Uvek Kuvelera

Uterus of Kuveler is a group of pathological symptoms accompanying untimely placental abruption on the background of massive bleeding. Uveka Kuvelera is diagnosed only on the background of pregnancy.

Uterus of Kuveler, fortunately, is diagnosed infrequently. This syndrome is named for the first time studied by his French gynecologist Alexander Kuveler who presented the characteristic appearance of the uterus against a background of placental abruption and massive bleeding: impregnated with blood, cyanotic, which has lost the ability to contract the uterus with characteristic petechial( dotted) bruises on the serous membrane.

Since the queer uterus arises in the pathology of the placenta, it is necessary to tell about it from the very beginning. The placenta( "child's place") is formed by the middle of pregnancy as a temporary vital organ fetus. It is an anatomical and physiological "mediator" between the mother's organism and the developing fetus. Thanks to the placenta, the fetus is able to "breathe", eat, get rid of the harmful products of its vital activity and get everything necessary for growth. Therefore, any trouble in the placenta can not but affect the fetus.

When a fertilized egg, breaking through the fallopian tubes, enters the uterus and immerses in the mucosa, an active process of shaping the future child's place begins. The source of the placenta is the embryonic membrane, mainly - villous( chorion) and decidual. With the help of special outgrowths( villi), the chorion is attached to the uterine wall, forming the so-called placental area - the site of the future placenta connection with the uterus. It is in this place that the placenta separates after the fetus in childbirth.

The placenta begins to function as an independent organ by the 16th-18th week. By this time she takes on all the functions of life support of the fetus, namely:

- Gas exchange. In fact, the placenta is functionally equivalent to light - it delivers oxygen and "takes" carbon dioxide.

- Food. To fully develop the fetus needs nutrients, minerals and vitamins. Their source is the mother's blood. In the space between the villus of the chorion, there is an exchange between the mother's blood enriched with the necessary substances and the blood of the fetus.

- Selection. All the "harmful" substances( metabolites) that the fetus secretes are also removed by the placenta.

- Hormone secretion. The uterus does not reject the developing fetus under the influence of a number of hormones secreted by the placenta. Also, these hormones help the mother's body to adapt to the new state.

- Protection. The fetus in the womb is practically defenseless, as it is in the stage of development and is in a sterile environment. The placenta misses the mother's antibodies to it so that they protect the developing organism and help shape the immune system.

Thus, the development and life of the fetus depends on how the function is located and how the placenta is developed. If the placenta prematurely ceases to perform its functions, the fetus can not develop and maintain vital functions on its own, so as a result it dies.

Diagnosis of pathology is the presence of a typical clinic. Uchet Kuveler on ultrasound is visualized well enough, therefore diagnostic search does not take much time.

What is the Kuveler's uterus

The uterus of the Kuveler arises when the detachment of the child's place is not timely, when it is too early to separate from the uterine wall. This can occur at any gestation period or during childbirth. According to the time of the onset of detachment, it is classified as an early, detachment at a later date and an abruption in labor( contractions or an excruciating period).

The extent to which the area of ​​the exfoliated part of the placenta is large determines the prognosis for all participants in the pathological event. If the entire surface of the placenta is separated from the uterine wall within a short period of time, the detachment is considered complete. Remaining without the necessary means for life, the fetus quickly dies.

If the child's place loses only part of the functioning area, the placental abruption is regarded as partial.

Any part of the placenta can exfoliate. If it is located with the edge( marginal detachment), the blood flows into the uterine cavity, if in the center( the central detachment) accumulates in a delimited space, forming a hematoma.

Uterus of Kuvelera is observed in case of massive bleeding in the zone of detachment of a child's place, when the blood not only fills the uterine cavity, but also seeps, like through a sponge, through the uterine wall, the ovary cellulose, eventually ending up in the pelvic cavity. Blood-soaked uterus loses its ability to contract, maternal blood begins to form small blood clots due to violation of clotting processes( DIC-syndrome), the threat to life of the pregnant woman becomes too high. The fetus, due to acute oxygen deficiency( fetal hypoxia), dies very quickly, but the most urgent problem is to prevent the death of the woman herself in conditions of increased bleeding and a high probability of hemorrhagic shock.

Causes of the appearance of the uterus of Kuveler

The only cause of the uterus of Kuveler is the early detachment of the child's place. Even in the conditions of a normally developing pregnancy, there are natural prerequisites for placenta rejection, because it is located between a powerful uterine wall with a large number of muscles and a fetal bladder that increases and exerts constant pressure. Usually, if the pregnancy is formed correctly, and the woman is healthy, these acting forces counterbalance each other, in addition the placenta itself is able to stay in place due to elasticity.

The reasons for the detachment of the children's place are very diverse. As a rule, its sources rarely have only one provoking factor. It is believed that the detachment is triggered by three combined causes:

- the pathology of the vessels( more often the mother than the fetus);

- changes in the clotting system;

- mechanical effect on the area of ​​the placenta.

More often such an unfavorable combination is realized in pregnant women having:

- Hypertension. The circulatory system undergoes serious stress during pregnancy, so any circumstance contributing to an increase in such a load( stress, physical overwork, a habit of lying for a long time on the back), provokes a vascular spasm and an increase in pressure. The risk of hypertension increases if the pregnant woman initially had hypertensive disease and / or kidney pathology, as well as diabetes mellitus.

