Cuvelera uterus)
1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.
See what “Uteroplacental apoplexy” is in other dictionaries:
- (apoplexia uteroplacentalis; synonym for Cuveler's uterus) extensive hemorrhage into the wall of the uterus with premature placental abruption; sometimes combined with hemorrhage into the broad ligaments of the uterus, into the peritoneal cavity... Large medical dictionary
Large medical dictionary
Large medical dictionary
- (A. Couvelaire, 1873 1948, French gynecologist) see Uteroplacental apoplexy ... Medical encyclopedia
See Uteroplacental apoplexy... Medical encyclopedia
Placental abruption during pregnancy or childbirth before the birth of the fetus. A distinction is made between premature abruption of a normally located placenta and placenta previa. The main causes of premature abruption of a normally located placenta were previously considered... Medical encyclopedia
Uteroplacental apoplexy occurs only in pregnant women. The disease is characterized by complications during pregnancy. Kuveler's uterus is a premature detachment of the baby's place (placenta), accompanied by severe bleeding.
This condition was first studied by the French gynecologist Alexandre Couveler. The placenta is called the “baby place”, which forms by 16-18 weeks of pregnancy. It allows the child to breathe, eat and receive the necessary substances for full growth, as well as get rid of harmful waste products. The placenta performs functions such as fetal protection, hormonal secretion, gas exchange, removal of metabolites, and nutrition. That is, the life of a baby depends on the location of the child’s place, the correctness of its functioning and development.
Causes of placental abruption
If for any reason the placenta is unable to continue performing its intended functions, it detaches and is unable to further support the fetus and ensure its development. Uteroplacental apoplexy occurs for the following reasons:
- late appearance of toxicosis;
- inflammatory diseases in the pelvis;
- changes in the placental vessels lead to the appearance of microthrombosis and microembolism in them, which disrupt the outflow of venous blood, and retroplacental hematomas are formed that exfoliate the placenta;
- mechanical impact on the place where the placenta is located.
Kuveler's uterus occurs due to hypertension, post-term pregnancy, multiple births, in the presence of cicatricial deformity, atypical attachment of the baby's place, and anatomical defects. Uteroplacental apoplexy can occur due to a short umbilical cord, incompatibility of the child and mother according to the Rh factor. In addition, such a pathological condition occurs as a result of autoimmune diseases, abdominal trauma, if the child is too large.
Symptoms of the syndrome
Couveler's syndrome is not asymptomatic. This pathological condition progresses rapidly. The main symptom of uteroplacental apoplexy is external bleeding.
Attention! Bleeding is not always the main sign of pathology; often all the blood accumulates in the uterus, so vaginal bleeding is not significant.
Placental abruption is manifested by severe pain in the lower abdomen and lower back, which resembles pushing. Kuveler's uterus also causes the following symptoms:
- nausea occurs, in rare cases it turns into vomiting;
- the woman begins to panic, worry about the health of the baby, this leads to a rapid heartbeat;
- due to the lack of oxygen and substances necessary for the child, the fetus becomes too mobile, movements are sudden, and the baby also experiences a heart rhythm disturbance;
- symptoms of internal bleeding, up to the appearance of acute vascular insufficiency, characterized by a sharp drop in arterial and venous pressure.
The appearance of such signs cannot be ignored. Uteroplacental apoplexy threatens the life of the child. If you find signs of placental abruption, immediately call an ambulance and do not self-medicate. Only an experienced doctor will be able to make a diagnosis and prescribe appropriate therapy.
Detection of uteroplacental apoplexy
The diagnosis of “Kuveler syndrome” is made on the basis of symptoms, physical examination of the patient and ultrasound. During a physical examination, the woman is placed on a gynecological chair to palpate the fetus; if the fetus cannot be palpated, and the attending doctor’s touch to the uterus causes severe pain, the diagnosis is definitely confirmed.
The pregnant woman will have to undergo an ultrasound examination so that the doctor can look at the placenta and detect a hematoma, if any. Doppler ultrasound is also necessary. This method detects disturbances in blood microcirculation and rupture of blood vessels. Suspecting Couveler's uterus, the doctor is obliged to refer the patient for cardiotocography. Cardiotocography allows you to determine the fetal heart rate: if an insufficient amount of oxygen reaches the baby, the heart rate will be slow.
Main methods of treatment
To save the life of the mother and baby, urgent measures should be taken immediately. If the gestational age allows, a caesarean section is performed. In this way, doctors manage to save the lives of mother and baby. To stop bleeding during surgery, the doctor ligates some vessels. Uteroplacental apoplexy cannot be treated with medication. Only surgery can save both lives or one. Hysterectomy involves removal of the ovaries, but such a reproductive organ is no longer viable, it is a source of mortal danger, so removal should be performed.
