Conservative management of classic Couvelaire uterus with postpartum hemorrhage: A case report
DOI:
https://doi.org/10.59692/jogeca.v33i4.458Keywords:
Couvelaire uterus, placenta abruption, fresh stillbirth, antepartum hemorrhageAbstract
Background: Couvelaire uterus is an uncommon outcome of severe placental abruption and can only be diagnosed by visual inspection of the uterus or biopsy.
Case presentation: A 28-year-old gravida 2 para 1 presented with labor-like pain and vaginal bleeding at 38 weeks + 6 days. She gave no history of hypertensive disorders in pregnancy or trauma. The fetal heart rate was not detected by cardiotocography. An emergency cesarian section revealed a fresh stillbirth male with placental abruption in a Couvelaire uterus. She developed immediate postpartum hemorrhage, which was managed with uterotonics, uterine balloon tamponade, and was transfused 1.5liters of blood. She was discharged on the third postoperative day and was stable on three distinct postnatal clinic visits.
Conclusion: Couvelaire uterus can be managed conservatively as it resolves spontaneously. This case highlights one of its fatal fetal and maternal complications when the opportunity for timely intervention is missed.
References
Sunanda N, Sruthi T, Sheela SR. Feto-maternal outcome in patients with couvelaire uterus: a 3 year study in a tertiary care hospital in rural Karnataka, India. Int J Reprod Contraception, Obstet Gynecol. 2018;7(2):503
Ming GS, Lee WKR, Tan SQ. An Unusual Case of Placenta Abruption Leading to Couvelaire Uterus in a Previable Pregnancy. J Med Cases. 2020;11(4):103–5
Hubbard JL, Hosmer SB. Couvelaire uterus. J Am Osteopath Assoc. 1997 Sep;97(9):536–7
Habek D, Selthofer R, Kulas T. Uteroplacental apoplexy (Couvelaire syndrome). Wien Klin Wochenschr. 2008;120(3–4):88
Rubí-palacios FDM, Duarte-pineda AJ, Barón-salgado AL, Vásquez- IH, Zelaya-guido CJ.
Couvelaire uterus, consequence of premature placental detachment. A case report. Ginecol Obs Mex. 2018;86(5):351–6
Ananth C V., Keyes KM, Hamilton A, Gissler M, Wu C, Liu S, et al. An international contrast of rates of placental abruption: An age-period- cohort analysis. PLoS One. 2015;10(5):1–15Tikkanen M, Nuutila M, Hiilesmaa V, Paavonen J, Ylikorkala O. Clinical presentation and risk factors of placental abruption. Acta Obstet Gynecol Scand. 2006;85(6):700–5
Schmidt P, Skelly CL, Raines DA. Placental Abruption. In Treasure Island (FL); 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK4823 35/#article-17041.s15
Uwagbai ON, Wittich AC. A 30-year-old female found to have a couvelaire uterus with placenta accreta during planned cesarean delivery. Mil Med. 2017;182(3):e1877–9
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