis mothers were younger, with more smokers and higher rate of infections in line with previously published literature indicating gastroschisis to be influenced by social disadvantage (young maternal age, poor nutrition, poor prenatal care), as well as environmental and behavioural factors (maternal febrile illness and infections, cigarette smoking, medicines, illegal drugs) [2,21,27,28]. For omphalocele, both advanced and young maternal age were identified as risk factors [9,29]. We confirm in our cohort an overall mean older population.…”

“…Prognosis is thus primarily determined by the number and severity of associated anomalies for omphalocele and by the degree of bowel injury for gastroschisis. Both conditions may be easily detected at late first-trimester ultrasound [3,9,10] where gastroschisis presents as a full-thickness defect at the insertion of the umbilical cord [2,7] [5], whilst omphalocele presents as an anterior membrane-covered midline mass, containing abdominal contents, entered by the umbilical cord [11,12].…”

Successful outcome after spontaneous first trimester intra-amniotic haematoma and early preterm premature rupture of membranes

“…In this case, the intra-amniotic haemorrhage mimicked an anterior abdominal wall defect and required a fetal MRI to confirm the diagnosis 4. In a similar case that presented at 29 weeks of gestation, the intra-amniotic haemorrhage was misdiagnosed as a gastroschisis, the correct diagnosis being confirmed on MRI 5. Intra-amniotic haemorrhage has presented in two cases in the third trimester with uterine contractions, vaginal bleeding and anaemia6 7 In one case at 36 weeks, ultrasound imaging revealed real-time rapidly increasing polyhydramnios, and a transplacental tear was visible with a freely mobile flap of placental tissue extending into the amniotic cavity.…”