{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T22:19:09Z","timestamp":1791757149149,"version":"4.3.4"},"reference-count":8,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01 HD094347"],"award-info":[{"award-number":["R01 HD094347"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,27]]},"abstract":"Abstract<\/jats:title>\n \n Objectives<\/jats:title>\n Placental abruption occurs when a normally implanted placenta prematurely separates, causing rupture of decidual spiral arteries and retroplacental hemorrhage. Estimates place the incidence of placental abruption somewhere between 0.22% and 1% of all deliveries. Clinical abruption represents a spectrum from mild to the most severe form, in which blood can extravasate into or through the myometrium, the broad ligament, or the peritoneum, causing the uterus and surrounding structures to take on a blue discoloration. This phenomenon is a clinical entity known as Couvelaire uterus, so named because it was first described by French physician Alexandre Couvelaire in the early 20th century as \u201cuteroplacental apoplexy.\u201d Its incidence is difficult to estimate because it has classically been diagnosed only by direct intraoperative visualization. Imaging is not usually indicated in this clinical setting, so radiologic correlation with operative findings has not been previously described.<\/jats:p>\n <\/jats:sec>\n \n Case presentation<\/jats:title>\n In this report, we discuss the case of a multipara who presented with abdominal pain and vaginal discharge several days after a classical cesarean delivery. Her prolonged and complex clinical course led to evaluation via several radiologic modalities. At first, a focal placenta accreta or retained products of conception were suspected, however these diagnoses did not correlate with the patient\u2019s reported intraoperative findings of a clean endometrial cavity or with histopathology that was consistent with massive abruption.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The clinical presentation and features identified on multimodal imaging were ultimately most consistent with the patient\u2019s intraoperative diagnosis of Couvelaire uterus.<\/jats:p>\n <\/jats:sec>","DOI":"10.1515\/crpm-2021-0013","type":"journal-article","created":{"date-parts":[[2022,6,7]],"date-time":"2022-06-07T06:19:57Z","timestamp":1654582797000},"source":"Crossref","is-referenced-by-count":7,"title":["Multimodal postpartum imaging of a severe case of Couvelaire uterus"],"prefix":"10.1515","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5790-4551","authenticated-orcid":false,"given":"Josef","family":"Jackson","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology , Baylor College of Medicine and Texas Children\u2019s Hospital Pavilion for Women , Houston , TX , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verghese","family":"George","sequence":"additional","affiliation":[{"name":"Department of Radiology , Baylor College of Medicine and Texas Children\u2019s Hospital Pavilion for Women , Houston , TX , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"McKinney","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Baylor College of Medicine and Texas Children\u2019s Hospital Pavilion for Women , Houston , TX , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin A.","family":"Fox","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Baylor College of Medicine and Texas Children\u2019s Hospital Pavilion for Women , Houston , TX , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2022,6,7]]},"reference":[{"key":"2025120519295327971_j_crpm-2021-0013_ref_001","unstructured":"Cunningham, F, Leveno, KJ, Bloom, SL, Dashe, JS, Hoffman, BL, Casey, BM, et al., editors. Obstetrical hemorrhage. In: Williams obstetrics, 25th ed. New York (NY): McGraw-Hill; 2018."},{"key":"2025120519295327971_j_crpm-2021-0013_ref_002","doi-asserted-by":"crossref","unstructured":"Ananth, CV, Lavery, JA, Vintzileos, AM, Skupsi, DW, Varner, M, Saade, G, et al.. Severe placental abruption: clinical definition and associations with maternal complications. Am J Obstet Gynecol 2016;214:272. https:\/\/doi.org\/10.1016\/j.ajog.2015.09.069.","DOI":"10.1016\/j.ajog.2015.09.069"},{"key":"2025120519295327971_j_crpm-2021-0013_ref_003","doi-asserted-by":"crossref","unstructured":"Ruiter, L, Ravelli, AC, de Graaf, IM, Mol, BW, Pajkrt, E. Incidence and recurrence rate of placental abruption: a longitudinal linked national cohort study in the Netherlands. Am J Obstet Gynecol 2015;213:573.","DOI":"10.1016\/j.ajog.2015.06.019"},{"key":"2025120519295327971_j_crpm-2021-0013_ref_004","unstructured":"Couvelaire, A. Deux nouvelles observations d\u2019apoplexie ut\u00e9ro-placentaire (hemorrhagies r\u00e9tro-placentaires avec infiltration sanguine de la pavoi musculaire de l\u2019ut\u00e9rus). Ann Gynecol Obstet 1912;9:486."},{"key":"2025120519295327971_j_crpm-2021-0013_ref_005","doi-asserted-by":"crossref","unstructured":"Smith, RP, Turek, PJ, editors. Pregnancy. In: Netter collection of medical illustrations: the reproductive system, 2nd ed. St. Louis, MO: Elsevier; 2011:241\u201381 pp.","DOI":"10.1016\/B978-1-4377-0595-9.50020-9"},{"key":"2025120519295327971_j_crpm-2021-0013_ref_006","doi-asserted-by":"crossref","unstructured":"Hubbard, J, Hosmer, S. Couvelaire uterus. J Am Osteopath Assoc 1997;97:536\u20137. https:\/\/doi.org\/10.7556\/jaoa.1997.97.9.536.","DOI":"10.7556\/jaoa.1997.97.9.536"},{"key":"2025120519295327971_j_crpm-2021-0013_ref_007","doi-asserted-by":"crossref","unstructured":"Habek, D, Selthofer, R, Kula\u0161, T. Uteroplacental apoplexy (Couvelaire syndrome). Wien Klin Wochenschr 2008;120:88. https:\/\/doi.org\/10.1007\/s00508-008-0931-7.","DOI":"10.1007\/s00508-008-0931-7"},{"key":"2025120519295327971_j_crpm-2021-0013_ref_008","doi-asserted-by":"crossref","unstructured":"Rathi, M, Rathi, SK, Purohit, M, Pathak, A. Couvelaire uterus. BMJ Case Rep 2014. PMID: 24686812; PMCID: PMC3975566. https:\/\/doi.org\/10.1136\/bcr-2014-204211.","DOI":"10.1136\/bcr-2014-204211"}],"container-title":["Case Reports in Perinatal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/crpm-2021-0013\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/crpm-2021-0013\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T19:29:57Z","timestamp":1764962997000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/crpm-2021-0013\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,1]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,6,7]]},"published-print":{"date-parts":[[2022,1,27]]}},"alternative-id":["10.1515\/crpm-2021-0013"],"URL":"https:\/\/doi.org\/10.1515\/crpm-2021-0013","relation":{},"ISSN":["2192-8959"],"issn-type":[{"value":"2192-8959","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,1]]},"article-number":"20210013"}}