Abruptio placenta, Couvelaire uterus following severe early-onset preeclampsia: A case report

Abstract

Background: Abruptio placenta refers to premature placental detachment from the uterus. Couvelaire
uterus is a rare complication of abruptio placenta marked by blood infiltration of the myometrium following
hemorrhage into the decidua basalis. This is a case of severe early-onset preeclampsia with rapid
deterioration.
Case presentation: A 35-year-old primigravida presented at 26 weeks 4 days with frontal headache and
elevated blood pressure. On admission, with severe preeclampsia and type 1 fetal growth restriction, the
patient received labetalol, nifedipine, magnesium sulfate, and antenatal steroids. After two days of
hospitalization, she was discharged home to be closely monitored as an outpatient. She was readmitted
with severe hypertension and developed abruptio placenta with fetal death. Following labor induction, the
patient had significant antepartum hemorrhage necessitating an emergency hysterotomy.
Intraoperatively, she had postpartum hemorrhage refractory to uterotonics with a Couvelaire uterus.
Hemostasis was achieved using B-Lynch brace sutures. She developed hemolysis, elevated liver
enzyme and low platelet count (HELLP) syndrome and acute kidney injury. She was transfused with
packed red cells, fresh frozen plasma, and platelets. Hemodynamically unstable, she was admitted to the
critical care unit and later stepped down to ward status and allowed home.
Conclusion: Abruptio placenta is a clinical diagnosis, and a high index of suspicion is required because
prompt action may be lifesaving. Complications such as Couvelaire uterus pose a significant challenge in
management and may lead to hysterectomy. However, in select cases, the uterus can be preserved by
applying B-lynch brace sutures.