At laparotomy for severe antepartum hemorrhage at 33 weeks, the surgeon notes the uterus is dusky purple with blood dissecting into the myometrial fibers and beneath the serosa. After delivery the uterus responds poorly to uterotonics. This appearance results from which underlying process?

• A Concealed hemorrhage complicating placental abruption ✓
• B Placental site vessel thrombosis
• C Septic embolization from chorioamnionitis
• D Venous congestion from umbilical cord entrapment

Explanation

This is a Couvelaire uterus. In severe abruption, retroplacental blood penetrates the decidua basalis, dissects between myometrial muscle bundles, and reaches the serosa, staining it dark purple. The infiltrated myometrium contracts poorly, contributing to atonic PPH after delivery. Chorioamnionitis produces a boggy infected uterus with pus, not serosal discoloration, which distinguishes it clearly.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.