Couvelaire Uterus
A 29-year-old primigravid woman presented to the labor and delivery unit with contractions at 33 weeks 3 days of gestation. She had had no recent vaginal bleeding, ruptured membranes, or abdominal trauma. A physical examination was notable for a firm and tender uterine fundus. Transabdominal ultrasonography revealed retroplacental hemorrhage (Panel A, arrow; arrowhead shows the placenta), and a fetal heart-rate tracing showed a nonreassuring pattern with deep variable decelerations. An emergency cesarean section was performed. Intraoperatively, the uterus appeared bruised owing to the extravasation of blood into the myometrium, a condition known as a Couvelaire uterus (Panel B). The patient received a diagnosis of concealed placental abruption, which refers to the premature separation of the placenta resulting in hemorrhage that is contained between the detached placenta and the uterus. Affected patients thus do not present with vaginal bleeding, and there is a risk of intrauterine fetal death or hypoxic brain injury if the diagnosis is delayed. The newborn’s 1-minute and 5-minute Apgar scores were 8 and 9, respectively. After delivery, the uterus was atonic, and the patient received treatment with carbetocin, oxytocin, misoprostol, and tranexamic acid. Her postoperative recovery was uncomplicated, and the baby was discharged after hospitalization for prematurity.