Unraveling the enigma: A case of dynamic morphological changes in the niche at 25 weeks of gestation recapitulating the ontogenesis of uterine scar dehiscence

We present the first report of a case with a peculiar configurational change in the lower uterine segment detected during transvaginal ultrasonography observation over a short period of time at 25 weeks of gestation, predicting the presence of uterine scar dehiscence at term.

Uterine dehiscence in pregnant with previous caesarean delivery

BACKGROUND

The main risk factor for uterine scar dehiscence is a previous caesarean section. Better characterisation of the ultrasonographic features of uterine scar dehiscence may improve preoperative diagnostic accuracy in pregnant women with a caesarean scar. This study aimed to evaluate the ultrasonographic features of uterine scar dehiscence in pregnant women and maternal and neonatal outcomes.

MATERIALS AND METHODS

This was a retrospective review of the records of 23 women with a previous caesarean section found to have uterine scar dehiscence during surgery. The integrity and thickness of the lower uterine segment were recorded, ultrasonographic features were evaluated, and maternal and infant outcomes were analysed.

RESULTS

Of the 23 cases of uterine scar dehiscence, six were detected by preoperative ultrasonography, while 17 were missed. The ultrasonographic features of the 23 cases of uterine dehiscence included anechoic areas protruding through the caesarean section scar with an intact serosal layer (4/23), disappearance of the muscular layer (2/23), and a thinner lower uterine segment (17/23). There were no cases of maternal or neonatal mortality. One woman chose to undergo pregnancy termination.

CONCLUSION

Preoperative detection of uterine scar dehiscence in women with previous caesarean delivery helps prevent maternal and neonatal morbidity and mortality. However, the maximum benefit can only be obtained by scanning at appropriate intervals during pregnancy and accurate recognition of the ultrasonographic features of uterine scar dehiscence.KEY MESSAGESPreoperative detection of uterine scar dehiscence in women with previous caesarean delivery helps prevent maternal and neonatal morbidity and mortality.Scanning at appropriate intervals during pregnancy and accurate recognition of the ultrasonographic features of uterine scar dehiscence could be beneficial.Even when uterine dehiscence is detected by ultrasound during the second trimester, conservative management via strict observation alone is also feasible.

Treatment and repair of uterine scar dehiscence during cesarean section

The incidence of cesarean section (c‐section) has increased worldwide. Because the major risk factor for uterine scar dehiscence (USD) is a previous c‐section, the rate of this complication has also increased. Its clinical significance and management strategies are unclear. Here, we discuss USD particularly pertaining to its surgical treatment.