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Cesarean section scar dehiscence during pregnancy: Case reports
Ibrahim A Abdelazim1,2, Svetlana Shikanova3, Sakiyeva Kanshaiym3
1Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Ahmadi, Kuwait.
Journal of Family Medicine and Primary Care
|January 8, 2019
Summary
Cesarean section scar dehiscence (CSSD) is a rare but serious complication. Early ultrasound assessment can help identify at-risk women, allowing for safer surgical planning and repair during future cesarean sections.
Area of Science:
- Obstetrics and Gynecology
- Surgical Complications
- Maternal-Fetal Medicine
Background:
- Rising cesarean section rates globally correlate with increased risk of cesarean section scar dehiscence (CSSD).
- The clinical significance and optimal management strategies for CSSD remain incompletely understood.
Observation:
- Two cases of severe CSSD are presented, involving uterine wall deficiency and bulging fetal membranes during cesarean delivery.
- One patient had a previous single cesarean section, while the other had undergone three prior cesarean sections.
- Both cases required meticulous two-layer uterine incision repair with vicryl sutures.
Findings:
- Severe uterine wall thinning and deficiency at previous cesarean scar sites were observed.
- Successful surgical repair and uneventful postoperative recovery were achieved in both cases.
- Post-discharge counseling emphasized findings and future pregnancy management.
Implications:
- Preoperative ultrasound assessment of the lower uterine segment in women with prior cesarean sections is recommended.
- Anticipating and preparing for CSSD allows for selection of the safest uterine incision and repair technique.
- Improved diagnostic and management protocols for CSSD can minimize complications in future pregnancies.
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