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Placenta previa and placental abruption
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
At the time of cesarean section, the obstetrician may note a dark purple discoloration of the uterus. This is called a Couvelaire uterus; it is caused by extravasation of blood into the myometrium. This was described by Alexandre Couvelaire, a French obstetrician, who wrote a classic paper on the subject in 1911 (57). He termed the condition “uterine apoplexy” and noted that blood from abruption could extravasate not only into the uterine muscle but also into the serosa of the uterus, the broad ligament, and the pelvic peritoneum. Initially it was thought that Couvelaire uterus was an indication for hysterectomy, but with the current therapy for coagulopathy, Couvelaire uterus per se is not considered an indication for hysterectomy.
Antepartum Haemorrhage
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Most women will present in labour, and usually labour will progress rapidly in these women, thus making vaginal delivery feasible. Vaginal delivery could be assisted with the use of forceps or a vacuum in order to expedite delivery, when the criteria for an instrumental vaginal delivery are fulfilled (discussed in Chapter 9). The associated consumptive coagulopathy that follows placental abruption, as well as uterine atony which occurs as a result of extravasation of maternal blood into the myometrium, may cause severe PPH, and preparations should be in place to manage such an event (discussed in Chapter 14). The placenta should be examined following delivery to confirm abruption. The consumptive coagulopathy should be aggressively managed. Management in the case of a ‘Couvelaire uterus’ may include hysterectomy, if medical and uterus-conserving measures are not successful in controlling haemorrhage. Anti D immunoglobin should be administered if the woman’s blood group is Rhesus negative. A Kleihauer test should also be conducted in order to ensure that an adequate dose of anti D immunoglobulin is given to cover the feto-maternal haemorrhage.
Post-Partum Haemorrhage
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
A few factors that can cause atonicity are: Multiparity.Multiple gestations.Overdistension due to polyhydramnios and macrosomia.Large intramural fibroid, more so when they are overlying the placental site.Abruption with Couvelaire uterus: The intra-myometrial bleed in severe abruption prevents the uterus from contracting firmly. Also, there may be associated coagulation abnormalities in case of severe abruption.Preterm delivery, preterm premature rupture of membranes (PPROM), and chorioamnionitis can predispose to atonic PPH if it is severe. It is because of the presence of inflammatory cells in the myometrium, the uterus fails to contract firmly.The previous history of PPH is a vital predictor and warning alert.Precipitate labour can be associated with atonicity.Induction of labour, prolonged labour, and arrest in the second stage can cause atonicity after delivery.Obesity with BMI above 40 was found to increase the risk of PPH by two-fold [4].Women with pre-eclampsia are also more prone to PPH.
The Association between Placental Abruption and Platelet Indices
Published in Fetal and Pediatric Pathology, 2023
Duygu Tugrul Ersak, Özgür Kara, Kadriye Yakut, Aytekin Tokmak, Cem Yaşar Sanhal, Aykan Yücel, Dilek Şahin
Of the 62 patients from the PA study group, 19 had insufficient antenatal care. Of the 130 control patients, 40 had insufficient antenatal care (p = 1.000). In the PA study group, 3 patients developed disseminated intravascular coagulation (DIC), 1 patient had acute kidney failure, 1 patient had DIC accompanied by acute kidney failure, 1 patient had HELLP syndrome, and 3 patients had Couvelaire uterus. None of these patients required hysterectomy.