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Placental abruption leading to hysterectomy
  1. Hannah Catherine Sylvester,
  2. Madeleine Stringer
  1. Department of Obstetrics and Gynaecology, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
  1. Correspondence to Dr Hannah Catherine Sylvester, hannah.sylvester{at}


A 32-year-old multigravid patient at 21 weeks gestation presents with major concealed placental abruption and subsequent fetal demise. During an eventually failed misoprostol regime aiming for vaginal delivery she develops severe disseminated intravascular coagulopathy. Subsequent hysterotomy reveals Couvelaire uterus with major haemorrhage and requires subtotal hysterectomy for haemostasis. This case highlights the severity of the systemic response to abruption and fetal demise in utero and the multifactorial nature of its management.

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  • Contributors HCS is the primary author and initial preceptor of the idea of writing up this case. Carried out the literature review and is the writer of the discussion part of the case. Final editor of figures and text. Was the on call labour ward doctor during this patient's entire stay and assistant surgeon at the procedure in question. Have liaised with the patient and family and gained patient consent. MS is the coauthor, and was involved in the planning and development of the clinical part of the case write up. Designed the first draft of the case report and involved in subsequent editing.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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