A 29-year-old G2P1 at 36 weeks presents with severe preeclampsia. She develops sudden severe abdominal pain with board-like rigidity of the uterus, fetal bradycardia, and vaginal bleeding. Emergency cesarean reveals a dead fetus and a Couvelaire uterus. What is the correct management of the uterus?
- A Immediate hysterectomy
- B Oxytocin infusion and observation; the uterus usually contracts ✓
- C B-Lynch suture as first line
- D Bilateral uterine artery ligation
Correct answer: B. Oxytocin infusion and observation; the uterus usually contracts
Explanation
Couvelaire uterus itself is not an indication for hysterectomy. The uterus usually contracts well with oxytocin after delivery. Surgery is reserved for atony unresponsive to oxytocin. Hysterectomy, B-Lynch, and arterial ligation are only needed if the uterus fails to contract despite uterotonics.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.