ANESTHETIC MANAGEMENT OF OBSTETRIC HEMORRAGE. CASE REPORT OF COUVELAIRE UTERUS.

Proposal Number:

MCC-7136 

Proposal Type:

Medically Challenging Case Report Poster 

Author:

Mónica Giménez Hernández  
Fundación Jiménez Diaz

Co-Author(s):

Marcia Cabrera  
Hospital Fundación Jiménez diaz
Maria Montes Fernández-Micheltorena  
Fundación Jiménez Díaz

Abstract:

The main learning objetives are:
- Management of obstetric hemorrhage
- Importance of early diagnosis and knowing the main symptoms
- Importance of teamwork and communication.

Couvelaire uterus is a rare state of infiltration of uterine myometrium by a massive retroplacental hematoma.

We present the case of a 35-year-old pregnant woman with a history of spina bifida. During admission, emergency cesarean section was indicated due to loss of fetal well-being, performing regional anesthesia.

After placental delivery, anemization, hypotension and tachycardia were observed, requiring intravenous vasoactive drugs. There was no active bleeding in the surgical field, the uterus showed induration, purple color and considerable size increase within a few minutes. A Couverlaire syndrome was quickly diagnosed and urgent interventional radiological embolization was indicated.

During this process, the patient required transfusion of red blood cell concentrates, platelets, frozen plasma, fibrinogen, tranexamic acid and calcium following our obstetric hemorrhage protocol.

After embolization, the patient stabilized hemodynamically and was moved to the resuscitation room for 24 hours with good evolution.

Professional Category:

Resident/Trainee

Keywords:

Obstetric

Enter up to two references.

  Reference
1. Rathi M, Rathi SK, Purohit M, et al Couvelaire uterus Case Reports 2014;2014:bcr2014204211.