Although USD has not been precisely defined, the reported incidence of this condition ranges between 0.2% and 4.3% of all pregnancies associated with a previous c‐section 1. A previous c‐section with USD is a well‐known risk factor for
Results: Among 588 patients included in this study, 27 cases of uterine scar dehiscence were identified with an incidence of 4.6%.
Scar dehiscence has an incidence of 0.6% in pregnancies with previous caesarean section and has a more favourable outcome for both mother and fetus than does uterine rupture1. Due to the high morbidity and mortality associated with uterine rupture, it is important to identify those patients who are at risk.
Maternal outcomes
Able to plan a known delivery date in select patients. This may however change based on circumstances surrounding maternal and fetal wellbeing in the antenatal period. Approximately 0.5% risk of uterine scar rupture.
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 patient should be advised the wound will heal by secondary intention as a result of the dehiscence and that this can take several weeks.
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.
Keep an eye on your healing process and check the incision daily to ensure it's been gently cleaned. With careful monitoring, you'll know if the incision has opened slightly. It may not be a serious issue, but call your surgeon's office to be sure.
If you notice heavy bleeding or oozing from your incision site, reddened edges, increasing C-section scar pain, or have a fever higher than 100.4°, call your doctor right away, as these could be signs of infection.
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.
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.
Even minor wound disruption needs to be treated right away to keep it from getting worse. An open wound is easily infected, and infection can lead to further separation. Complete wound dehiscence is a medical emergency, as it can lead to evisceration, where internal organs protrude through the wound.
Treatment of uterine dehiscence after cesarean section with no active hemorrhage, generally stable condition and no evidence of severe infection, conservative treatment accompanied by broad-spectrum antibiotic therapy can be appropriate treatment.
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.
Clinical consequences of C-section scar defects may include abnormal uterine bleeding (AUB), dysmenorrhea, pelvic pain, postmenstrual spotting, adenomyosis, endometriosis, abscess formation, cesarean scar ectopic pregnancy, and infertility (Tower & Frishman, 2013; Patel et al., 2015; Fabres et al., 2005; