Case 189

Medical history

A 33-year-old pregnant patient, 37 weeks gestation, G3P2A0, was admitted at ER presenting vaginal bleeding, abdominal pain and absence of fetal movement. To date, pregnancy progressed uneventfully, but she reports that do not received prenatal care. She denies comorbidities, smoking, alcohol consumption and previous uterine surgery. Physical examination revealed normal vital signs, uterine contractions every 5 minutes, fetal heart rate (FHR) not audible, regular uterine tone, pervious lap and moderate active vaginal bleeding. Emergency caesarean section was performed: extracted new-born (NB) with lightly macerated head, Apgar 0. It was performed CPR, without success.

Considering the clinical picture and the appearance of placenta (images), which is the most likely diagnosis?

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