Spontaneous cesarean scar dehiscence during pregnancy: A case report and review of the literature

Tilahun, Temesgen; Nura, Abdulaziz; Oljira, Rut; Abera, Mesfin; Mustafa, Jafar

doi:10.1177/2050313x231153520

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…A lower uterine segment thickness of less than 2 mm is considered a criterion for poor healing and differentiates the risk group of potential uterine rupture with sensitivity and specificity of 86.7% and 100%. In our case, the measurement of the lower section was 3.4 mm [21][22][23]. Additionally, a full LUS thickness of 2.3 mm in women during the first stage of labor is associated with a high risk of complete uterine rupture during a trial of labor.…”

Section: Discussionmentioning

confidence: 55%

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Unexpected Uterine Rupture—A Case Report, Review of the Literature and Clinical Suggestions

Flis,

Socha,

Wartęga

et al. 2023

JCM

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Background and Objectives: Women with a history of cesarean section are a high-risk group because they are likely to develop uterine rupture during their next pregnancy. Current evidence suggests that a vaginal birth after cesarean section (VBAC) is associated with lower maternal mortality and morbidity than elective repeat cesarean delivery (ERCD). Additionally, research suggests that uterine rupture can occur in 0.47% of cases of trial of labor after cesarean section (TOLAC). Case Description: A healthy 32-year-old woman at 41 weeks of gestation, in her fourth pregnancy, was admitted to the hospital due to a dubious CTG record. Following this, the patient gave birth vaginally, underwent a cesarean section, and successfully underwent a VBAC. Due to her advanced gestational age and favorable cervix, the patient qualified for a trial of vaginal labor (TOL). During labor induction, she displayed a pathological CTG pattern and presented symptoms such as abdominal pain and heavy vaginal bleeding. Suspecting a violent uterine rupture, an emergency cesarean section was performed. The presumed diagnosis was confirmed during the procedure—a full-thickness rupture of the pregnant uterus was found. The fetus was delivered without signs of life and successfully resuscitated after 3 min. The newborn girl of weight 3150 g had an Apgar score of 0/6/8/8 at 1, 3, 5, and 10 min. The uterine wall rupture was closed with two layers of sutures. The patient was discharged 4 days after the cesarean section without significant complications, with a healthy newborn girl. Conclusions: Uterine rupture is a rare but severe obstetric emergency and can be associated with maternal and neonatal fatal outcomes. The risk of uterine rupture during a TOLAC attempt should always be considered, even if it is a subsequent TOLAC.

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Section: Discussionmentioning

confidence: 55%

“…Such dehiscence can significantly weaken the uterine wall, making it more susceptible to rupture in the next delivery. In addition, such a dehiscence may remain clinically silent and be an incidental finding during a caesarean section [21].…”

Section: Discussionmentioning

confidence: 99%

Unexpected Uterine Rupture—A Case Report, Review of the Literature and Clinical Suggestions

Flis,

Socha,

Wartęga

et al. 2023

JCM

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“…Choden et al [ 19 ] presented a case of uterine wound dehiscence with pelvic abscess following a cesarean section, characterized by symptoms of paralytic ileus and surgical site infection. Spontaneous cesarean scar dehiscence only 4 months after previous cesarean delivery was reported [ 20 ]. This case underscores the importance of thorough evaluation and readiness to address such complications during pregnancy, particularly in women with previous cesarean scars.…”

Section: Discussionmentioning

confidence: 99%

Severe Complications of Uterine Dehiscence Post-Lower Segment Cesarean Section: A Case Report Emphasizing the Importance of Timely Diagnosis and Intervention

