Early prenatal detection of anterior uterine sacculation resulting from previous cesarean sections

Abstract

Anterior uterine sacculation was diagnosed at 15 weeks of gestation in a woman with two previous cesarean sections, based on hourglass appearance of two distinct uterine segments, namely the empty upper segment and the large thinned wall lower segment containing a fetus with posteriorly attached placenta. The pregnancy developed through the bulging weakened anterior wall instead of growing toward the upper segment. Urgent hysterectomy was performed. The operative and pathological findings confirmed the prenatal ultrasound findings. This is the first report of prenatal diagnosis of sacculation due to cesarean section, which prevented the catastrophic event of uterine rupture.

Uterine Sacculation With Entrapped Placenta After Delivery

“…Most existing literature describes uterine sacculation diagnosed antenatally in the setting of a retroverted, incarcerated uterus in the second or early third trimester 2,8,9 or based on grossly abnormal prenatal ultrasound findings. 1,10 In contrast, the two cases above report uterine sacculations diagnosed and managed immediately postpartum. These cases highlight the need to understand best practices for management of postpartum uterine sacculation.…”

“…There were no obvious anatomic distortions of the cervix or corpus on ultrasonogram, as described in other cases. 1,2,8 Additionally, these sacculations may have been clinically impossible to detect given their location in the fundus as opposed to lower in the uterus, where sacculation can cause cervical displacement. On review of prenatal ultrasound images from case 1, the most recent ultrasonogram, at 30 weeks of gestation, showed no obvious uterine deformation or areas of concern (Fig.…”

“…Uterine sacculation can be diagnosed antepartum or after delivery. 1 The majority of cases of antepartum uterine sacculation occur in the setting of uterine incarceration, which is reported to occur in approximately 1 in 3,000 pregnancies. 2 The incidence of uterine sacculation outside of this setting is not known.…”