Couvelaire uterus - Wikipedia, the free encyclopedia

10/03/15 09:38

Couvelaire uterus
From Wikipedia, the free encyclopedia

Couvelaire uterus (also known as

uteroplacental apoplexy)[1] is a lifethreatening condition in which loosening
of the placenta (abruptio placentae)
causes bleeding that penetrates into the
uterine myometrium forcing its way into
the peritoneal cavity.

Couvelaire uterus
Classification and external resources
ICD-10 O45.8
(http://apps.who.int/classifications/icd10/browse/2015/en#/O45.8)
ICD-9 641.2 (http://www.icd9data.com/getICD9Code.ashx?icd9=641.2)

Contents
1 Symptoms and signs
2 Pathophysiology
3 Prevention
4 Treatment
5 Prognosis
6 References

Symptoms and signs

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,
hypovolaemic shock (shock secondary to severe blood loss). The uterus may adopt a bluish/purplish, mottled
appearance due to extravasation of blood into uterine muscle.

Pathophysiology
"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 haematoma may remain within the decidua or
may extravasate into the myometrium (the muscular wall of the uterus). The myometrium becomes weakened
and may rupture due to the increase in intrauterine pressure associated with uterine contractions. This may lead
to a life-threatening obstetric emergency requiring urgent delivery of the fetus.

Prevention
http://en.wikipedia.org/wiki/Couvelaire_uterus

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Couvelaire uterus - Wikipedia, the free encyclopedia

10/03/15 09:38

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 consumption of 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 fetus may be compromised if there is prolonged delivery because of the non-contractile uterus; severe
bleeding may cause hypovolemic shock in the mother.

References
1. ^ Hubbard JL, Hosmer SB (September 1997). "Couvelaire uterus". J Am Osteopath Assoc 97 (9): 5367. PMID 9313351
(https://www.ncbi.nlm.nih.gov/pubmed/9313351).

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Categories: Pathology of pregnancy, childbirth and the puerperium
This page was last modified on 11 July 2014, at 04:42.
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