Couvelaire Uterus: Point-of-Care Ultrasonography in the Diagnosis of an Uncommon Obstetric Emergency

Abstract

Point-of-care ultrasonography (POCUS) is a key tool in critical care, including obstetric patients in intensive care units (ICUs). Point-of-care ultrasonography can aid in pregnancy diagnosis, fetal assessment, and detection of complications. This case study is based on a 39-year-old pregnant woman, admitted to critical care for preeclampsia. After cesarean delivery, the patient experienced decreased hematocrit levels, renal dysfunction, and uterine tenderness. The POCUS demonstrated uterine atony (inability of the uterus to contract after childbirth), leading to exploratory surgery that confirmed a Couvelaire uterus (CU). Hysterectomy was performed, and histology showed necrosis and bleeding. Couvelaire uterus is a rare complication of placental abruption, caused by placental vascular damage and uterine bleeding. Conservative management and uterine contraction-stimulating drugs are typically used to treat CU. In this case, POCUS provided real-time data for the diagnosis of this obstetric emergency and perhaps other conditions. This report underscores the significance of surveillance and prompt intervention to prevent adverse outcomes for both mothers and infants.