FETOMATERNAL OUTCOMES IN COUVELAIRE UTERUS: A TERTIARY CARE HOSPITAL–BASED OBSERVATIONAL STUDY FROM SOUTHERN RAJASTHAN
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Keywords
Couvelaire uterus; Placental abruption; Fetomaternal outcome; Postpartum hemorrhage; Hypertensive disorders of pregnancy; Stillbirth
Abstract
Background: Couvelaire uterus, also known as uteroplacental apoplexy, is a rare but severe complication of placental abruption characterized by extravasation of blood into the myometrium. It is often associated with significant maternal morbidity and adverse perinatal outcomes. Due to its intraoperative diagnosis and rarity, regional data on fetomaternal outcomes remain limited.
Objectives: To evaluate the maternal and fetal outcomes in cases of Couvelaire uterus and to assess associated risk factors at a tertiary care hospital in southern Rajasthan.
Materials and Methods: This hospital-based observational study was conducted in the Department of Obstetrics and Gynecology at a tertiary care center in southern Rajasthan over a six-month period from April 2025 to September 2025. All pregnant women diagnosed intraoperatively with Couvelaire uterus at gestational age ≥28 weeks were included. A total of 35 cases were analyzed. Data regarding maternal demographics, risk factors, mode of delivery, intraoperative findings, maternal complications, and fetal outcomes were collected from hospital records. Statistical analysis was performed using SPSS version 25. Categorical variables were expressed as frequencies and percentages, and associations were analyzed using Chi-square or Fisher’s exact test, with p <0.05 considered statistically significant.
Results: Most women were aged 25–34 years (60%) and multiparous (71.4%), with a majority being unbooked (65.7%). Hypertensive disorders of pregnancy were the most common associated risk factor (51.4%), followed by anemia (40%). Emergency cesarean section was required in 88.6% of cases. Maternal complications included postpartum hemorrhage (45.7%), blood transfusion requirement (60%), disseminated intravascular coagulation (17.1%), and ICU admission (22.9%). Obstetric hysterectomy was required in 5.7% of cases, with no maternal mortality. Perinatal outcomes were poor, with a stillbirth rate of 40% and NICU admission in 37.1% of live births. Hypertensive disorders were significantly associated with postpartum hemorrhage, ICU admission, and stillbirth (p <0.05).
Conclusion: Couvelaire uterus is a marker of severe placental abruption associated with high maternal morbidity and adverse perinatal outcomes. Early recognition, prompt intervention, and comprehensive tertiary care are crucial to improving fetomaternal outcomes.
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Dr Nisha Meena
Post Graduate Student, Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India.
Dr Susheela Khoiwal
Senior Professor, Unit Head & Superintendent, Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India.
Dr Jatin Prajapati
Senior Resident, Department of Community Medicine, World College of Medical Sciences and Research, Jhajjar, Haryana, India (ORCID: https://orcid.org/0009-0004-7298-4499)
