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All Journal Indonesian Journal of Obstetrics & Gynecology Science
Aisyah Shofiatun Nisa
Department of Obstetrics and Gynecology, Hasan Sadikin General Hospital-Padjadjaran University, Bandung, Indonesia
Health Professions Public Health

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Placental Abruption with Couvelaire Uterus in a Primigravida: A Case Report Immanuel Bachtiar Parlindungan; Dadan Susandi; Windi Nurdiawan; Hadi Susiarno; Aisyah Shofiatun Nisa
Indonesian Journal of Obstetrics & Gynecology Science Volume 9s Number 2 July 2026 Special Issue Case Report & Systematic Review
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v9i2.1117

Abstract

Introduction: Placental abruption typically presents with the classic triad of vaginal bleeding, abdominal pain, and uterine tenderness. However, atypical presentations lacking these features may delay diagnosis. The occurrence of an extensive couvelaire uterus requiring a hysterectomy in a young primigravida without classical risk factors is rare. This case adds to the limited literature on severe, atypical presentations of placental abruption.Case Illustration: A 20-year-old primigravida at 32 – 33 weeks of gestation presented with decreased fetal movements, lacking vaginal bleeding or significant abdominal pain. Notably, she reported a recent history of traditional abdominal massage. She was diagnosed with intrauterine fetal death (IUFD), and ultrasonography demonstrated a retroplacental hemorrhage suggestive of placental abruption. Despite the absence of classic symptoms, clinical suspicion remained high. Due to concerns of ongoing concealed hemorrhage and impending maternal deterioration, an emergency cesarean section was performed. Intraoperatively, a couvelaire uterus involving approximately 60% of the anterior uterine wall was identified. Following delivery, the patient developed refractory uterine atony unresponsive to uterotonics (oxytocin, methylergometrine, and misoprostol), necessitating a supravaginal hysterectomy to control life-threatening hemorrhage. The patient recovered well postoperatively.Conclusion: This case highlights an atypical presentation of placental abruption that progressed to severe maternal complications, including a couvelaire uterus and refractory atony requiring surgical intervention. Early recognition based on clinical suspicion and imaging is essential to prevent maternal morbidity when classical symptoms are absent. While the patient had a history of traditional abdominal massage, a definitive causal relationship cannot be established; further research is needed to explore its potential role as a trigger.Solusio Plasenta dengan Uterus Couvelaire pada Primigravida: Sebuah Laporan KasusAbstrakPendahuluan: Solusio plasenta umumnya bermanifestasi dengan triad klasik berupa perdarahan pervaginam, nyeri abdomen, dan nyeri tekan uterus. Namun, presentasi atipikal tanpa gejala tersebut dapat menyebabkan keterlambatan diagnosis. Kejadian uterus couvelaire luas yang memerlukan histerektomi pada primigravida muda tanpa faktor risiko klasik merupakan kondisi yang jarang dan menambah keterbatasan literatur mengenai presentasi berat solusio plasenta yang atipikal.Ilustrasi Kasus: Seorang wanita berusia 20 tahun, primigravida dengan usia kehamilan 32 – 33 minggu, datang dengan keluhan penurunan gerak janin tanpa disertai perdarahan pervaginam maupun nyeri abdomen bermakna. Pasien didiagnosis dengan intrauterine fetal death (IUFD). Pemeriksaan ultrasonografi menunjukkan adanya perdarahan retroplasenta yang mengarah pada solusio plasenta. Meskipun tanpa gejala klasik, kecurigaan klinis tetap tinggi berdasarkan temuan kematian janin dan hasil pencitraan, dengan pertimbangan adanya perdarahan tersembunyi yang sedang berlangsung serta risiko perburukan kondisi maternal. Selanjutnya, dilakukan seksio sesarea emergensi terhadap pasien. Secara intraoperatif ditemukan uterus couvelaire yang melibatkan sekitar 60% dinding anterior uterus. Setelah persalinan, pasien mengalami atonia uteri refrakter yang tidak responsif terhadap terapi uterotonik (oksitosin, metilergometrin, dan misoprostol) sehingga dilakukan histerektomi supravaginal untuk mengendalikan perdarahan yang mengancam jiwa. Pasien menunjukkan perbaikan klinis yang baik pascaoperasi.Kesimpulan: Kasus ini menyoroti presentasi atipikal solusio plasenta tanpa triad klasik yang dapat berkembang menjadi komplikasi maternal berat, termasuk uterus couvelaire dan atonia uteri refrakter yang memerlukan histerektomi. Pengenalan dini berdasarkan kecurigaan klinis dan temuan pencitraan sangat penting untuk mencegah morbiditas maternal. Meskipun pasien memiliki riwayat pijat abdomen tradisional, hubungan kausal tidak dapat dipastikan; diperlukan penelitian lebih lanjut untuk mengeksplorasi kemungkinan perannya.
Survival Outcomes at Three Years After Primary vs Interval Debulking in Advanced Ovarian Cancer: A Retrospective Study from Hasan Sadikin Hospital (2021) Alce Everdien; Andi Kurniadi; Dini Pusianawati; Aisyah Shofiatun Nisa; Dadang Hawari Subhan
Indonesian Journal of Obstetrics & Gynecology Science Volume 8 Nomor 3 November 2025
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v8i3.1003

