The possibility of using organ-sparing tactics in patients with a Couvelaire uterus


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Placental abruption is one of the most life-threatening and dramatic complications encountered in obstetric practice. The severe form of placental abruption with the formation of a retroplacental hematoma, the so-called Couvelaire uterus, is a serious accident in the second half of pregnancy and during childbirth with severe consequences for the mother and fetus, which often lead to a fatal outcome. The article presents a review of literature on the management tactics for pregnant women and parturients with premature detachment of the normally situated placenta, which is complicated by the development of Couvelaire uterus. Much attention is paid to the possibility of choosing organ-sparing tactics for this pathology. Using six cases from their own clinical practice as an example, the authors demonstrate the possibility of organ-sparing surgery for Couvelaire uterus. Conclusion. The complex process of choosing a surgical intervention directly depends on the amount of blood loss, hemodynamic parameters, and the severity of disorders in the hemostatic system, and uterine contractility. It is also necessary to take into account the general condition of a woman, her desire to preserve the uterus, as well as the level of equipment in the facility, and the capabilities of a surgeon. An individual approach ensures the success of a surgical intervention and the favorable course of the postoperative period.

Full Text

Restricted Access

About the authors

Vitaly B. Tskhai

Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of the Russian Federation

Email: tchai@yandex.ru
MD, Professor, Head of the Department of Perinatology, Obstetrics and Gynecology, Medical Faculty Krasnoyarsk, Russia

