Laparoscopic and vaginal repair of uterine scar dehiscence following cesarean section as detected by ultrasound
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Petra Klemm
Abstract
Introduction and Objective: Cesarean section (CS) is the most common operation in obstetrics, with rising incidence in most countries. As a result of this operation late scar dehiscence may occur, which may lead to uterine rupture in a subsequent pregnancy. In this case series we have described sonographic detection of scar dehiscence after CS and feasibility of vaginal or combined laparoscopic and vaginal scar excision and uterine repair.
Methods: Five consecutive patients underwent vaginal or laparoscopic assisted vaginal approach for repair of suspected scar dehiscence following CS, during a 5 year period. In all cases, transvaginal sonography detected suspicious features of scar dehiscence over the anterior uterine wall. Except of one, all patients had reported recurrent pelvic pain and/or irregular menstrual bleedings. Furthermore all patients planned for a further pregnancy.
Results: Resection of the uterine defect and re-constitution of the uterine wall was successfully achieved in all five patients. There were no intra-operative complications and none of the patients required blood transfusion. The mean operation time was 117 min (27–192). Presence of scar tissue was confirmed on histology in all specimens. Four patients remained free of symptoms with no evidence of recurrent scar dehiscence on sonography over a median follow up of 30 months (3–46). One patient had an uneventful pregnancy 24 months after scar removal and was delivered by repeat CS at 39 weeks' gestation.
Conclusion: Patients with a history of CS should undergo transvaginal sonography of the scar region in order to detect latent scar dehiscence in combination with uterine wall thinning prior to planning further pregnancy. In suspected cases, a combined laparoscopic – vaginal or vaginal approach can be employed to repair the defect.
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© Walter de Gruyter
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- The epidemiology of preterm labor – a global perspective
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- Laparoscopic and vaginal repair of uterine scar dehiscence following cesarean section as detected by ultrasound
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Artikel in diesem Heft
- The epidemiology of preterm labor – a global perspective
- Erythropoietin and prematurity – where do we stand?
- The quality of nifedipine studies used to assess tocolytic efficacy: a systematic review
- Unexplained intrauterine fetal death is accompanied by activation of complement
- Anaphylatoxins in preterm and term labor
- The transcription factor Ets-1 is expressed in human amniochorionic membranes and is up-regulated in term and preterm premature rupture of membranes
- Recombinant human lactoferrin has preventive effects on lipopolysaccharide-induced preterm delivery and production of inflammatory cytokines in mice
- Laparoscopic and vaginal repair of uterine scar dehiscence following cesarean section as detected by ultrasound
- Cerebral ventricular volume assessment by three-dimensional ultrasonography
- Nomogram of the fetal gastric size development in normal pregnancy
- Therapeutic hypothermia: from lab to NICU
- Alveolar capillary dysplasia: a six-year single center experience
- Spina bifida – a follow-up study of neonates born from 1991 to 2001
- Concordant occipital encephalocele in monoamniotic twins
- Changes of lactate, glucose, ionized calcium and glutamate concentrations in cephalic vein blood during brain hypothermia using extracorporeal membrane oxygenation (ECMO) in a newborn infant with hypoxic-ischemic encephalopathy
- Treatment of symptomatic congenital cytomegalovirus infection with valganciclovir
- A coiled nasogastric tube in a newborn
