A G3P2 at 33 weeks presents with vaginal bleeding, a tense tender uterus, and fetal demise. At emergency laparotomy the serosa of the uterus shows widespread dark purple discoloration and the myometrium is infiltrated with blood. This finding indicates:

• A Uterine rupture with hemoperitoneum
• B Superficial venous thrombosis of the broad ligament
• C Placenta accreta with serosal invasion
• D Couvelaire uterus from extravasated blood penetrating the myometrium ✓

Explanation

Couvelaire uterus describes blood forced through the decidua basalis into the myometrium and out to the serosa during severe placental abruption, giving the uterus a bruised, mahogany appearance. It does not represent true muscle rupture, so contractility is usually preserved and hysterectomy is not required for this finding alone. It is associated with concealed abruption, coagulation failure, and poor fetal outcomes.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.