Recurrent Bleeding From the Lower Segment Scar—a Late Complication of Caesarean Section

Abstract

Summary Hysterectomy became necessary six months after Caesarean section because of recurrent severe haemorrhage from the uterine scar.

Treatment for Uterine Isthmocele, A Pouchlike Defect at the Site of a Cesarean Section Scar

“…An isthmocele, also called a niche, cesarean scar defect, or cesarean scar dehiscence, is a pouchlike defect of the anterior uterine isthmus at the site of a prior cesarean section [5], which was first described by Morris in 1995 [6] and treated first laparoscopically by Jacobson et al in 2003 [7]. The first scar defect ever reported was in 1975 when Stewart et al [8] noted that preoperative hysterography or pelvic arteriography might help with diagnosis and that the uterus could be saved by excision of the lower segment scar. The worldwide prevalence of isthmoceles out of all cesarean sections ranges from 19% to 84% [9][10][11][12][13], but this may be underestimated because of asymptomatic patients and a lack of clinician awareness.…”

Diagnostic Methods, Risk Factors of Niches, Related Symptoms and Therapies

“…The fi rst publications on CS scar defects in relation to bleeding symptoms date from 1975 (Stewart and Evans 1975 ). However, the relation of such defects with gynecological symptoms in non-pregnant state such as postmenstrual bleeding has only recently been proven in prospective cohort studies in a unselected population of women with a history of CS (BijdeVaate et al 2011 ).…”

Niche After Cesarean Section

“…Therefore, the cesarean-induced isthmocele may lead to the occurrence of gynecologic symptoms such as abnormal uterine bleeding (AUB) secondary to intermittent passage of retained menstrual blood within the cesarean scar defect (CSD), pelvic pain, and sterility [1,3]. The first scar defect ever reported was in 1975 when Stewart, et al who noted that preoperative historiography or pelvic arteriography might help with diagnosis and that the uterus could be saved by excision of the lower segment scar [4]. The worldwide Page: 20 www.raftpubs.com prevalence of isthmoceles out of all cesarean sections ranges from 19% to 84% [5], but this may be underrated because of asymptomatic patients and a lack of clinician awareness.…”