Abruptio placenta, Couvelaire uterus following severe early-onset preeclampsia: A case report

Abstract

Background: Abruptio placenta refers to premature placental detachment from the uterus. Couvelaireuterus is a rare complication of abruptio placenta marked by blood infiltration of the myometrium followinghemorrhage into the decidua basalis. This is a case of severe early-onset preeclampsia with rapiddeterioration.Case presentation: A 35-year-old primigravida presented at 26 weeks 4 days with frontal headache andelevated blood pressure. On admission, with severe preeclampsia and type 1 fetal growth restriction, thepatient received labetalol, nifedipine, magnesium sulfate, and antenatal steroids. After two days ofhospitalization, she was discharged home to be closely monitored as an outpatient. She was readmittedwith severe hypertension and developed abruptio placenta with fetal death. Following labor induction, thepatient had significant antepartum hemorrhage necessitating an emergency hysterotomy.Intraoperatively, she had postpartum hemorrhage refractory to uterotonics with a Couvelaire uterus.Hemostasis was achieved using B-Lynch brace sutures. She developed hemolysis, elevated liverenzyme and low platelet count (HELLP) syndrome and acute kidney injury. She was transfused withpacked red cells, fresh frozen plasma, and platelets. Hemodynamically unstable, she was admitted to thecritical care unit and later stepped down to ward status and allowed home.Conclusion: Abruptio placenta is a clinical diagnosis, and a high index of suspicion is required becauseprompt action may be lifesaving. Complications such as Couvelaire uterus pose a significant challenge inmanagement and may lead to hysterectomy. However, in select cases, the uterus can be preserved byapplying B-lynch brace sutures.