Antepartum haemorrhage: Couvelaire uterus: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Antepartum haemorrhage: Couvelaire uterus

Sample item

At emergency caesarean for severe placental abruption the uterus appears purple and mottled with blood extravasation under the serosa, but it contracts well after oxytocin and carboprost. What should be done?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Close the uterus and continue medical measures; hysterectomy is not required for this appearance alone

Couvelaire uterus is extravasation of blood into the myometrium and under the serosa, and it does not by itself indicate atony or need for hysterectomy. If the uterus responds to uterotonics, it is conserved. Hysterectomy is for uncontrolled bleeding that fails medical and conservative surgical measures.

Option by option

  • A. Immediate hysterectomy because of Couvelaire uterus

    The appearance alone is not an indication for hysterectomy.

  • B. Close the uterus and continue medical measures; hysterectomy is not required for this appearance alone (correct)

    Correct. A well-contracting uterus is conserved despite the Couvelaire appearance.

  • C. Pack the uterus and delay closure

    Packing is not the standard approach to a contracting uterus.

  • D. Remove the placenta and leave the uterus open

    The uterus must be closed after delivery of the placenta.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Close the uterus and continue medical measures; hysterectomy is not required for this appearance alone. Couvelaire uterus is extravasation of blood into the myometrium and under the serosa, and it does not by itself indicate atony or need for hysterectomy.

Why is "Immediate hysterectomy because of Couvelaire uterus" not the answer?

The appearance alone is not an indication for hysterectomy.

Why is "Pack the uterus and delay closure" not the answer?

Packing is not the standard approach to a contracting uterus.

Why is "Remove the placenta and leave the uterus open" not the answer?

The uterus must be closed after delivery of the placenta.

What concept does this question test?

It tests Antepartum haemorrhage: Couvelaire uterus in OBG. If the uterus responds to uterotonics, it is conserved. Hysterectomy is for uncontrolled bleeding that fails medical and conservative surgical measures.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Antepartum haemorrhage: Couvelaire uterus?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.