Post Caesarean Uterine Scar Dehiscence: A Case Report and a Short Review of Literature

Gunjan Bahuguna; Naheeda Shaikh; Ashok Anand; Pratyasha Swain; Rajashree Thatikonda

doi:doi:10.11648/j.jgo.20221004.12

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Post Caesarean Uterine Scar Dehiscence: A Case Report and a Short Review of Literature

Gunjan Bahuguna, Naheeda Shaikh, Ashok Anand, Pratyasha Swain, Rajashree Thatikonda

Published in Journal of Gynecology and Obstetrics (Volume 10, Issue 4)

Received: 1 June 2022 Accepted: 4 July 2022 Published: 13 July 2022

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Abstract

There has been a rise in lower segment caesarean sections in modern obstetrics with the prevalence being 21.5% in India according to NFHS-5. With the rise in LSCS, there has been also been a rise in risks and complications associated with it. We are going to discuss one such complication of infected uterine incisional necrosis and dehiscence after caesarean delivery, and a brief review of risk factors, pathophysiology and the management of this postpartum complication. Diagnosis can be done using methods such as ultrasonography, magnetic resonance imaging, and computer-aided tomography. Treatment includes resuturing the uterine incision line, hysterectomy, or conservative treatment accompanied by broad-spectrum antibiotics administration. We evaluated 2 cases one of which presented as puerperal sepsis and was diagnosed with the help of USG and CT and was surgically managed by debridement of infected and necrosed tissue and reconstruction of uterine rent along with broad spectrum antibiotics. The other case presented to us as puerperal sepsis, secondary post-partum hemorrhage and acute kidney injury that was diagnosed by ultrasound as a dehiscent scar postpartum after caesarean section and was managed surgically by obstetric hysterectomy. Both the cases were high risk and required prompt diagnosis and management. A study of various presentation of post caesarean uterine scar dehiscence and the methods of management is been discussed so as to aid in prompt diagnosis and appropriate management can be done with good outcomes. Post Ceaserean uterine scar dehiscence can be managed conservatively or surgically, tailored to the patient attributes with a good outcome.

Published in	Journal of Gynecology and Obstetrics (Volume 10, Issue 4)
DOI	10.11648/j.jgo.20221004.12
Page(s)	176-182
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Uterine Scar Dehiscence, Puerperal Sepsis, Postpartum Haemorrhage, Uterine Necrosis, Puerperal Pyrexia, Heavy Vaginal Bleeding Postpartum, Post Caesarean Uterine Scar Dehiscence, Complications of Caesarean Section

