RESUMEN
INTRODUCTION AND IMPORTANCE: Couvelaire uterus, also previously known as uteroplacental apoplexy. This is a life-threatening condition resulting from bleeding into the myometrium that may extend to the parametrium and peritoneum. Couvelaire uterus is typically associated with abruptio placentae, the premature separation of the placenta. This syndrome can only be diagnosed by direct visualization during caesarean section or biopsy (or both). For this reason, its prevalence is under-reported and underestimated in the literature. CASES FINDINGS: We present a rare case series of two patients with Couvelaire uterus in previable pregnancy at Aga Khan Hospital, Dar es salaam. This combination is a rare occurrence and there are no cases reported in sub-Saharan Africa to the best of our knowledge. CLINICAL DISCUSSION AND CONCLUSION: Couvelaire uterus is a rare manifestation to find in a previable pregnancy. The incidence of Couvelaire uterus is difficult to estimate since the diagnosis can only be reached intra-operatively. In most cases it occurs with abruptio placentae which develops due to a disruption in the vessels within the placenta allowing for blood to seep into the decidua basalis leading to premature separation of the placenta and bleeding into the myometrium which may extend to the parametrium and peritoneum. Clinicians should be vigilant when dealing with vaginal bleeding in a pre-viable pregnancy and placental separation is considered as an important differential to avoid the maternal morbidity and mortality that may ensue.
RESUMEN
INTRODUCTION AND IMPORTANCE: Cervical vasovagal shock is termed as stimulation either by instruments or products of conception at cervical os results into bradycardia and hypotension. In primary care settings cervical vasovagal shock can occur during insertion of an intrauterine device (IUD) or any cervical stimulation during physical examination. This case we highlight an uncommon complication of incomplete abortion which is the rare cause of cervical vasovagal shock. CASE PRESENTATION: A 42-year-old Gravida 3 Para 2 Living 2 with Gestational age of 12 weeks presented with vaginal spotting for 2 days. Initial examination she was conscious with normal vital signs. However, after initiation of medical management of incomplete abortion, she had increased per vaginal bleeding with hypotension and bradycardia. Speculum examination was done; this revealed products of conceptus in cervical os and a diagnosis of cervical vasovagal shock was made. Patient was then counselled for evacuation and informed consent was sought. She was taken for evacuation; suction and gentle curettage was done. Post evacuation patients' vitals returned to normal ranges, and patient taken to the ward to continue with post procedure management. CLINICAL DISCUSSION: Bleeding in the first trimester is a common presentation in up to 30 % in early pregnancies and more than 50 % of those will go on to have a normal pregnancy. Most patients with incomplete abortion present at emergence department with shock, this will commonly be due to sepsis, hypovolemia, or haemorrhage. In this case report with discuss a rare cause of shock in women with incomplete abortion. CONCLUSION: Cervical vasovagal effect of the products of conception passing through the cervix causes a reflex bradycardia. It is crucial as physician attending women with incomplete abortion to make sure all the product of conception are passed out and in situation if there is remaining products of conception in the cervix should be removed using a sponge-holding forceps to prevent vasovagal stimulation in the cervix.