A 27-year-old primigravida at 33 weeks presents with severe abdominal pain and dark vaginal bleeding. The uterus is tense and tender and there is absent fetal heart sound. Emergency laparotomy reveals a uterus with bluish-purple discoloration and blood extravasated between muscle fibers. The impaired uterine contraction caused by this infiltration is termed:

• A Bandl contraction ring
• B Hegar sign
• C Couvelaire uterus ✓
• D Osiander sign

Explanation

In severe abruptio placentae, blood penetrates the decidua basalis and infiltrates the myometrium, reaching the serosa. The uterus becomes tense, tender, and non-contractile; this is the Couvelaire uterus, also called uteroplacental apoplexy. It does not require hysterectomy by itself, as function recovers. Bandl contraction ring is a pathological retraction ring seen in obstructed labor, and Hegar and Osiander signs are softening signs of early pregnancy.

Reference: Williams Obstetrics, 25th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.