Caso Clínico: Útero de Couvelaire, la importancia de una identificación temprana

BACKGROUND: Couvelaire Uterus or uteroplacental apoplexy is the blood extravasation to the uterine musculature and deep serosa, as a rare complication of severe forms of placental abruption. It is an infrequent syndrome, but has a rapid onset, that requires immediate attention in order to avoid maternal and fetal complications. CASE REPORT: A 33-year-old female patient, 38.4 weeks pregnant, calculated by LMP. She sought attention in a primary care health center, for a 12-hour history of uterine contraction-type abdominal pain, where controls were indicated every 4 hours. Approximately 13 hours later, in the last control, no fetal movements or heartbeat were evident, the mother had 3 cm of dilation and 80% cervical effacement, so she was transferred to a third level health care center. Upon admission, fetal death and presumptive diagnosis of PPD were confirmed, so it was decide to terminate the pregnancy immediately by cesarean section. CLINICAL COURSE: During the surgical procedure, the 2 500 grams stillborn was extracted, the uterus was macroscopically infiltrated with blood, compromising 100% of the tissue, as well as the wide ligament and the right ovary; uterine tone wasn’t achieved, Couvelaire Uterus was diagnosed and a hysterectomy was performed. During the surgical procedure the patient developed hypovolemic shock; she was stabilized with infusion of fluids, colloids, and blood components. She remained in the intensive care unit for 2 days and reached hemodynamic recovery. She developed high blood pressure that responded to nifedipine(10 mg/ 8 hours) administration. She was discharged, being stable, with hypotensive treatment. CONCLUSION: Couvelaire Uterus is a rare pathology that increases the risk of maternal complications and fetal death. The timely identification of premature placental abruption clinical signs decreases the probability to develop this pathology and increases the possibility of an optimal treatment.