Abruptio Placentae with Disseminated Intravascular Coagulation in a Robert’s Uterus: A Rare Multidisciplinary Obstetric Success Story

Abstract

Background: Placental Abruption is a major obstetric emergency associated with significant maternal and fetal morbidity and mortality. The coexistence of placental abruption with rare Müllerian anomalies such as Robert's uterus is exceptionally uncommon and poses unique diagnostic and surgical challenges. Severe cases may rapidly progress to Disseminated Intravascular Coagulation and catastrophic obstetric hemorrhage. Case Presentation: A 24-year-old gravida 3 abortion 2 woman at 32 weeks gestation presented with antepartum hemorrhage and hemodynamic instability. She was diagnosed clinically with abruptio placentae and underwent emergency lower segment cesarean section. Intraoperatively, a Robert’s uterus with Couvelaire changes and severe uterine atony was identified. Despite aggressive uterotonic therapy, Bakri balloon tamponade, uterine artery ligation, massive transfusion, and intensive resuscitative measures, persistent hemorrhage with consumptive coagulopathy necessitated emergency supracervical hysterectomy. The patient required multidisciplinary intensive care support involving obstetricians, anesthesiologists, hematologists, nephrologists, cardiologists, and transfusion medicine specialists. Postoperatively, disseminated intravascular coagulation and stage 1 acute kidney injury resolved with supportive management. The patient was discharged in stable condition. Conclusion: This case highlights the extreme rarity and life-threatening nature of abruptio placentae occurring in a Robert’s uterus complicated by disseminated intravascular coagulation. Early recognition, rapid multidisciplinary intervention, massive transfusion protocols, and timely obstetric hysterectomy were crucial in achieving maternal survival.