Uterine bleeding is accompanied by anemia, the fetus can be seriously harmed. Since the placenta functions poorly, intrauterine fetal hypoxia begins to develop. If a timely cesarean section is not performed, hypoxia can lead to the death of the baby. In addition, if you delay contacting a doctor, the risk of having the uterus removed increases several times, while the woman remains infertile. If a pregnant woman immediately seeks medical help, there is a chance to save the fetus and mother and not have to remove the uterus. The patient is prescribed the use of hemostatic and urethronic agents to stop bleeding. Next, an operation is performed to preserve the uterus as a reproductive organ.
When registering a woman, a qualified doctor takes into account the likelihood of uteroplacental apoplexy based on the pregnant woman’s tests. After this, tactics for managing the patient during pregnancy are formed.
Women, unfortunately, often suffer from diseases of the reproductive system. Moreover, some ailments occur in a normal state, while others can appear only during pregnancy. This article will discuss a pathology called “Cuveler’s uterus.” You will learn what tactics are used to treat it, and also find out the risk factors. It is worth mentioning the causes of Cuveler’s uterus and adding information about the method of prevention.
What kind of pathology is this?
Cuveler's uterus is a pathology that occurs exclusively during pregnancy. More often, the disease affects expectant mothers in the last weeks or during childbirth. The pathology “Cuveler’s uterus” received its name because of the scientist who first diagnosed such a disease. His last name is Kuveler.
This term can be heard quite rarely from doctors and expectant mothers. More often, Cuveler’s uterus has the colloquial name “premature placental abruption.”
Methods for diagnosing pathology
There are several ways to determine pathology. Cuveler's uterus is a disease that is diagnosed using indirect and obvious signs. Let's look at them in detail.
Clinical picture
As the disease develops, a woman develops pronounced symptoms. The expectant mother experiences severe unbearable pain, which is localized in the lower abdomen and spreads to the lower back. On manual examination, the uterus is very painful.
If the pathology develops during childbirth, then she complains of the feeling of one endless contraction. The intervals during which a woman in labor should rest are filled with pain in the lower abdomen.
In addition to pain, a woman may experience a decrease in blood pressure, perspiration, and nausea with uncontrollable vomiting. There is also heavy bleeding from the genital tract, but it may not exist.
Fetal condition
If a pathology such as Cuveler's uterus is suspected, obstetrics recommends a CTG study. During diagnosis, gynecologists and obstetricians note strong changes in the baby’s heart rate. This happens due to the fact that the detached placenta stops supplying oxygen and nutrients to the embryo. Oxygen starvation occurs, which doctors call hypoxia.
It is worth noting that this condition is quite dangerous, since during the restriction of oxygen supply, the fetal brain can be severely damaged. In some situations, the death of the embryo is possible.
Purely subjectively, a woman may note that the unborn baby in the womb behaves unusually. The fetus begins to show severe anxiety and decreased motor activity. In some cases, the opposite reaction occurs: the baby becomes quiet and practically stops moving.
Ultrasound diagnostics
Cuveler's uterus is most accurately determined by ultrasound. During diagnosis, the specialist notes thickening of one of the walls of the uterus. Also, between the placenta and the genital organ, which has a rather impressive volume.
Ultrasound (when examined with Doppler) reveals a violation of the blood flow between the fetus and the placenta, and damaged vessels are also visible.
Cuveler's uterus: therapeutic tactics
Women who develop this pathology need to receive emergency medical care. Otherwise, everything could end quite badly. Some pregnant women lose their babies due to this complication, while others may remain disabled for life. Prolonged inactivity can result in death.
The treatment strategy for placental abruption is always surgical. The woman undergoes an emergency caesarean section. It is worth noting that this method is chosen even when the baby is already dead.
After removing the fetus from the reproductive organ, the doctor notes the complexity of the pathology. In some cases, it is possible to stop the bleeding and save the uterus. In more complex situations, it is necessary to remove the organ completely (along with the cervix). The cervical canal is removed during surgery to prevent the formation of blood clots later. Very rarely, it may be necessary to remove appendages from a woman’s pelvis with a pathology called “Cuveler’s uterus.”
The prognosis after surgery depends entirely on the complexity of the pathology. If a woman has preserved her reproductive organ, then inpatient treatment is carried out. Medicines are prescribed to stop bleeding. When a reverse action is prescribed. In this case, the woman receives which prevent thrombosis.
