Signs can also be due to abruptio placentae including uterine hypertonus, fetal distress, fetal death, and rarely, hypovolemic shock shock secondary to severe blood loss. Pathophysiology[ edit ] Couvelaire uterus is a phenomenon where in the retroplacental blood may penetrate through the thickness of the wall of the uterus into the peritoneal cavity. This may occur after abruptio placentae. The hemorrhage that gets into the decidua basalis ultimately splits the decidua, and the haematoma may remain within the decidua or may extravasate into the myometrium the muscular wall of the uterus.
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Copyright BMJ Publishing Group Ltd Description A year-old primiparous woman with 37 weeks of amenorrhoea was admitted to the Obstetric ward with symptoms of severe abdominal pain and non-progression of labour past 20 h. The patient was registered for antenatal care at a peripheral health centre PHC. She had two previous antenatal visits at the PHC. Her last visit was 15 days prior to admission, during which her blood pressure was found to be normal. In her second trimester visit, her blood group was B positive, haemoglobin was found to be 8.
She had no history of diabetes mellitus or hypertension and had not undergone any surgeries in the past. Significant pallor was noted haemoglobin of 8. The total leucocyte count was Her coagulation profile was normal, bleeding time 4 min reference range 3—10 min , clotting time 3 min reference range 2—6 min and prothrombin time 12 s reference range 1—18 s. On per abdomen examination, there was uterine tenderness and the uterus did not relax between contractions.
Per vaginal examination revealed fresh bleeding from the uterine cavity. The cervix was 3 cm long and 2 cm dilated. Partial placental detachment from the lower uterine cavity was noted. The placenta was completely covering the internal os, a finding suggestive of central placenta praevia. A clinical diagnosis of cephalopelvic disproportion was also made. An emergency lower segment caesarean section was performed for non-progression of labour due to cephalopelvic disproportion with central placenta praevia with significant fetal distress.
On entering the uterine segment, a complete abruption of placenta was noted. A male child weighing 2. The baby cried immediately after birth. On inspection, the uterus was found to have dark purple patches with ecchymosis and indurations diagnostic of Couvelaire uterus or uteroplacental apoplexy figure 1 aA,B. A retroplacental clot with estimated blood loss of 2 L was also noted. The patient was transfused mL of packed cells during the surgery and two more transfusions of mL of packed cells were given in the postoperative period.
She was given cefazolin 1 gm every 8 hours for 5 days in view of leucocytosis. The rest of her postoperative stay was normal.
Definición de útero de Couvelaire
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