What is Couvelaire Uterus?

Couvelaire uterus is a rare but serious complication seen in cases of abruptio placenta—when the placenta separates from its bed before the delivery of the baby.

It is most commonly associated with Pregnancy-Induced Hypertension (PIH).

How does it occur?

• Placental blood vessels rupture

• Blood infiltrates into the uterine muscles

• This gives the uterus a red/purple patchy appearance instead of its normal pink color

• As a result, the uterus may fail to contract and retract properly, leading to atonic uterus and postpartum hemorrhage (PPH)

Diagnosis

Couvelaire uterus can only be diagnosed intraoperatively, usually during Lower Segment Cesarean Section (LSCS). It is considered an obstetric emergency requiring immediate medical and surgical intervention.

A Recent Case

We recently encountered a case of PIH with severe hypertension (BP 210/150) and a history of acute renal failure. The patient required emergency LSCS, during which the uterus showed the classic Couvelaire appearance.

Management

To control PPH, we immediately performed:

• B-Lynch suture

• Hayman’s suture

• Bilateral uterine artery ligation

With timely intervention and God’s grace, we were able to save both the patient and her uterus. The patient is now stable and recovering well.

This challenging case was kindly referred to us by Dr. Sahil Nadaf Sir (Soni).