References

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[2]	Royo, P., García Manero, M., Olartecoechea, B., & Alcázar, J. L. (2009). Two-dimensional power Doppler-three-dimensional ultrasound imaging of a cesarean section dehiscence with utero-peritoneal fistula: A case report. Journal of Medical Case Reports, 3. https://doi.org/10.1186/1752-1947-3-42.
[3]	Alwani M, Mishra S, Thakur R. Generalized peritonitis with uterine incision necrosis with dehiscence following cesarean section presenting as genitourinary fistula: A unique complication. J Med 2014; 3: 762-6.
[4]	Shaamash, A. H., Ahmed, A. G. M., Abdel Latef, M. M., & Abdullah, S. A. (2007). Routine postpartum ultrasonography in the prediction of puerperal uterine complications. International Journal of Gynecology & Obstetrics, 98 (2), 93–99. https://doi.org/10.1016/J.IJGO.2007.03.042.
[5]	El-Agwany, A. S. (2018). Conservative management of infected postpartum uterine dehiscence after cesarean section. Journal of Medical Ultrasound, 26 (1), 59–61. https://doi.org/10.4103/JMU.JMU_5_18.
[6]	Sengupta Dhar, R., & Misra, R. (2012). Postpartum Uterine Wound Dehiscence Leading to Secondary PPH: Unusual Sequelae. Case Reports in Obstetrics and Gynecology, 2012, 1–3. https://doi.org/10.1155/2012/154685.
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[8]	Ida A, Kubota Y, Nosaka M, Ito K, Kato H, Tsuji Y, et al. Successful management of a caesarean scar defect with dehiscence of the uterine incision by using wound lavage. Case Rep Obstet Gynecol 2014; 2014: 421014.
[9]	Rivlin ME, Carroll CS, Sr., Morrison JC. Infectious necrosis with dehiscence of the uterine repair complicating cesarean delivery: a review. Obstet Gynecol Surv. 2004; 59 (12): 833-837.
[10]	Zhang Y, Ma NY, Pang XA. Uterine incision dehiscence 3 mo after cesarean section causing massive bleeding: A case report. World J Clin Cases 2020; 8 (11): 2392-2398.
[11]	di Spiezio Sardo, A., Saccone, G., McCurdy, R., Bujold, E., Bifulco, G., & Berghella, V. (2017). Risk of Cesarean scar defect following single- vs double-layer uterine closure: systematic review and meta-analysis of randomized controlled trials. Ultrasound in Obstetrics and Gynecology, 50 (5), 578–583. https://doi.org/10.1002/uog.17401.
[12]	El Agwany, A. S. (2020). Gynecological and postpartum ultrasonography of cesarean uterine scar defects: a pictorial essay. Journal of Ultrasound, 23 (4), 613–619. https://doi.org/10.1007/S40477-019-00403-3.
[13]	Treszezamsky, A. D., Feldman, D., & Sarabanchong, V. O. (2011). Concurrent postpartum uterine and abdominal wall dehiscence and Streptococcus anginosus infection. Obstetrics and Gynecology, 118 (2 PART 2), 449–451. https://doi.org/10.1097/AOG.0b013e31821619e9.
[14]	Badr, D. A., al Hassan, J. M., & Ramadan, M. K. (2017). Conservative Surgical Management of Uterine Incisional Necrosis and Dehiscence After Primary Cesarean Delivery Due to Proteus mirabilis Infection: A Case Report and a Review of Literature. Journal of Clinical Gynecology and Obstetrics, 6 (3–4), 65–70. https://doi.org/10.14740/jcgo451w.
[15]	Thakur, G., Karmakar, P., Gupta, P., & Saha, S. C. (2021). Uterine Scar Dehiscence: A Rare Cause of Life-Threatening Delayed Secondary Postpartum Hemorrhage—A Case Report and Literature Review. Journal of Obstetrics and Gynecology of India, 71 (6), 629–632. https://doi.org/10.1007/s13224-021-01493-y
[16]	El-Agwany, Ahmed Samy. "Postpartum uterine caesarean incision necrosis and pelvis abscess managed by hysterectomy: a complication of puerperal endomyometritis." Res J Med Sci 8.2 (2014): 53-55.
[17]	Aggarwal, P., Ali, Z., & Sharma, A. (2019). Uterine Scar Dehiscence Rare Cause of Secondary Postpartum Hemorrhage-A Case Report. In International Journal of Obstetrics and Gynaecology Research (IJOGR) (Vol. 6, Issue 3). http://www.ijogr.com/http: //www.ijogr.com/
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APA Style

Gunjan Bahuguna, Naheeda Shaikh, Ashok Anand, Pratyasha Swain, Rajashree Thatikonda. (2022). Post Caesarean Uterine Scar Dehiscence: A Case Report and a Short Review of Literature. Journal of Gynecology and Obstetrics, 10(4), 176-182. https://doi.org/10.11648/j.jgo.20221004.12

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ACS Style

Gunjan Bahuguna; Naheeda Shaikh; Ashok Anand; Pratyasha Swain; Rajashree Thatikonda. Post Caesarean Uterine Scar Dehiscence: A Case Report and a Short Review of Literature. J. Gynecol. Obstet. 2022, 10(4), 176-182. doi: 10.11648/j.jgo.20221004.12

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AMA Style

Gunjan Bahuguna, Naheeda Shaikh, Ashok Anand, Pratyasha Swain, Rajashree Thatikonda. Post Caesarean Uterine Scar Dehiscence: A Case Report and a Short Review of Literature. J Gynecol Obstet. 2022;10(4):176-182. doi: 10.11648/j.jgo.20221004.12

