Caesarean scar dehiscence refers to the partial separation or thinning of the uterine scar from a previous Caesarean section. It is typically asymptomatic and discovered incidentally during imaging or subsequent surgery. It differs from uterine rupture, which involves a full-thickness tear of the uterine wall and often leads to significant complications.
Pathophysiology:
• Occurs due to poor healing of the Caesarean
section scar.
• Risk increases with excessive tension, poor
surgical technique, or inadequate vascularization
of the scar tissue.
Risk Factors:
1. Previous Caesarean section:
• Higher risk with classical or T-incisions.
• Multiple Caesarean deliveries.
2. Interdelivery interval: Short intervals (<18
Fmonths) between pregnancies.
3. Uterine overdistension:
• Multiple pregnancies.
• Polyhydramnios.
4. Infection: Postpartum or post-surgical infection impairs healing.
5. Other factors:
• Use of corticosteroids.
• Smoking or poor nutrition.
• Advanced maternal age.
Clinical Features:
• Often asymptomatic.
• Occasionally presents with:
• Mild lower abdominal pain.
• Vaginal bleeding (rare).
• Feeling of pressure in the pelvis.
Diagnosis:
1. Ultrasound (US):
• Thinning of the myometrium at the scar site (<2.5 mm considered high risk).
• Hypoechoic defect in the uterine wall.
2. MRI: Useful for detailed evaluation if US is inconclusive.
3. Intraoperative findings:
Seen during a repeat Caesarean section as a thin, translucent scar or partial separation.
Management:
1. Asymptomatic cases:
• Observation and regular antenatal monitoring.
• Advise delivery at 37–39 weeks via planned
Caesarean section.
2. Symptomatic or detected during pregnancy:
• Requires evaluation for uterine rupture risk.
• May necessitate early Caesarean delivery.
3. Severe cases:
Surgical repair may be indicated if detected outside of pregnancy.
Complications:
• Increased risk of uterine rupture in subsequent
pregnancies.
• Abnormal placentation (e.g., placenta accreta
spectrum).
• Adhesions or scarring in the pelvis
