At laparotomy for severe abruptio placentae, the uterus is noted to be dark purple and bruised in appearance with blood infiltration between muscle fibers. The fetus has already expired. This finding indicates:

• A Couvelaire uterus, which usually recovers function after delivery ✓
• B Uterine rupture requiring hysterectomy
• C Placenta accreta invading the myometrium
• D Amniotic fluid embolism

Explanation

Couvelaire uterus results from extravasation of retroplacental blood into the myometrium and serosa during severe abruption, giving a bruised, atonic-looking organ. It is a consequence of abruption, not a separate indication for hysterectomy; the uterus generally regains contractility once the fetus and placenta are delivered and uterotonics are given. It is not invasion by trophoblast, which defines accreta spectrum disorders.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.