The pre-partum, low-frequency, sinusoidal rhythm due to placental abruption—A case study

Shaohua Liu, Jinbo Zhao, Dongxia Yang, Ru Zhang, Hui Wang

.
Department of Gynecology and Obstetrics, Yantai Economic and Technological Development Zone Hospital, Shandong, China.

DOI: 10.4236/ojog.2013.32050                

Abstract

We consider that a low-frequency, sinusoidal rhythm detected by Electronic Fetal Monitoring (EFM) is a typical manifestation of a placental abruption. We present the case of a 26-year-old woman who was gestational 36 weeks. She had irregular contractions. The EFM showed a low-frequency, sinusoidal rhythm. The cycle of the sine curve increased in time from 90 seconds to 160 seconds gradually. A severely asphyxiated newborn was successfully resuscitated after an emergency Cesarean Section. The mother and child were discharged from our hospital in a good general condition seven days later. Upon examination it was proven that this was a case of a placental abruption. This is an original case study report about how to diagnose a placental abruption according to an EFM reading. We propose a definition of a low-frequency, sinusoidal rhythm having: 1) a stable baseline FHR (fetal heart rate) of 120 - 160 bpm; 2) a possible variation of 20 - 30 bpm; 3) a frequency of 90 - 160 seconds per cycle; 4) fixed or flat short-term variability; 5) oscillation of the sinusoidal wave from above and below a baseline; 6) no areas of normal FHR variability or reactivity. What is more, the lengths of the fluctuation cycle and the greater the amplitude has a close relationship with the prognosis of both mother and child. This pre-partum, low-frequency, sinusoidal rhythm is an ominous sign of fetal jeopardy needing immediate intervention. The medical literature has never reported such an association. Therefore, our case study report is possibly the first to mention this observation.

Keywords

Placental Abruption; Pre-Partum; Low-Frequency; Sinusoidal Rhythm

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Cao, Z.Y. (2010) Obstetrics and gynecology. Clinical Edition, People’s Medical Publishing House, Beijing, p. 145.
[2]	Masselli, G., Brunelli, R., Di Tola, M. et al. (2011) MR imaging in the valuation of placental abruption: Correlation with sonographic findings. Radiology, Epub Ahead of Print. doi:10.1148/radiol.10101547
[3]	Modanlou, H.D. and Murata, Y. (2004) Sinusoidal heart rate pattern: Reappraisal of its definition and clinical significance. Journal of Obstetrics and Gynaecology Research, 30, 169-180. doi:10.1111/j.1447-0756.2004.00186.x
[4]	Reddy, A., Moulden, M. and Redman, C.W. (2009) Antepartum high-frequency fetal heart rate sinusoidal rhythm: Computerized detection and fetal anemia. American Journal of Obstetrics & Gynecology, 200, e1-e6.
[5]	Cao, Z.Y. (2010) Obstetrics and gynecology. Clinical Edition, People’s Medical Publishing House, Beijing, p. 46.
[6]	Kayani, S.I., Walkinshaw, S.A. and Preston, C. (2003) Pregnancy outcome in severe placental abruption. BJOG, 110, 679-683. doi:10.1046/j.1471-0528.2003.02088.x
[7]	Wang, Y.N. and Yang, Z. (2010) Multivariate analysis of pregnancy outcomes and investigation of precaution in placental abruption. Chinese Journal of Obstetrics & Gynecology and Pediatrics, 26, 114-118.
[8]	(2003) Shanghai’s investigating team on placental abruption. The study on Shanghai’s placental abruption in 10 years. Shanghai Medicine, 26, 137-139.