32.有關Couvelaire uterus的敘述，下列何者錯誤？
(A)為胎盤早期剝離的子宮特徵
(B)原因是因為廣泛的extravasation，導致血液浸潤於子宮肌肉層
(C)很少造成子宮收縮乏力
(D)常須切除子宮以幫忙止血

來自Williams

(A) 為胎盤早期剝離的子宮特徵

• Couvelaire uterus 是胎盤早期剝離的典型病理表現，血液滲入子宮肌層及漿膜下。

→ (A) 正確。

 

(B) 原因是因為廣泛的 extravasation，導致血液浸潤於子宮肌肉層

• Couvelaire uterus 的成因正是由於胎盤早剝時廣泛的血液外滲，血液浸潤子宮肌層。

→ (B) 正確。

 

(C) 很少造成子宮收縮乏力

• 儘管子宮肌層有大量血液浸潤，Couvelaire uterus 通常不會導致子宮收縮乏力。

→ (C) 正確。

 

(D) 常須切除子宮以幫忙止血

• Couvelaire uterus 雖嚴重，但通常不需進行子宮切除來止血，僅在其他方法無效且無法控制出血時才考慮。

→ (D) 錯誤。

 Incidence, risk factors, and clinical outcomes of 
placental abruption in a tertiary hospital in Hong 
Kong: a retrospective case-control study
 Jade Wing Ngan SHEK, BMedSci, MBChB, MRCOG 
Po Lam SO, MBBS (HK), MMedSc (Genetic Counselling), MSc (Medical Genetics), FHKCOG, FHKAM (O&G) 
Lee Ting KWONG, MBBS (HK), FHKCOG, FHKAM (O&G)
 Sai Fun WONG, MBBS (HK), FRCOG, FHKCOG, FHKAM (O&G)
 Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Hong Kong
 Introduction: This study aims to identify risk factors for placental abruption and evaluate maternal and fetal outcomes 
of patients with placental abruption in a tertiary hospital in Hong Kong.
 Methods: Medical records of patients with placental abruption treated at the Tuen Mun Hospital between January 
2017 and December 2021 were retrospectively reviewed. Data retrieved included patient demographics, alcohol/
 substance abuse and smoking status, obstetric history, antenatal characteristics, body mass index at first antenatal 
visit, clinical presentation, intrapartum events, complications, and maternal and perinatal outcomes. Each patient 
was matched with a control who delivered just before the patient.
 Results: Of 22 990 deliveries and 23 230 live births, there were 86 placental abruption cases; the incidence 
was 0.37%. After adjusting for confounders, the risk factor for placental abruption was a history of antepartum 
haemorrhage. Compared with controls, patients with placental abruption had higher rates of caesarean sections 
(91.9% vs 23.3%, p<0.001), postpartum haemorrhage (62.8% vs 15.1%, p<0.001), uterine atony (31.4% vs 3.5%, 
p<0.001), blood transfusion (25.6% vs 3.5%, p<0.001), and disseminated intravascular coagulopathy (7.0% vs 
0%, p=0.029). Compared with controls, neonates complicated with placental abruption had lower Apgar score at 
1 minute (7 vs 8, p<0.001), higher preterm birth rate (64.0% vs 9.3%, p<0.001), lower birth weight (2296.4 g vs 
3088.8 g, p<0.001), and more perinatal morbidities. Patients with a Couvelaire uterus had higher rates of uterine 
atony (56.3% vs 27.0%, p=0.026), postpartum haemorrhage (93.8% vs 61.9%, p=0.014), disseminated intravascular 
coagulopathy (25.0% vs 3.2%, p=0.014), blood transfusion (68.8% vs 17.5%, p<0.001), and secondary intervention 
(25.0% vs 1.6%, p=0.005). Neonates born from patients with a Couvelaire uterus had higher rates of acidosis 
(umbilical cord blood pH <7.1) [53.3% vs 5.8%, p<0.001], lower Apgar score at 1 minute (25.0% vs 4.8%, p=0.028), 
and hypoxic-ischaemic encephalopathy (12.5% vs 0%, p=0.039).
 Conclusion: Clinicians should be vigilant for placental abruption in patients with antepartum haemorrhage, especially 
in high-risk patients with a history of placental abruption, hypertension, or pre-eclampsia. Early and consistent 
antenatal care is imperative to identify those with risk factors. Proper education and timely preventive management 
should be provided to improve maternal and fetal outcomes