Traumatic placental abruption and intra-uterine fetal death

Single intrauterine fetus with a cephalic presentation. The uterus has an irregular contour at the right mid and inferior lateral edge and there is adjacent hyperattenuating fluid. Right anterolateral placenta has active contrast blush on angiogram with pooling of blood on PV phase imaging, in keeping with active placental bleeding. A 3cm focus of acute haemorrhage is adjacent to the inferior rightleft uterus. 

Hyperattenuating fluid representing with haemorrhage is also demonstrated adjacent to the inferior liver and splenic edges. Liver and spleen otherwise appear normal with no parenchymal injury evident. 

Duplex left kidney. Both kidneys otherwise normal. Gallbladder, adrenal glands and pancreas have a normal appearance. 

Small bowel loops are adjacent to the inferior right aspect of the uterus where this is haemorrhage, however no discrete bowel injury is demonstrated. No free gas. 

Aorta, IVC and portal vein have a normal appearance. 

No pelvic or hip fractures. Normal lumbosacral spine.

Impression

• Active placenta haemorrhage and irregular uterine wall as described with free intraperitoneal blood is concerning for uterine wall injury.
• Small amount haemorrhage at the inferior liver and splenic edges without discrete injury demonstrated, most likely tracking up from uterine injury.
• Small bowel loops are adjacent to the haemorrhage at the right inferior uterus, however no discrete bowel injury is demonstrated.