Utérus de Couvelaire: aspect impressionnant mais utérus fonctionnel

We here report the case of a 32-year-old primigravid patient presenting at 28 weeks of amenorrhea in a typical clinical state of retroplacental hematoma complicated by intrauterine fetal death. Obstetric ultrasound performed in the operating room confirmed intrauterine fetal death. Fetal biometry assessed that fetal growth corresponded with the number of weeks of pregnancy and that there was no overlapping of fetal skull bones, which was in favour of a recent death. Moreover, it showed echogenic retroplacental rounded zone measuring 8 cm in diameter evoking retroplacental hematoma. Complete blood count (CBC) showed haemoglobin 9 g/dl. Global hemostatic coagulation tests were normal. As the patient was hemodynamically unstable, cesarean section was performed. The patient undergone Pfannenstiel cesarean section performed under general anaesthesia; it revealed a tensive, edematous, bluish uterus (Couvelaire uterus). Hysterectomy showed bright red blood, placental abruption and retroplacental haematoma weighing 600 g. The fetus was in a state of apparent death and weighed 700 g. After evacuation procedure, the uterus presented a bluish aspect almost in its totality but the retraction of the uterine wall was correct. After hysterography the patient had persistent moderate bright red bleeding which stopped following prostaglandin infusion (Nalador®). The postoperative course was uneventful.