What is Uterine Dehiscence?
Uterine dehiscence (partial or full) is a rare consequence of an LSCS (lower segment cesarean section). It is most commonly used to describe the process of progressive myometrial rupture that occurs with no sign of a membrane rupture. However, some authors use it interchangeably with uterine rupture. In the context of a scar from a cesarean section, it is often referred to as an incisional dehiscence. Both a partial and a complete dehiscence are possible. Uterine scar dehiscence can make a cesarean section more difficult by increasing the risk of complications such as postpartum bleeding, endomyometritis, localized or generalized peritonitis, and sepsis.
Uterine scar dehiscence is a pregnancy-related complication commonly observed in patients with past cesarean scars. It raises the possibility of a uterine rupture, which is associated with a high rate of maternal and newborn morbidity and mortality. Ultrasound is an efficient method for monitoring the defect throughout pregnancy to predict uterine rupture or newborn complications. It is possible to repair dehiscence, thereby enabling future pregnancy.
Uterine Dehiscence Symptoms
Dehiscences of the lower uterine segment that are asymptomatic are occasionally observed at the time of a repeat cesarean delivery, but they are rarely diagnosed during the early stages of pregnancy. Uterine dehiscence is the incomplete detachment of a uterine scar from the serosa layer. The risk of uterine rupture is increased when there is dehiscence; as a result, it is necessary to perform a thorough inspection of the tissue that surrounds the outpouching. Uterine rupture is characterized by the complete disruption of all uterine layers, including the serosa, and is linked with a high incidence of maternal and neonatal morbidity and mortality.
Patients are usually asymptomatic when a dehiscence is discovered, thus it is not a very worrisome finding when it occurs during a repeat cesarean delivery.
Uterine Dehiscence Causes
A scar dehiscence occurs during pregnancy when a weaker uterus, generally after a previous cesarean operation, expands. As the pregnancy progresses and the uterus enlarges, the scar may lose its integrity, resulting in the separation of the uterine layers.
The opening of the incision line that occurs after having a cesarean section is known as postpartum uterine dehiscence. It is an uncommon clinical condition. Diabetes, urgent surgery, an infection, improper suturing, a hematoma at the site of the uterine incision, and retrovesical hematoma are all risk factors.
Dehiscence of the uterine wound is also linked to severe abdominal wound infection after cesarean section and greatly increases the risk of future pregnancies for the woman.
Uterine Dehiscence Treatment
Cesarean incisional necrosis and dehiscence due to infection are life-threatening consequences that can be avoided with prompt treatment. Because there are no treatment standards that are supported by a sufficient amount of evidence, surgical treatment should be customized for each patient on an individual basis (for example, according to the clinical presentation, surgical findings, and the patient’s wish to preserve their fertility). The gold standard treatment remains total or partial hysterectomy, surgical debridement, and preservation of the unaffected adnexa.
Uterine Dehiscence vs Full Uterine Rupture
Uterine dehiscence is regarded as an incomplete division of the three layers of the uterus, as it allows the fetus to be seen through the perimetrium, but uterine rupture is a complete division of all three layers of the uterus: the perimetrium, the myometrium, and the endometrium.
Uterine dehiscence is typically asymptomatic and is not linked to negative maternal or neonatal outcomes. In contrast, uterine rupture is an uncommon but dangerous pregnancy problem that can result in severe mother and fetal morbidity and mortality.
Imaging techniques including ultrasonography, MRI, and CT can be utilized to detect uterine dehiscence. Laparotomy, on the other hand, is the diagnostic procedure that is utilized to confirm a diagnosis of uterine rupture.