The patient was registered for antenatal care at a peripheral health centre PHC. She had two previous antenatal visits at the PHC. 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.
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The patient was registered for antenatal care at a peripheral health centre PHC. She had two previous antenatal visits at the PHC. 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 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.
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. The rest of her postoperative stay was normal. A,B The dark purple and copper colour patches with ecchymosis and indurations diagnostic of Couvelaire uterus or uteroplacental apoplexy.
Haemorrhagic infiltration in the lateral portions of the uterus is also seen. Couvelaire 1 first described the entity in It is a rare non-fatal complication of severe abruption. Couvelaire uterus is caused when haemorrhage from placental blood vessels seeps into decidua basalis causing placental separation, followed by infiltration in the lateral portions of the uterus.
Couvelaire uterus is managed conservatively. Couvelaire uterus or uteroplacental apoplexy is a rare non-fatal complication of abruptio placentae. Diagnosis is made on visual inspection of the uterus.
Management is conservative and hysterectomy is usually not required. AP performed the literature review, wrote the draft and revised the manuscript. All authors are responsible for clinical follow-up of the case and read and approved the final version of the manuscript. Competing interests: None.
Patient consent: Obtained. Provenance and peer review: Not commissioned; externally peer reviewed. National Center for Biotechnology Information , U. BMJ Case Rep. Published online Mar Author information Article notes Copyright and License information Disclaimer. Correspondence to Dr Ashish Pathak, moc.
Accepted Feb Open in a separate window. Learning points. References 1. Couvelaire A. Deux nouvelles observations d'apoplexie utero-placentaire hemorrhagies retro-placentaires avec infiltration sanguine de la pavoi musculaire de l'uterus. Ann Gynecol Obstet ; 9 [ Google Scholar ]. Uteroplacental apoplexy Couvelaire syndrome. Wien Klin Wochenschr ; Couvelaire uterus.
Couvelaire uterus also known as uteroplacental apoplexy  is a life-threatening condition in which loosening of the placenta abruptio placentae causes bleeding that penetrates into the uterine myometrium forcing its way into the peritoneal cavity. Patients can have pain secondary to uterine contractions, uterine tetany or localized uterine tenderness. 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. Couvelaire uterus is a phenomenon where the retroplacental blood may penetrate through the thickness of the wall of the uterus into the peritoneal cavity. This may occur after abruptio placentae.
2018, Number 05