- Numerous births with a small gap. Each pregnancy leaves after itself certain changes in the structure of the endometrium, in particular, the degenerative process in the zone of attachment of the placenta to the uterus( "placental platform").Each subsequent pregnancy aggravates these changes, therefore the placenta, as a result, is attached incorrectly and can exfoliate untimely.

- Pregnant pregnancy. The placenta, relatively speaking, grows old by the end of pregnancy, as nature has calculated the life expectancy, equal to the term of full term pregnancy. When pregnancy lasts longer, the placenta may begin to degrade and tear away.

- Coagulation system pathologies. The tendency to thrombosis( hereditary or acquired) provokes negative changes in the blood flow in the placenta zone.

- gestosis( late toxicosis).Late toxicosis is always accompanied by fluctuations in blood pressure and changes in the clotting system.

- Presence of cicatricial deformity of the uterine wall, which always occurs after operations. If the placental area is formed in the area of ​​the scar, the child's place is loosely attached to the uterine wall.

- Pathology of the placenta: atypical attachment, the presence of an "extra" share, premature "aging".

- Anatomical defects deforming the uterine cavity.

The cause of premature detachment can be a trauma - a fall and / or a strong blow. After trauma in the area of ​​the placental area, a large hematoma can form, which gradually "peels off" the placenta from the uterus. In addition, the uterus responds to a strong blow with muscle contractions, which, in turn, provoke detachment.

The placenta may prematurely peel off and during labor. It should be noted that this situation is more favorable for the fetus, because by the time of delivery it is ready to live outside of the uterus, and if timely help is provided, the child may not suffer.

In the birth of the placenta is also "born", like the fetus. After the baby leaves the womb, the uterine musculature again shrinks and rejects the child's place. Pathological is the beginning of detachment before the child is born - during labor or attempts.

Symptoms of the uterus of Kuveler

Since the detachment can start at any time, including childbirth, the appearance of the uterus of Kuveler also does not have a clear time frame.

In addition to the typical symptoms of detachment, the Kuveler's uterus has a number of special clinical signs:

- Intensive uterine pain reminiscent of those with attempts, with clear irradiation into the lumbar region;

- Bleeding. Usually, all the blood accumulates in the uterus and penetrates beyond it, so vaginal bleeding is not significant;

- Feeling of "faintness", nausea, recurrent vomiting;

- If the detachment begins in childbirth, intense pain begins between contractions;

- Fetus under conditions of increasing hypoxia moves sharply and intensively or becomes sluggish. When measuring the heart rate( CTG) in the fetus, its disturbances are recorded - in the conditions of hypoxia, the fetal heart rhythm slows down.

- Signs of internal bleeding, right up to the collapse.

- The palpation of the uterus is painful, tense. Due to the pronounced tone of the uterine wall, parts of the fetus are difficult to determine.

Also diagnosed is the uterus of Kuveler on ultrasound. When ultrasound scanning is well visualized thickening of one of the uterine walls and the presence of a hematoma - an atypical "formation" between the wall of the uterus and the surface of the placenta.

Dopplerography( a technique for studying peripheral blood flow) can detect a violation of blood flow and rupture of blood vessels in the placenta.

Treatment of the uterus of Kuveler

There is only one way to eliminate the source of dangerous bleeding - the urgent removal of the placenta, and, consequently, the fetus - immediate delivery( caesarean section).The sole purpose of the operation is to save the patient's life, even if the child dies. After examination( revision) of the uterus, the question of further action is decided. The presence of signs of the uterus of the Kuveler often requires its removal( extirpation) with preservation of the ovaries, since this uterus is already unviable and is only a source of mortal danger.

Modern advanced clinics have the ability to try to save the uterus when it has not yet lost its ability to contract, and the bleeding gradually stops against a background of haemostatic and uterotonic agents. An operation is performed that allows the uterus to be preserved as a genital organ.

The technique of temporary embolization of uterine arteries is also used, when a special substance( gelatin sponge) is introduced into them. It performs the role of the embolus, so that the bleeding stops, and then resolves. The method is suitable for a situation where the uterus was able to contract, bleeding became insignificant.

Prevention of the uterus of Kuveler

There is no special prophylaxis for the uterus of Kuveler. In fact, the only preventative measure is preventing the untimely detachment of a child's place.

As a rule, placental abruption is often provoked by placental pathology, namely, a circulatory failure in the "placenta-mother" system. It is logical to assume that timely therapy of gestosis, as well as provoking extragenital pathologies, can significantly reduce the risk of a dangerous syndrome.

Preventive maintenance gestozov starts almost from the first weeks of pregnancy, when a specialist finds out the presence of pathological factors and makes a personal plan for prevention. Appointed drugs that improve metabolic processes, vitamins, hypotensive and soothing drugs.

The first signal of trouble in the placenta is the changes in the fetal condition that the cardiotachogram registers. The presence of characteristic signs for hypoxia indicates the need to "help" the placenta so that in the future it does not become a source of serious complications.