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Re: Couvelaire Uterus From: Steve & Eryl Raymond (eryl@intekom.co.za) Sat Feb 10 11:22:17 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: William McIntosh: "Re: ny times article" Previous message: ainsron@msn.com: "Re: Couvelaire Uterus" Maybe in reply to: Debbie Laxague: "Couvelaire Uterus" When the placenta separates, whatever the cause, the blood starts to invade the myometrium. It can then track between the muscle fibres of the myometrium spreading almost at will throughout the uterine wall. There is nothing in the way of fascia to prevent this spread, so, depending on the amount of blood that finds its way into the myometrium, it can spread throughout the whole uterine wall. The concealed abruption is more likely to produce a Couvelaire uterus. The Couvelaire uterus is *caused* by the abruption, the pathophysiology being similar to a quadriceps haematoma but there the muscle fascia prevents it from extending beyond the belly of the muscle. When the cause of abruption is fully explained then the cause of the Couvelaire uterus is explained. Abruption, as you know, is most often seen in hypertensive disease, but may be seen in anaemia, multiple pregnancies and in conditions causing hydramnios. Trauma may also be a cause, but this is not very common a finding. Surprisingly there is often no obvious explanation, but I think a failing placenta (and here a viral illness might start the train of events) is more common than we think. Debbie Laxague wrote: > 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? > > Do you know of any information on healing/involution implications, and the likelihood of this occurring in a subsequent pregnancy? 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? > > 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. > > Debbie Laxague, RNC - Dr. S.H. Raymond Department of Obstetrics & Gynaecology Empangeni Hospital Private Bag X20005 Empangeni South Africa 3880 Ph. (+27) (035) 7721111 Fax (+27) (035) 7922596 Next message: William McIntosh: "Re: ny times article" Previous message: ainsron@msn.com: "Re: Couvelaire Uterus" Maybe in reply to: Debbie Laxague: "Couvelaire Uterus"

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