Uterine scar dehiscence following caesarean section

Objective: To investigate p/egnancy outcomes in patients with uterine sca/ dehiscence (lowe/ uterine segment thickness 41-1.2 mm) and analyze the pathomo/phological findings of the dissected sca/. Materials and methods: In this study, a /et/ospective analysis was conducted of 80 delive/y notes of patients with uterine sca/ dehiscence afte/ the lowe/ uterine segment cesa/ean section. Results: A history of one, two, and three cesarean sections had 54/80(67.5%), 23/80 (28.7%), and 3/80 (3.8%) patients with uterine scars dehiscence, respectively. The indication for elective surgical delivery in 60/80 (75%) was a scar thickness < 1-1.2 mm when evaluated by ultrasound. The onset of uterine contractions was an indication for delivery in 20/80 (25%) patients. At the time of delivery, the gestational age was 38 (38;39) weeks, and the uterine aneurysms were diagnosed at 37 (37;38) weeks. In 16/80 (20%) pregnant women, aneurysms were detected before 37 weeks, with the earliest diagnosis at 21 weeks. Pregnancies resulted in singletons in 79/80 (98.8%) and a twin in 1/80 (1.2%) women. Among singleton pregnant women, 10/79 (12.7%) gave birth to large babies. Histological examination revealed scar thinning to 1 mm, myometrium replacement by connective tissue > 50% in 63/80 (78.8%) patients. Splitting hemorrhages in the scar were found in 33/80 (41.3%). Conclusion: Post cesarean uterine scar dehiscence detected by ultrasound in asymptomatic pregnant women should be managed conservatively. Prolongation of pregnancy beyond 38-39 weeks is inappropriate because it is associated with a potential increase in fetal weight, a predictor of bleeding in the thinned scar caused by excessive stretching.

uterine aneurysm, cesarean section, uterine scar dehiscence, connective tissue scar