A “miracle” pregnancy outcome of severe placental abruption

Abstract Severe placental abruption is associated with high maternal and perinatal morbidity and mortality. Prompt delivery is usually mandatory in this situation. We report a case of a 33-year-old woman, gravida 5, para 3 + 1, at 26 weeks + 3 days’ gestation who had severe placental abruption involving 40% of the placental surface complicated with maternal moderate anaemia and thrombocytopenia. In view of the extreme foetal prematurity and stable condition of both mother and foetus, expectant management was undertaken. The pregnancy was further complicated by foetal growth restriction detected 2 weeks later. At 30 weeks of gestation, an emergency caesarean section was performed for foetal distress. The surgery was uneventful and she delivered a live baby with good Apgar scores. This case report illustrates an atypically satisfactory pregnancy outcome of severe placental abruption. Conservative management of severe placental abruption is possible in rare cases, taking into consideration the gestational week as well as the maternal haemodynamic condition and foetal well-being. When severe placental abruption is confounded by severe prematurity, a decision on whether to prolong the pregnancy to improve the perinatal outcome and neonatal survival needs to be carefully weighed against the usual management option of immediate delivery.