According to researchers in a recently published study the presence of a Couvelaire uterus during placental abruption is a predictor of worse maternal outcomes but has no significant effect on neonatal outcomes. The study was published in the International Journal of Obstetrics and Gynecology by Kazuya and colleagues. This was a single-center retrospective study done at a tertiary perinatal center in Japan, which aimed to show maternal and neonatal outcomes based on the presence or absence of a Couvelaire uterus.

The study involved patients who were diagnosed with acute placental abruption, gave live birth by cesarean section from 2016 to 2023, and were divided according to whether a Couvelaire uterus was or was not present during surgery into the Couvelaire group and the normal uterus group. Parameters studied in regard to maternal and neonatal outcomes included the effect of Couvelaire uterus on them.
A total of 76 patients were included in the study, with 24 in the Couvelaire group and 52 in the normal uterus group. Key findings include:
• Intraoperative blood loss was significantly higher in the Couvelaire group (median 1152g vs 948g, P=0.010).
• Blood transfusion rates were higher in the Couvelaire group (58% vs 31%, P=0.022).
• Fibrinogen administration rates were higher in the Couvelaire group (38% vs 13%, P=0.038).
• Intensive care unit/high care unit admission rates were higher in the Couvelaire group (29% vs 7.7%, P=0.013).
• Disseminated intravascular coagulation complication rates were higher in the Couvelaire group (25% vs 7.7%, P=0.038).

• There were no significant differences between the two groups in neonatal outcomes, including birth weight (median 2387g vs 2065g, P=0.082), Apgar score <4 at 5 minutes (4.2% vs 3.9%, P=0.95), umbilical artery blood pH <7.1 (25% vs 22%, P=0.82), and neonatal death (4.2% vs 1.9%, P=0.57).
Results suggest that the presence of a Couvelaire uterus in placental abruption should alert the health professional to possible adverse maternal outcomes, with preparation required for blood transfusions and intensive monitoring of the patient. After all, despite the increased risks to the mother, neonatal outcome was unaffected. Therefore, proper management may minimize its effect on the newborn.
This study found that in cases of placental abruption, a Couvelaire uterus was associated with poor maternal outcomes; therefore, thorough preparation and close monitoring in that regard are very essential. Neonatal outcomes, however, were not that much affected, raising the need for individual maternal care in order to optimize outcomes.
Reference:
Hiiragi, K., Obata, S., Miyagi, E., & Aoki, S. (2024). Clinical implications of a Couvelaire uterus with placental abruption: A retrospective study. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics. https://doi.org/10.1002/ijgo.15821