With fullness and appendages, a woman requires long-term therapy, which is subsequently replaced by lifelong use of hormonal drugs.
Cuveler's uterus: risk factors
Is it possible to find out who is more susceptible to this pathology? Absolutely yes. There is a group of certain risk factors. If you find at least one of them, then you should be more attentive to your own condition, and also inform the doctor managing the pregnancy about this. So, what are the risk factors for developing a pathology called “Cuveler’s uterus”?
- Diseases of the uterus. If a woman has had severe inflammatory diseases of the pelvic organs in the past, then problems with the attachment of the placenta may occur. Also, some diseases can cause premature detachment of the child's place. These include endometritis, endometriosis, adenomyosis and others.
- Features of pregnancy. In multiple pregnancies, Cuveler's uterus occurs more often than in normal pregnancies. Also, frequent births in the past (more than five) can cause abnormalities in the placenta.
- Bad habits of the expectant mother. If a pregnant woman smokes, drinks alcohol or takes drugs, the placenta quickly ages. Having reached a certain point of development, it simply begins to peel off.
- Gestosis, or late toxicosis. If the expectant mother has health problems (kidney pathology, edema, high blood pressure, etc.), then there is a risk of Cuveler's uterus.
- Abnormalities of placenta attachment. If a pathology such as breech presentation is discovered during pregnancy, then there is a high risk of developing abruption. Also, the placenta located in the front is more likely to have developmental anomalies than the placenta located on the rear wall.
Preventive measures
When registering and throughout pregnancy, a woman undergoes numerous examinations. These include blood and urine tests, diagnosis of the condition of the genitourinary system, examination by a therapist and cardiologist. If any risk factor is detected, it is necessary to carry out prophylaxis in the last trimester of pregnancy and during the childbirth period. There are several ways to prevent the development of the pathological process. Let's look at them in detail.
Limiting physical activity
Expectant mothers who have problems with the cardiovascular system, as well as those who have placenta previa, should completely limit physical activity. Otherwise, sudden force may cause vascular damage and a hematoma may appear between the uterus and placenta.
If bleeding occurs during pregnancy, which is caused by placenta previa or low position of the placenta, then you should be especially careful about yourself. Your doctor may recommend that you listen to the advice of a specialist.
Taking certain medications
If you have health problems, then you should focus your efforts on eliminating them. For example, if you have a disease of the genitourinary system, you should take diuretics and anti-inflammatory drugs. Also, during high blood pressure, you need to take pills that regulate blood flow.
If you experience swelling, consult a doctor. The doctor will prescribe you the appropriate medications. Remember that you cannot carry out treatment on your own. Taking any medications must be coordinated with a gynecologist. Otherwise, you can harm the unborn baby more than help.
In the later stages of pregnancy, the doctor will prescribe you special medications that improve blood circulation between the fetus, placenta and mother. Most often, this treatment is carried out in a hospital. Do not refuse such a correction. It will always be useful to the future baby.
Maintaining sexual rest
In case of possible placental abruption and the occurrence of Cuveler's uterus, it is recommended to completely limit sexual intercourse in the second and third trimester of pregnancy.
During sexual intercourse, increased contraction of the uterus occurs, which can stimulate the separation of the placenta from the wall of the reproductive organ.
Fetal monitoring
In the later stages of pregnancy (before and during childbirth), it is necessary to monitor the behavior of the unborn baby. At short intervals, it is necessary to examine the expectant mother using CTG. If there is a suspicion of deterioration in the condition of the fetus, it is necessary to carry out diagnosis using ultrasound.
An ultrasound should be performed a few weeks before the planned birth. During the examination, great attention should be paid to the condition of the placenta. The specialist determines the degree of maturity of this organ and makes an appropriate conclusion.
Timely treatment of diseases
The main prevention of Cuveler's uterus is timely treatment of emerging pathologies. So, if hormonal diseases appear, it is necessary to begin the appropriate correction in time.
Also, if complaints arise during pregnancy, the expectant mother should be carefully examined and, if necessary, treatment prescribed.
Conclusion
So, now you know what Cuveler’s uterus is. Photos of ultrasound pathology are presented in this article. If it occurs, surgical intervention should be performed as soon as possible. Only in this case is there a possibility of a positive outcome.
Carefully monitor your health during pregnancy. If symptoms of pathology appear, consult a doctor or call an ambulance. Health to you and your baby!
