A 30-year-old G3P2 at 34 weeks presents with severe abdominal pain and vaginal bleeding. On laparotomy for abruption, the uterine surface shows diffuse dark purple ecchymoses with blood visible beneath the serosa. The uterus contracts poorly. This appearance is MOST consistent with which condition?

• A Placenta percreta
• B Uterine rupture
• C Couvelaire uterus ✓
• D Acute red degeneration of fibroid

Explanation

Couvelaire uterus (uteroplacental apoplexy) occurs in severe abruption when blood dissects through the myometrium to the serosal surface, producing characteristic purplish ecchymoses. It is NOT an indication for hysterectomy; the uterus often contracts after oxytocin and massage. Uterine rupture would show a definite uterine wall defect, which is absent here.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.