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Re: Couvelaire UterusFrom: ainsron@msn.comSat Feb 10 10:50:51 2001
At Wed, 7 Feb 2001, Debbie Laxague wrote: > >I'm an OB RN working in a small rural OB unit, and a longtime lurker-and-learner on this list. We recently sectioned a woman for a partial abruption, at which time a Couvelaire Uterus (uterine apoplexy) was found. Mom and baby are fine, no problems with PPH. DIC labs were normal. I didn't see the uterus (busy with baby) but it was described by the OB as large and "zebra-like" with stripes of blood-filled spaces. > >I haven't been able to find enough information on this condition to satisfy my curiosity. Our Williams describes Couvelaire Uterus, but doesn't really speculate on the physiology involved. Others state its "associated with" or "caused by" abruption, which are two different things. Do you think the abruption came first and if so, why would it precipitate this bleeding into the ENTIRE uterus, rather than just the abruption site? It seems more logical to me that perhaps the Couvelaire condition came first and then "blew" the placenta off its implantation site. Your thoughts? With abruption, bleeding can be occult (behind the placenta), into the amniotic fluid, or out into the vagina. It is not hard to postulate that under some occaision, the tetanic contractions will result in bleeding directly into the muscle fibers of the uterus (hence a Courelaire uterus).
>Do you know of any information on healing/involution implications, and the likelihood of this occurring in a subsequent pregnancy? Healing should not be a big issue, it is much the same as a severe bruise in any other muscle. The real problem is getting the uterus to contract and prevent uterine atony and postpartum hemorrhage and the need for hysterectomy.
>This woman did have some sort of viral illness (fever, sore throat, cough, uterine irritability) prior to presenting with her abruption. Could this have some connection? Doubt it.
>Perhaps this condition is so rare that there are no answers to these questions, but I thought that if anyone would have answers, it would be on this list. Thank you for your time and the sharing of your knowledge.
-- Ronald E. Ainsworth, MD
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