There is no appropriate screening method for the detection of uterine scar dehiscence. Using ultrasound examination, measuring the thickness of the uterine wall at the previous uterine incision site could be used to predict the occurrence of uterine dehiscence during pregnancy or in labor.
The main ultrasonographic diagnostic features of uterine scar dehiscence are the absence of the uterine muscle layer and an anechoic area protruding through the lower segment caesarean section scar with an intact serosal layer.
Generally, uterine dehiscence is clinically occult and is not associated with any adverse maternal or perinatal outcomes. Interestingly classical transverse cesarean section scars are more likely to rupture before labor, whereas lower uterine segment cesarean section (LSCS) scars tend to rupture after labor.
Results: Among 588 patients included in this study, 27 cases of uterine scar dehiscence were identified with an incidence of 4.6%.
Symptoms of scar tissue pain can include some of the following: Itching and burning sensation near the scar. Tenderness and sensitivity in the region around the scar.
Scar tissue can have a local area of pain when touched or stretched or it can produce a referred pain that feel like that of a nerve which is a constant annoying burn that occasionally turns sharp.
The risk factors reported for scar dehiscence are multiparity, diabetes, emergency surgery, infection, and incision placed too low in the uterine segment [2]. Two out of these, i.e., multiparity and diabetes were present in our patient.
If the scar partially opens, much like a zip coming open a little way, this is referred to as a uterine dehiscence. The existing scar tissue stretches and the lower layer separates, but the outer layer of the uterus (perimetrium) remains intact.
In contrast to frank uterine rupture, uterine scar dehiscence involves the disruption and separation of a preexisting uterine scar. Uterine scar dehiscence is a more common event than uterine rupture and seldom results in major maternal or fetal complications.
Early complications include hematoma, infection, wound dehiscence, and thrombus formation. Long-term complications include placenta accreta, peritoneal adhesions, infertility, and myometrial thinning with uterine rupture 2-4.
If scar tissue is suspected, then a diagnostic laparoscopy (a procedure that allows a doctor to view the tissue and remove it if necessary) may be utilized.
Dermatologists at NYU Langone determine the type of scar by evaluating its size, location, and texture during a physical exam. Scar tissue, which consists of a tough, fibrous protein called collagen, forms when the body repairs a wound.
They include pain, itching, swelling, tightness, restriction of movement, skin colour changes, allodynia or hypersensitivity to touch, and hyperalgesia or marked pain to deeper palpation. Scar tissue pain is usually caused by damage to the nerves or when a nerve is compressed by the scar.
Symptoms of wound dehiscence
Pain. Feeling of pulling or ripping like something popped. Drainage or bleeding from the wound, most often a clear to pink fluid. Signs of wound infection such as fever, redness, swelling, bad smelling discharge, or chills.
Dehiscence is a partial or total separation of previously approximated wound edges, due to a failure of proper wound healing. This scenario typically occurs 5 to 8 days following surgery when healing is still in the early stages.
Even minor cases of wound dehiscence require immediate attention to prevent the wound from worsening. If left untreated, dehiscence can progress and lead to serious infection and life threatening complications.
Although rates of dehiscence are low, once it occurs, the possibility of further complications or death is high. 7 Thus, any break in a post-surgical incision should be reported to your surgeon at once, before it becomes a potentially life-threatening medical emergency.
What Are Risk Factors for Dehiscence? A variety of underlying health conditions can increase a patient's risk for developing dehiscence after surgery. Such conditions include the patient being overweight or obese, hypertension, anemia, and hypoproteinemia.
Patients older than 65 years are more likely to develop wound dehiscence because of deterioration in tissue repair mechanism compared with younger patients [3].
After a surgical procedure, an excess of scar tissue is formed by the body at the site of the procedure and could make a popping noise as it breaks up in the weeks and months to follow.
It is never too late to receive a scar tissue release massage. You may just need a couple of sessions to feel confident and comfortable to do this on yourself at home.
Identifying a seroma
Most seromas present as a cyst or lump beneath the skin near the incision site that may be sore and sensitive to the touch. If you suspect you may have a seroma, gently tap one side of the area and watch to see if there is a wave-like motion beneath the skin that would indicate fluid collection.