A 34-year-old G4P3 at 33 weeks presents with severe abdominal pain, a tense tender uterus, and fetal demise. At emergency laparotomy the serosal surface of the uterus appears dark purple and ecchymotic, and the uterus does not contract well after delivery. This appearance results from:
- A Infiltration of blood into the myometrium from retroplacental hemorrhage ✓
- B Venous thrombosis of the uterine and ovarian veins
- C Necrosis of the myometrium due to prolonged vasospasm
- D Disseminated intravascular coagulation causing serosal microhemorrhages
Correct answer: A. Infiltration of blood into the myometrium from retroplacental hemorrhage
Explanation
This is a Couvelaire uterus, seen in severe abruptio placentae. Retroplacental blood dissects between muscle fibers and reaches the serosa, giving the uterus a bruised, purplish appearance. The extravasated blood interferes with myometrial contraction, contributing to atonic postpartum hemorrhage. It is not caused by venous thrombosis or myometrial necrosis, and although DIC may coexist with abruption, the discoloration itself comes from direct blood infiltration of the uterine wall.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.