The placenta is the most important organ for a person in the embryonic period of development. During pregnancy, it nourishes the fetus, ensures its respiration and removal of metabolic products. The placenta functions until birth, and only then detaches from the wall of the uterus. If this happens earlier, the most dangerous syndrome for mother and baby develops - Kuveler's uterus.
The name of the pathology comes from the name of the French gynecologist A. Couveler, who was the first to describe the detachment of a normally located placenta in 1912. Couveler's uterus develops in 0.5–1.5% of pregnant women and is the most common cause of maternal mortality.
Uteroplacental apoplexy
Premature placental abruption triggers the mechanism of Couveler syndrome. Massive bleeding begins, and a large retroplacental hematoma forms between the placenta and the uterine wall. Blood penetrates the muscular layer of the organ, soaking it through and pouring into the abdominal cavity.
The detached placenta can no longer perform its functions, which leads to rapidly developing hypoxia (oxygen starvation) of the fetus. If more than a third of the placenta detaches, the fetus dies.
The classic Cuveler uterus is a bluish, blood-soaked organ that is unable to contract.
Symptoms of Cuveler's uterus
Quite often, uteroplacental apoplexy develops against the background of a successful pregnancy. In the later stages, pain suddenly appears, which continues to increase, the placenta exfoliates and Kuveler’s uterus forms.
Symptoms of pathology on the part of the mother:
- increasing lower back pain;
- sharp pain in the abdomen;
- nausea;
- anxiety and fear;
- discharge of blood from the vagina;
- signs accompanying acute internal bleeding;
- rupture of the membranes;
- acute renal and liver failure;
- cerebrovascular accident;
- coma;
on the part of the fetus experiencing oxygen starvation:
- sudden sharp movements, soon slowing down and disappearing completely;
- weakening, change in the frequency and quality of the heartbeat.
External bleeding is the most important diagnostic sign of Couveler syndrome, but it does not always occur. Pain on palpation of the uterus is indicative. There is hypertonicity, muscle hardness, and it is impossible to palpate the fetus. In addition, the changed nature of fetal movement should alert you: sharp, convulsive, gradually fading jerks indicate hypoxia.
The woman's condition is rapidly deteriorating and immediate qualified surgical care is required. In this situation, minutes can count.
Causes of placental abruption and risk factors
The true cause of Couveler's syndrome is unknown; perhaps it is a manifestation of some hidden systemic pathologies. It all starts with structural changes in the placental vessels, microthrombosis and microembolism in them. Due to a violation of the outflow of venous blood, the vessels rupture and hematomas form. Merging with each other, they form a retroplacental hematoma, which exfoliates the placenta.
There are some signs indicating the possibility of uteroplacental eclampsia in late pregnancy and during childbirth.
Risk factors:
- multiple pregnancy;
- a large number of pregnancies and births in the past;
- mother's age over 35 years;
- abnormal attachment of the placenta;
- gestosis and preeclampsia in later stages;
- maternal hypertension, heart disease;
- renal and liver failure, pyelonephritis;
- diabetes;
- endocrine disorders, hypothyroidism;
- smoking, drinking alcohol and using drugs during pregnancy;
- stressful effects;
- acute viral infections during pregnancy;
- discoordinated labor, complicated delivery.
Prevention and treatment
Kuveler's uterus is an extremely severe symptom complex, the development of which requires the use of urgent measures to save the life of the mother and baby. Immediate surgical intervention and artificial birth by cesarean section are indicated. If indicated, the uterus is removed.
If there is a history of risk factors for uteroplacental eclampsia, it is necessary to especially carefully monitor the progress of pregnancy and carry out preventive measures. Already when a pregnant woman is registered at the antenatal clinic, the attending physician assesses the likelihood of pathology. Based on this, pregnancy management tactics are formed.
If a diagnosis of preeclampsia or late gestosis is established, special attention is paid to the prevention of fetal hypoxia.
It is important to promptly and completely treat inflammatory diseases of the reproductive system, as they can cause pathology of the placenta.
Kuveler syndrome is a serious complication of pregnancy that threatens the life of the mother and the unborn child. Pathology requires urgent and qualified treatment.
Couveler's uterus, also called uteroplacental apoplexy, is a type of pathology that occurs against the background of a weakened placenta and is dangerous due to the development of bleeding, as a result of which blood can enter the cavity of the uterine muscles.
Basic definitions
During pregnancy, a woman may encounter various complications and anomalies that can negatively affect the progress of pregnancy and the health of the patient and her child. These include Couveler's uterine syndrome. It was identified by the gynecologist Kuveler, in whose honor the syndrome received this name, in 1911, and the following year it was described in his work.
