Uwagbai Omici N, Wittich Arthur C
Family Medicine Residency, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA 22060.
Department of Obstetrics and Gynecology, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA 22060.
Mil Med. 2017 Mar;182(3):e1877-e1879. doi: 10.7205/MILMED-D-16-00146.
A case of Couvelaire uterus with placenta accreta found during scheduled repeat low transverse Cesarean section will be discussed within this article. First described in the 1900s, Couvelaire syndrome, also known as uteroplacental apoplexy, is a rare form of nonfatal placenta abruption complication. The case involves a 30-year-old gravida 3 para 2 otherwise healthy female with an uncomplicated pregnancy and two previous cesarean deliveries without complication. She received routine prenatal care. During her pregnancy, she did not experience any symptoms such as vaginal bleeding or abdominal pain. After delivering a healthy female, there were several unsuccessful attempts to remove the placenta from the uterus. Upon inspection, the uterus was found have dark purple patches with ecchymosis and indurations, diagnostic of Couvelaire uterus. Furthermore, there was high clinical suspicion for placenta accreta as the 30-minute mark approached without placenta detachment. A telephonic emergency review with the wet desk radiologist of the 18-week ultrasound revealed high suspicion for placenta accreta. A Cesarean hysterectomy was performed for prevention of significant hemorrhage. This case report may be the first documented association of Couvelaire uterus with placenta accreta. Providers should be vigilant in monitoring for antenatal bleeding, timing of placenta separation, and postpartum hemorrhage.
本文将讨论一例在计划性重复低位横切口剖宫产术中发现的伴有胎盘植入的库弗莱尔子宫病例。库弗莱尔综合征，也称为子宫胎盘卒中，于20世纪首次被描述，是一种罕见的非致命性胎盘早剥并发症。该病例涉及一名30岁、孕3产2的健康女性，此次妊娠无并发症，前两次剖宫产也无并发症。她接受了常规产前检查。孕期，她未出现任何阴道出血或腹痛等症状。产下一名健康女婴后，多次尝试从子宫取出胎盘均未成功。检查发现子宫有暗紫色斑块，伴有瘀斑和硬结，诊断为库弗莱尔子宫。此外，在接近30分钟时胎盘仍未剥离，高度怀疑存在胎盘植入。与18周超声的湿读放射科医生进行电话紧急会诊，结果显示高度怀疑胎盘植入。为预防大出血，实施了剖宫产子宫切除术。本病例报告可能是库弗莱尔子宫与胎盘植入相关的首例文献记载。医护人员应警惕产前出血、胎盘剥离时间及产后出血的监测。