Chawanpaiboon,

Sompagdee,

Kaewsrinual

et al. 2024

Am J Case Rep

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Patient: Female, 28-year-old Final Diagnosis: Uterine dehiscence Symptoms: Fever • lower abdominal pain • malodorous discharge Clinical Procedure: Total abdominal hysterectomy Specialty: Obstetrics and Gynecology Objective: Unusual clinical course Background: Uterine dehiscence, an infrequent event often mistaken for uterine rupture, is rarely linked to post-cesarean section procedures and can result in severe complications, notably puerperal sepsis. In this report, we present a case that exemplifies the onset of puerperal sepsis and the emergence of intra-abdominal abscesses attributed to uterine dehiscence following a lower segment cesarean section (LSCS). Case Report: Our patient, a 28-year-old woman in her third pregnancy, underwent LSCS 1 week earlier. Subsequently, she returned to the hospital with lower abdominal pains, fever, and malodorous vaginal discharge. Computed tomography (CT) scan of whole abdomen verified uterine dehiscence and pus collection at the subhepatic region and right paracolic gutter. After referral to a specialized hospital, laboratory findings indicated an elevated white blood cell count and alkaline phosphatase levels, and coagulation abnormalities. She underwent an exploratory laparotomy, which unveiled uterine dehiscence, abscesses, and adhesions, necessitating a total abdominal hysterectomy and abdominal toileting. Pus culture analysis identified the presence of E. coli , which was susceptible to ampicillin/sulbactam. Complications were encountered after surgery, including wound dehiscence and pus re-accumulation. Successful management involved vacuum dressings and percutaneous drainage. Eventually, her condition improved and she was discharged, without additional complications. Conclusions: This report underscores the importance of considering cesarean scar dehiscence as a diagnosis in women with previous cesarean deliveries who present during subsequent pregnancies with symptoms such as abdominal pain or abdominal sepsis. Diagnostic tools, such as CT, play pivotal roles, and the timely performance of an exploratory laparotomy is paramount when suspicion arises.

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“…Scar dehiscence is a rare but potentially serious complication that can occur when the scar from a previous c-section opens up during labour. Scar dehiscence typically occurs at the site of the previous c-section incision and is more likely to occur in women who have had multiple csections, particularly if the incisions were made in a vertical rather than horizontal direction [6,7] . It was proposed that the transvaginal ultrasonography's measurement of residual myometrial thickness (from the apex of the uterine scar niche to the serosa) may prove to be a useful technique for predicting obstetric problems in later pregnancy and delivery [8] .…”

Section: Introductionmentioning

confidence: 99%

Comparison of lower uterine segment thickness among pregnant women by transabdominal and transvaginal sonography

Rana,

Bansal,

Minhas

et al. 2024

Int. J. Clin. Obstet. Gynaecol.

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Background: Ultrasound is used to evaluate the Lower Uterine Segment, (LUS) especially if there is a previous scar, and it is more beneficial to predict the possibility of the occurrence of any complication during labour such as repeat caesarean section or during trial for vaginal delivery. Aim: This study aimed to compare the lower uterine segment (LUS) thickness measured by both transvaginal (TVS) and transabdominal ultrasonography (TAS) after completion of 37 weeks of pregnancy with that measured manually using a calliper at the time of caesarean delivery and to determine minimum LUS thickness indicative of its integrity in women who have undergone a previous caesarean section. Material and Methods: This was a single-centre, hospital-based, cross-sectional study conducted over a period of 18 months by enrolling a total of 120 pregnant women with previous one C-section. All patients were examined by both TAS and TVS to evaluate the thickness of the LUS and the thickness was reme asured using a vernier calliper intraoperatively. Results: Of the 120 participants enrolled in the present study-64 (53.3%) underwent elective LSCS and 56 (46.7%) underwent emergency LSCS. The mean thickness of the LUS as measured by TAS, TVS, and VC was 2.69 mm, 2.25 mm, and 2.22 mm, respectively. As the inter pregnancy interval increased, the thickness of the LUS increased. There were 3 cases of scar dehiscence, all cases were noted among women with scar thickness of < 2 mm on VC. Conclusion:Transvaginal ultrasonographic measurement of the lower uterine segment in previous LSCS patient is better predictor of LUS thickness in comparison to transabdominal sonography.

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Spontaneous cesarean scar dehiscence during pregnancy: A case report and review of the literature

Cited by 4 publications

References 18 publications

Unexpected Uterine Rupture—A Case Report, Review of the Literature and Clinical Suggestions

Unexpected Uterine Rupture—A Case Report, Review of the Literature and Clinical Suggestions

Severe Complications of Uterine Dehiscence Post-Lower Segment Cesarean Section: A Case Report Emphasizing the Importance of Timely Diagnosis and Intervention

Comparison of lower uterine segment thickness among pregnant women by transabdominal and transvaginal sonography

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