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a hollow muscular organ in the pelvic cavity of females; contains the developing fetus (同)womb

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子宮(womb)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/22 03:17:08」(JST)

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Couvelaire uterus (also known as uteroplacental apoplexy)^[1] is a life-threatening condition in which loosening of the placenta (abruptio placentae) causes bleeding that penetrates into the uterine myometrium forcing its way into the peritoneal cavity.

Symptoms and signs

Patients can have pain secondary to uterine contractions, uterine tetany or localized uterine tenderness. Signs can also be due to abruptio placentae including uterine hypertonus, fetal distress, fetal death, and rarely, hypovolaemic shock (shock secondary to severe blood loss). The uterus may adopt a bluish/purplish, mottled appearance due to extravasation of blood into uterine muscle.

Pathophysiology

"Couvelaire uterus" is a phenomenon wherein the retroplacental blood may penetrate through the thickness of the wall of the uterus into the peritoneal cavity. This may occur after abruptio placentae. The hemorrhage that gets into the decidua basalis ultimately splits the decidua, and the haematoma may remain within the decidua or may extravasate into the myometrium (the muscular wall of the uterus). The myometrium becomes weakened and may rupture due to the increase in intrauterine pressure associated with uterine contractions. This may lead to a life-threatening obstetric emergency requiring urgent delivery of the fetus.

Prevention

The occurrence of couvelaire uterus can be prevented by prevention of abruptio placentae. This include proper management of hypertensive states of pregnancy; treatment of maternal diseases like diabetes mellitus, and other collagen disease complicating pregnancy; prevention of trauma during pregnancy; mothers should also avoid smoking or consumption of alcohol during pregnancy.

Treatment

The uterus should be evacuated and contractions should be stimulated using intravenous oxytocin; hysterectomy (the removal of the uterus) may be needed in some cases.

Prognosis

The fetus may be compromised if there is prolonged delivery because of the non-contractile uterus; severe bleeding may cause hypovolemic shock in the mother.

References

^ Hubbard JL, Hosmer SB (September 1997). "Couvelaire uterus". J Am Osteopath Assoc 97 (9): 536–7. PMID 9313351.

UpToDate Contents

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1. 胎盤早期剥離：管理 placental abruption management
2. 妊婦における腟出血の病因および評価の概要 overview of the etiology and evaluation of vaginal bleeding in pregnant women
3. Anesthesia for the patient with peripartum hemorrhage

English Journal

Placental abruption: etiopathogenic aspects, diagnostic and therapeutic implications.

Brăila AD1, Gluhovschi A, Neacşu A, Lungulescu CV, Brăila M, Vîrcan EL, Cotoi BV, Gogănău AM.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie.Rom J Morphol Embryol.2018;59(1):187-195.
PMID 29940627

Placental abruption leading to hysterectomy.

Sylvester HC1, Stringer M1.
BMJ case reports.BMJ Case Rep.2017 Dec 11;2017. pii: bcr2016218349. doi: 10.1136/bcr-2016-218349.
PMID 29233830

A 30-Year-Old Female Found to Have a Couvelaire Uterus With Placenta Accreta During Planned Cesarean Delivery.

Uwagbai ON1, Wittich AC2.
Military medicine.Mil Med.2017 Mar;182(3):e1877-e1879. doi: 10.7205/MILMED-D-16-00146.
PMID 28290978

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Placental Abruption (Accidental hemorrhage) Couvelaire Uterus, Maternal Pulmonary Embolism Couvelaire Uterus | Fans Share Images (PDF) Uteroplacental apoplexy (Couvelaire syndrome) Obg seminar Uterine Rupture with Placental Detachment - TrialExhibits Inc. PPT - Faculdade de Medicina da Universidade de Santo Amaro Disciplina de Obstetrícia PowerPoint