Jackson Josef, George Verghese, McKinney Jennifer, Fox Karin A
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
Department of Radiology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
Case Rep Perinat Med. 2022 Jun 7;11(1):20210013. doi: 10.1515/crpm-2021-0013. eCollection 2022 Jan 1.
Placental abruption occurs when a normally implanted placenta prematurely separates, causing rupture of decidual spiral arteries and retroplacental hemorrhage. Estimates place the incidence of placental abruption somewhere between 0.22% and 1% of all deliveries. Clinical abruption represents a spectrum from mild to the most severe form, in which blood can extravasate into or through the myometrium, the broad ligament, or the peritoneum, causing the uterus and surrounding structures to take on a blue discoloration. This phenomenon is a clinical entity known as Couvelaire uterus, so named because it was first described by French physician Alexandre Couvelaire in the early 20th century as "uteroplacental apoplexy." Its incidence is difficult to estimate because it has classically been diagnosed only by direct intraoperative visualization. Imaging is not usually indicated in this clinical setting, so radiologic correlation with operative findings has not been previously described.
In this report, we discuss the case of a multipara who presented with abdominal pain and vaginal discharge several days after a classical cesarean delivery. Her prolonged and complex clinical course led to evaluation via several radiologic modalities. At first, a focal placenta accreta or retained products of conception were suspected, however these diagnoses did not correlate with the patient's reported intraoperative findings of a clean endometrial cavity or with histopathology that was consistent with massive abruption.
The clinical presentation and features identified on multimodal imaging were ultimately most consistent with the patient's intraoperative diagnosis of Couvelaire uterus.
胎盘早剥是指正常着床的胎盘过早分离，导致蜕膜螺旋动脉破裂和胎盘后出血。据估计，胎盘早剥的发生率在所有分娩中的比例为0.22%至1%之间。临床胎盘早剥表现为从轻度到最严重形式的一系列情况，其中血液可渗入或穿过子宫肌层、阔韧带或腹膜，导致子宫及周围结构呈现蓝色变色。这种现象是一种名为库弗莱尔子宫的临床实体，因其最早由法国医生亚历山大·库弗莱尔在20世纪初描述为“子宫胎盘卒中”而得名。其发生率难以估计，因为传统上仅通过术中直接观察来诊断。在这种临床情况下通常不进行影像学检查，因此此前尚未描述影像学与手术结果的相关性。
在本报告中，我们讨论了一例经产妇的病例，她在经典剖宫产术后数天出现腹痛和阴道分泌物。她漫长而复杂的临床病程促使通过多种影像学检查手段进行评估。起初，怀疑有局灶性胎盘植入或残留妊娠产物，然而这些诊断与患者报告的术中子宫内膜腔清洁的发现以及与大量胎盘早剥一致的组织病理学结果不相符。
多模态影像学检查所确定的临床表现和特征最终与患者术中库弗莱尔子宫的诊断最为相符。