Abstract

Objective: Ovarian cancer is the third most prevalent malignancy among women in Indonesia. The 5-year survival rate is approximately 49%, with 68% of patients diagnosed at an advanced stage. Standard treatment involves debulking surgery, which is categorized into primary debulking surgery (PDS) and interval debulking surgery (IDS). This study aims to compare the survival outcomes of ovarian cancer patients treated with PDS versus IDS at Dr. Hasan Sadikin General Hospital (RSHS) during 2021.Methods: A retrospective review of medical records was performed for ovarian cancer patients who underwent surgery at RSHS in 2021. Patients were classified according to the type of surgical management (PDS or IDS), and survival data were analyzed accordingly.Result: A total of 46 patients were included, with 38 undergoing PDS and 8 undergoing IDS. The mean overall survival was 34.1 months for the PDS group and 27.5 months for the IDS group. Bivariate analysis showed no significant difference in survival between the two groups (HR: 1.810, p = 0.341; 95% CI: 0.53–6.13). However, age (HR: 0.950, p = 0.014; 95% CI: 0.91–0.99) and progression-free survival duration (HR: 0.788, p = 0.0001; 95% CI: 0.71–0.86) were identified as significant prognostic factors for overall survival.Conclusion: The mean overall survival for patients undergoing primary debulking surgery (PDS) was higher than for those undergoing interval debulking surgery (IDS), although this difference was not statistically significant.Angka Kelangsungan Hidup Tiga Tahun Setelah Debulking Primer vs Interval pada Kanker Ovarium Stadium Lanjut: Sebuah Studi Retrospektif di RSUP Hasan Sadikin (2021)AbstrakTujuan: Kanker ovarium merupakan keganasan ketiga terbanyak pada wanita di Indonesia. Angka kelangsungan hidup 5 tahun sekira 49%, dengan 68% pasien datang pada stadium lanjut. Tatalaksana standar melibatkan operasi debulking yang diklasifikasikan menjadi operasi debulking primer (PDS) dan operasi debulking interval (IDS). Penelitian ini bertujuan untuk membandingkan hasil kelangsungan hidup pasien kanker ovarium yang diobati dengan PDS versus IDS di RSUP Dr. Hasan Sadikin (RSHS) selama tahun 2021.Metode: Sebuah studi retrospektif dilakukan melalui tinjauan rekam medis pasien kanker ovarium yang menjalani tatalaksana bedah di RSHS pada tahun 2021. Pasien dikategorikan berdasarkan jenis tatalaksana bedah (PDS atau IDS), dan data kelangsungan hidup dianalisis.Hasil: Sebanyak 46 subjek diikutsertakan, dengan 38 pasien menjalani PDS dan 8 pasien menjalani IDS. Rerata kelangsungan hidup keseluruhan adalah 34,1 bulan pada kelompok PDS dan 27,5 bulan pada kelompok IDS. Analisis bivariat tidak menunjukkan perbedaan signifikan dalam kelangsungan hidup antara kedua kelompok (HR: 1,810, p = 0,341; 95% CI: 0,53–6,13). Namun, usia (HR: 0,950, p = 0,014; 95% CI: 0,91–0,99) dan durasi kelangsungan hidup bebas progresi (HR: 0,788, p = 0,0001; 95% CI: 0,71–0,86) diidentifikasi sebagai faktor prognostik yang signifikan terhadap kelangsungan hidup keseluruhan.Kesimpulan: Rata-rata kelangsungan hidup keseluruhan pasien yang menjalani operasi debulking primer (PDS) lebih tinggi daripada rata-rata kelangsungan hidup keseluruhan pasien yang menjalani operasi debulking interval (IDS), meskipun tidak signifikan secara statistik.Kata kunci: Angka kelangsungan hidup; kanker ovarium; pembedahan debulking interval; pembedahan debulking primer
Co-Authors Alce Everdien Andi Kurniadi Dadan Susandi Dadang Hawari Subhan Dini Pusianawati Hadi Susiarno Immanuel Bachtiar Parlindungan Windi Nurdiawan