Non-penetrating uterine rupture along the scar after cesarean section and dehiscence/aneurysm of the uterine scar in the second half of pregnancy and during childbirth

Aim. To provide scientific substantiation of the distinction between the notions “incomplete uterine rupture after surgery” and “dehiscence/aneurysm of the uterine scar during pregnancy and childbirth”. Materials and methods. A retrospective analysis of 112 birth histories with uterine rupture along the scar after cesarean section, 44 birth histories of patients with dehiscence/aneurysm of the uterine scar after cesarean section and myomectomy was carried out. The births took place in maternity hospitals of Moscow Department of Healthcare, clinical hospital MD Group in the period from 1999 to 2018. Results. Out of 112patients with uterine rupture along the scar after cesarean section, delivery by re-surgery was in 62 patients, spontaneous delivery was in 50. Out of 62 patients with abdominal delivery, the risk symptoms of uterine rupture were in 53, and the incipient uterine rupture was in 48 women. Out of 50patients, uterine rupture after spontaneous delivery was in 49 women in early postpartum period. Out of 112 babies, 5 were born dead, 3 - with severe asphyxia, and 6 - with moderate asphyxia. In 29patients, the total blood loss volume was more than 1000 ml. Dehiscence/aneurysm of the uterine scar had common signs: the patients had no complaints, ultrasound examination detected very thin lower uterine segment (<1 mm), pregnancy was prolonged to full-term or almost full-term pregnancy, the intraoperative scar dehiscence was seen as a translucent bulging into the gestational sac and blood loss during cesarean section was with in the typical range for the blood loss. Conclusion. The notion “dehiscence/aneurysm of the uterine scar” should be distinguished from “incomplete uterine rupture”, since the concept of commonality of these notions will justify the doctors and contribute to their incompetence. The doctors should know both the symptoms of the risk for uterine rupture and the incipient uterine rupture.

uterine rupture, uterine rupture along the scar after cesarean section, dehiscence of the uterine scar, aneurysm, organ-sparing surgery