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@article{10.11648/j.jgo.20221004.12,
  author = {Gunjan Bahuguna and Naheeda Shaikh and Ashok Anand and Pratyasha Swain and Rajashree Thatikonda},
  title = {Post Caesarean Uterine Scar Dehiscence: A Case Report and a Short Review of Literature},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {10},
  number = {4},
  pages = {176-182},
  doi = {10.11648/j.jgo.20221004.12},
  url = {https://doi.org/10.11648/j.jgo.20221004.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20221004.12},
  abstract = {There has been a rise in lower segment caesarean sections in modern obstetrics with the prevalence being 21.5% in India according to NFHS-5. With the rise in LSCS, there has been also been a rise in risks and complications associated with it. We are going to discuss one such complication of infected uterine incisional necrosis and dehiscence after caesarean delivery, and a brief review of risk factors, pathophysiology and the management of this postpartum complication. Diagnosis can be done using methods such as ultrasonography, magnetic resonance imaging, and computer-aided tomography. Treatment includes resuturing the uterine incision line, hysterectomy, or conservative treatment accompanied by broad-spectrum antibiotics administration. We evaluated 2 cases one of which presented as puerperal sepsis and was diagnosed with the help of USG and CT and was surgically managed by debridement of infected and necrosed tissue and reconstruction of uterine rent along with broad spectrum antibiotics. The other case presented to us as puerperal sepsis, secondary post-partum hemorrhage and acute kidney injury that was diagnosed by ultrasound as a dehiscent scar postpartum after caesarean section and was managed surgically by obstetric hysterectomy. Both the cases were high risk and required prompt diagnosis and management. A study of various presentation of post caesarean uterine scar dehiscence and the methods of management is been discussed so as to aid in prompt diagnosis and appropriate management can be done with good outcomes. Post Ceaserean uterine scar dehiscence can be managed conservatively or surgically, tailored to the patient attributes with a good outcome.},
 year = {2022}
}

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TY  - JOUR
T1  - Post Caesarean Uterine Scar Dehiscence: A Case Report and a Short Review of Literature
AU  - Gunjan Bahuguna
AU  - Naheeda Shaikh
AU  - Ashok Anand
AU  - Pratyasha Swain
AU  - Rajashree Thatikonda
Y1  - 2022/07/13
PY  - 2022
N1  - https://doi.org/10.11648/j.jgo.20221004.12
DO  - 10.11648/j.jgo.20221004.12
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 176
EP  - 182
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20221004.12
AB  - There has been a rise in lower segment caesarean sections in modern obstetrics with the prevalence being 21.5% in India according to NFHS-5. With the rise in LSCS, there has been also been a rise in risks and complications associated with it. We are going to discuss one such complication of infected uterine incisional necrosis and dehiscence after caesarean delivery, and a brief review of risk factors, pathophysiology and the management of this postpartum complication. Diagnosis can be done using methods such as ultrasonography, magnetic resonance imaging, and computer-aided tomography. Treatment includes resuturing the uterine incision line, hysterectomy, or conservative treatment accompanied by broad-spectrum antibiotics administration. We evaluated 2 cases one of which presented as puerperal sepsis and was diagnosed with the help of USG and CT and was surgically managed by debridement of infected and necrosed tissue and reconstruction of uterine rent along with broad spectrum antibiotics. The other case presented to us as puerperal sepsis, secondary post-partum hemorrhage and acute kidney injury that was diagnosed by ultrasound as a dehiscent scar postpartum after caesarean section and was managed surgically by obstetric hysterectomy. Both the cases were high risk and required prompt diagnosis and management. A study of various presentation of post caesarean uterine scar dehiscence and the methods of management is been discussed so as to aid in prompt diagnosis and appropriate management can be done with good outcomes. Post Ceaserean uterine scar dehiscence can be managed conservatively or surgically, tailored to the patient attributes with a good outcome.
VL  - 10
IS  - 4
ER  -

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Author Information

Gunjan Bahuguna

Department of Obstetrics and Gynaecology, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, India
Naheeda Shaikh

Department of Obstetrics and Gynaecology, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, India
Ashok Anand

Department of Obstetrics and Gynaecology, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, India
Pratyasha Swain

Department of Obstetrics and Gynaecology, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, India
Rajashree Thatikonda

Department of Obstetrics and Gynaecology, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, India

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APA Style

Gunjan Bahuguna, Naheeda Shaikh, Ashok Anand, Pratyasha Swain, Rajashree Thatikonda. (2022). Post Caesarean Uterine Scar Dehiscence: A Case Report and a Short Review of Literature. Journal of Gynecology and Obstetrics, 10(4), 176-182. https://doi.org/10.11648/j.jgo.20221004.12

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ACS Style

Gunjan Bahuguna; Naheeda Shaikh; Ashok Anand; Pratyasha Swain; Rajashree Thatikonda. Post Caesarean Uterine Scar Dehiscence: A Case Report and a Short Review of Literature. J. Gynecol. Obstet. 2022, 10(4), 176-182. doi: 10.11648/j.jgo.20221004.12