Uteroplacental apoplexy, as a characteristic type of uterus, is a condition in which the placenta is rejected prematurely. In this case, the deviation is accompanied by severe bleeding with a high probability of penetration into the uterine cavity lined with muscle tissue and into the peritoneum.
This complication is dangerous not only for the mother, but also, first of all, for the baby in the womb. The fact is that the placenta plays the role of lungs, and its detachment earlier than expected causes hypoxia, as a result of which the fetus is deprived of oxygen and suffocates. In situations where Kuveler's uterus appears directly during the period of gestation of the embryo before delivery, this can threaten the woman in the situation with disability.
Pathology identified by characteristic symptoms in the early stages of development is subject to treatment. At the same time, the tactics of pregnancy change. Treatment is prescribed by a doctor, taking into account the physiological and individual characteristics of a pregnant woman. Most often, treatment of uteroplacental apoplexy involves keeping the patient under constant observation in a hospital. In this case, doctors will be able to promptly identify abnormalities and provide professional assistance.
Identification of the pathological symptom complex of Kuveler's uterus in the later stages of formation increases the risk of a retroplacental hematoma (extensive). In most cases, under such circumstances, the fetus cannot be saved, and the woman in labor may experience complications due to the large volume of lost blood. Treatment in such situations is long-term therapy under the supervision of a physician to eliminate negative consequences.
Disturbances during pregnancy when uteroplacental apoplexy occurs occur in 1 case out of 100. Knowing the symptoms of the condition and promptly seeking medical help increases the likelihood of preserving the fetus and avoids adverse consequences for the woman and her baby.
Why might a complication occur, and how to recognize it?
During the normal development of pregnancy, the placenta maintains its position throughout the entire period of gestation. She begins to be rejected after the actual delivery. If this phenomenon occurs prematurely, there is a risk of hypoxia when the fetus experiences oxygen starvation. The initial causes that constitute the prerequisites for the appearance of pathology are still not fully understood by doctors. At the same time, they identified the main factors that determine the group of predispositions to the development of uteroplacental apoplexy. These include:
- addiction to alcohol, drugs, smoking;
- hypertension;
- diabetes;
- toxicosis in the third trimester of pregnancy.
Also included in the list of causes of Kuveler's uterine syndrome is a large number of previous pregnancies with successful births. According to the data demonstrated by statistics, patients who have given birth multiple times are more likely to suffer from the pathology of premature uterine rejection.
In addition to these reasons, there are other factors that can increase the risk of pathology during pregnancy. This:
- premature pregnancy or delivery of a post-term fetus;
- injuries from the abdominal area;
- interventions by gynecologists (rough manipulations during examination, external rotation of the child during childbirth);
- tendency to polyhydramnios;
- disruption of the normal functioning and contractions of the uterus.
Symptoms
Couveler's uterus may appear against the background of deteriorating blood flow in the subplacental space, as a result of which the villi connecting the placenta to the uterus begin to function worse. As a result, the connection between the uterus and the placenta weakens, and blood vessels burst, provoking its premature rejection.
The development of Couveler's uterine syndrome may be accompanied by the following symptoms:
- severe pain in the lumbar region, the nature of which resembles pushing;
- anxiety, restlessness;
- change in the motor activity of the fetus - its movements become very sharp, which also affects the heart rate;
- nausea, urge to vomit;
- the appearance of slight bloody uterine discharge;
- severe pain between contractions (if the placenta is rejected at the initial stage of labor).
However, the symptoms of placental abruption ahead of time do not always include bleeding. There are situations when hemorrhage occurs through the external organs of the reproductive system, accumulating in the space between the wall of the uterus and the placenta. In this case, Kuveler's uterus can be diagnosed by severe pain that occurs when palpating the abdominal area.
Prevention of pathology
As you know, it is much easier to prevent a disease than to treat it. Therefore, in the case of patients prone to developing uteroplacental apoplexy, the problem can be solved through prevention.
To prevent the occurrence of premature placental abruption and the negative consequences of deviation, you can take the following measures:
- comprehensive examination at all stages of pregnancy;
- timely treatment of diseases of any nature;
- when identifying a tendency to develop vascular abnormalities and the appearance of uterine hypertonicity, as well as with placenta previa, restriction of motor activity and sexual activity;
- at the first alarming sensations and the presence of the first symptoms of trouble, consult professional medical staff.
The intervention of doctors at the first symptoms of Kuveler's uterus allows one to avoid adverse consequences and save the life of the child and the health of the mother.
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