A Double-Hit Placental Catastrophe: Spontaneous Expulsion of Placenta Previa with Concurrent Co-Twin Placental Abruption a Case Report
Sujnanendra Mishra* and Swadhin Kumar Mishra
ABSTRACT
Background: Placenta previa and placental abruption are critical obstetric emergencies. Their simultaneous occurrence in a dichorionic twin pregnancy where one placenta presents as previa and the other undergoes acute abruption is an exceptionally rare and life-threatening event.
Case: A 26-year-old multiparous woman (G2P1) with a dichorionic twin pregnancy at 28 weeks’ gestation was brought to the emergency department with active bleeding and contractions. Within minutes of being shifted to the labour room, she spontaneously and completely expelled the placenta of the first twin a placenta previa. An emergency Cesarean section was performed immediately for a non-reassuring fetal heart rate in the second twin and maternal shock. Intraoperative findings revealed a 40% retroplacental clot confirming complete abruption of the second twin’s placenta, and a Couvelaire uterus. Twin 1 was stillborn; Twin 2 was resuscitated from severe asphyxia (umbilical artery pH 7.01). The mother developed disseminated intravascular coagulation (DIC) and uterine atony, managed with a massive transfusion protocol and B-Lynch compression sutures. Both mother and surviving twin were discharged in stable condition.
Conclusion: This case represents a “double-hit” placental emergency. Survival was predicated on the rapid recognition of dual placental pathologies, immediate surgical intervention, and early activation of a massive transfusion protocol. To our knowledge, this is the first documented case of survival of both mother and co-twin following such a catastrophic sequence.