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AMA Style

Gunjan Bahuguna, Naheeda Shaikh, Ashok Anand, Pratyasha Swain, Rajashree Thatikonda. Post Caesarean Uterine Scar Dehiscence: A Case Report and a Short Review of Literature. J Gynecol Obstet. 2022;10(4):176-182. doi: 10.11648/j.jgo.20221004.12

Copy | Download

@article{10.11648/j.jgo.20221004.12,
  author = {Gunjan Bahuguna and Naheeda Shaikh and Ashok Anand and Pratyasha Swain and Rajashree Thatikonda},
  title = {Post Caesarean Uterine Scar Dehiscence: A Case Report and a Short Review of Literature},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {10},
  number = {4},
  pages = {176-182},
  doi = {10.11648/j.jgo.20221004.12},
  url = {https://doi.org/10.11648/j.jgo.20221004.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20221004.12},
  abstract = {There has been a rise in lower segment caesarean sections in modern obstetrics with the prevalence being 21.5% in India according to NFHS-5. With the rise in LSCS, there has been also been a rise in risks and complications associated with it. We are going to discuss one such complication of infected uterine incisional necrosis and dehiscence after caesarean delivery, and a brief review of risk factors, pathophysiology and the management of this postpartum complication. Diagnosis can be done using methods such as ultrasonography, magnetic resonance imaging, and computer-aided tomography. Treatment includes resuturing the uterine incision line, hysterectomy, or conservative treatment accompanied by broad-spectrum antibiotics administration. We evaluated 2 cases one of which presented as puerperal sepsis and was diagnosed with the help of USG and CT and was surgically managed by debridement of infected and necrosed tissue and reconstruction of uterine rent along with broad spectrum antibiotics. The other case presented to us as puerperal sepsis, secondary post-partum hemorrhage and acute kidney injury that was diagnosed by ultrasound as a dehiscent scar postpartum after caesarean section and was managed surgically by obstetric hysterectomy. Both the cases were high risk and required prompt diagnosis and management. A study of various presentation of post caesarean uterine scar dehiscence and the methods of management is been discussed so as to aid in prompt diagnosis and appropriate management can be done with good outcomes. Post Ceaserean uterine scar dehiscence can be managed conservatively or surgically, tailored to the patient attributes with a good outcome.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Post Caesarean Uterine Scar Dehiscence: A Case Report and a Short Review of Literature
AU  - Gunjan Bahuguna
AU  - Naheeda Shaikh
AU  - Ashok Anand
AU  - Pratyasha Swain
AU  - Rajashree Thatikonda
Y1  - 2022/07/13
PY  - 2022
N1  - https://doi.org/10.11648/j.jgo.20221004.12
DO  - 10.11648/j.jgo.20221004.12
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 176
EP  - 182
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20221004.12
AB  - There has been a rise in lower segment caesarean sections in modern obstetrics with the prevalence being 21.5% in India according to NFHS-5. With the rise in LSCS, there has been also been a rise in risks and complications associated with it. We are going to discuss one such complication of infected uterine incisional necrosis and dehiscence after caesarean delivery, and a brief review of risk factors, pathophysiology and the management of this postpartum complication. Diagnosis can be done using methods such as ultrasonography, magnetic resonance imaging, and computer-aided tomography. Treatment includes resuturing the uterine incision line, hysterectomy, or conservative treatment accompanied by broad-spectrum antibiotics administration. We evaluated 2 cases one of which presented as puerperal sepsis and was diagnosed with the help of USG and CT and was surgically managed by debridement of infected and necrosed tissue and reconstruction of uterine rent along with broad spectrum antibiotics. The other case presented to us as puerperal sepsis, secondary post-partum hemorrhage and acute kidney injury that was diagnosed by ultrasound as a dehiscent scar postpartum after caesarean section and was managed surgically by obstetric hysterectomy. Both the cases were high risk and required prompt diagnosis and management. A study of various presentation of post caesarean uterine scar dehiscence and the methods of management is been discussed so as to aid in prompt diagnosis and appropriate management can be done with good outcomes. Post Ceaserean uterine scar dehiscence can be managed conservatively or surgically, tailored to the patient attributes with a good outcome.
VL  - 10
IS  - 4
ER  -

Copy | Download