Couvelaire uterus
From Wikipedia, the free encyclopedia
| Couvelaire uterus Classification and external resources |
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| ICD-10 | O45.8 |
|---|---|
| ICD-9 | 641.2 |
Couvelaire uterus 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.
Alternative name. uteroplacental apoplexy
Symptoms and signs. Patients can have pain secondary to uterine contractions, uterine tetany or localized uterine tenderness; signs can also be due to abruptio placenta including uterine hypertonus, fetal distress, fetal death, and rarely, hypovolemic shock (shock secondary to severe blood loss); bluish, purplish, mottled appearance of uterus due to extravasation of blood into uterine muscles
About the disease. "Couvelaire uterus" is a phenomenon wherein 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 hematoma may remain within the decidua or may extravasate into the myometrium (the uterine wall). The myometrium becomes weakened and may rupture with an increase in intrauterine pressure during contractions. This may lead to life-threatening obstetrical emergency.
Prevention. The occurrence of couvelaire uterus can be prevented by prevention of abruptio placentae. This include proper management of hypertensive states of pregnancy; treatment of maternal diseases like diabetes mellitus, and other collagen disease complicating pregnancy; prevention of trauma during pregnancy; mothers should also avoid smoking or taking alcohol during pregnancy.
Treatment. The uterus should be evacuated and contractions should be stimulated using intravenous oxytocin; hysterectomy (the removal of the uterus) may be needed in some cases
Prognosis. The baby may be compromised if there is prolonged delivery because of the non-contractile uterus; severe bleeding may cause hypovolemic shock in the mother.