Ekaterina A. Levanova

Krasnoyarsk Territorial Clinical Center for Maternal and Child Care

Email: levanovakatrin@gmail.com
obstetrician-gynecologist Krasnoyarsk, Russia

References

  1. Couvelaire A. Deux nouvelles observations d'apoplexie utero-placentaire (hemorrhagies retro-placentaires avec infiltration sanguine de la pavoi musculaire de l'uterus). Ann. Gynecol. Obstet. 1912; 9: 48
  2. Bräila A.D., Gluhovschi A., Neacsu A., Lungulescu C.V., Bräila M., Vircan E.L. et al. Placental abruption: etiopathogenic aspects, diagnostic and therapeutic implications. Rom. J. Morphol. Embryol. 2018; 59(1): 187-95.
  3. Downes K.L., Grantz K.L., Shenassa E.D. Maternal, labor, delivery, and perinatal outcomes associated with placental abruption: A systematic review. Am. J. Perinatol. 2017; 34(10): 935-57. https://dx.doi.org/10.1055/s-0037-1599149.
  4. Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet. Gynecol. Scand. 2011; 90(2): 140-9. https://dx.doi.org/10.1111/j.1600-0412.2010.01030.x.
  5. Oyelese Y., Ananth C.V. Placental abruption. Obstet. Gynecol. 2006; 108(4): 1005-16. https://dx.doi.org/10.1097/01.AOG.0000239439.04364.9a.
  6. Li Y., Tian Y, Liu N., Chen Y., Wu F. Analysis of 62 placental abruption cases: risk factors and clinical outcomes. Taiwan. J. Obstet. Gynecol. 2019; 58(2): 223-6. https://dx.doi.org/10.1016/j.tjog.2019.01.010.
  7. Mei Y., Lin Y. Clinical significance of primary symptoms in women with placental abruption. J. Matern. Fetal Neonatal Med. 2018; 31(18): 2446-9. https://dx.doi.org/10.1080/14767058.2017.1344830
  8. Cheng W., Lin S. Analysis of risk factors for uteroplacental apoplexy complicating placental abruption. Zhonghua Fu Chan Ke Za Zhi. 2008; 43(8): 593-6.
  9. Ananth C.V., Vintzileos A.M. Ischemic placental disease: epidemiology and risk factors. Eur. J. Obstet. Gynecol. Reprod. Biol. 2011; 159(1): 77-82. https://dx.doi.org/10.1016/j.ejogrb.2011.07.025.
  10. Parker S.E., Werler M.M. Epidemiology of ischemic placental disease: a focus on preterm gestations. Semin. Perinatol. 2014; 38(3): 133-8. https://dx.doi.org/10.1053/j.semperi.2014.03.004.
  11. Roberts J.M. Pathophysiology of ischemic placental disease. Semin. Perinatol. 2014; 38(3): 139-45. https://dx.doi.org/10.1053/j.semperi.2014.03.005.
  12. Braila M., Fortofoiu M., Goganau A., Braila A.D. Uterine rupture - dramatic obstetrical accident. In: Anastasiu D.M., ed. Proceeding of the 13th Conference of the Romanian-German Society of Obstetrics and Gynecology. Timi§oara, Romania, 14-16 September 2017. Filodiritto International Proceedings, Filodiritto Editore. Bologna; 2017: 95-7.
  13. Глуховец Б.И., Глуховец Н.Г. Патология последа. СПб.: Грааль; 2002. 448с.
  14. Honda M., Matsunaga S., Era S., Takai Y., Baba K., Seki H. Intrapartum antidisseminated intravascular coagulation therapy leading to successful vaginal delivery following intrauterine fetal death caused by placental abruption: a case report. J. Med. Case Rep. 2014; 8: 461. https://dx.doi.org/10.1186/1752-1947-8-461.
  15. Pantovic S., Kadija S., Dotlic J., Stojnic J., Jeremic K., Sparic R., Stefanovic A. Treatment of pregnant patient with disseminated intravascular coagulation (DIC) due to placental abruption - a case report. Clin. Exp. Obstet. Gynecol. 2015; 42(5): 692-5.
  16. Wang L., Matsunaga S., Mikami Y., Takai Y., Terui K., Seki H.J. Pre-delivery fibrinogen predicts adverse maternal or neonatal outcomes in patients with placental abruption. Obstet. Gynaecol. Res. 2016; 42(7): 796-802. https://dx.doi.org/10.1111/jog.12988.
  17. Министерство здравоохранения Российской Федерации. Профилактика, алгоритм ведения, анестезия и интенсивная терапия при послеродовых кровотечениях. Клинические рекомендации. М.; 2018. 76с.
  18. Cunningham F.G., Leveno K.J., Bloom S.L., Dashe J.S., Hoffman B.L. Williams obstetrics. 25th ed. McGraw-Hill; 2018. 1343p.
  19. Эйныш Е.А., Крот И.Ф.,Вакульчик И.О.,Кирьянова В.Л. Органосохраняющая тактика при матке кувелера. Проблемы здоровья и экологии. 2013; 3: 136 40.
  20. Rathi M., Rathi S.K., Purohit M., Pathak A. Couvelaire uterus. BMJ Case Rep. 2014; 2014: bcr2014204211. https://dx.doi.org/10.1136/bcr-2014-204211.
  21. Kehila M., Hmid R.B. Couvelaire uterus: bad aspect but normal uterine function. Pan. Afr. Med. J. 2016; 25: 11. https://dx.doi.org/10.11604/pamj.2016.25.11.10606.
  22. Цхай В.Б., Колесниченко А.П., Гарбер Ю.Г., Распопин Ю.С., Яметов П.К., Реодько С.В., Шнейдерман Е.В. Спонтанный разрыв матки по рубцу после операции кесарево сечения в сочетании с врастанием плаценты. Сибирское медицинское обозрение. 2015; 4: 74-8.
  23. Eskes T.K. Abruptio placentae. A classic dedicaced to Elisabet Ramsey. Eur. J. Obstet. Gynecol. Reprod. Biol. 1997; 75(1): 63-70.
  24. Hall D.R. Abruptio placentae and disseminated intravascular coagulopathy. Semin. Perinatol. 2009; 33(3): 189-95. https://dx.doi.org/10.1053/j.semperi.2009.02.005.

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2021 Bionika Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies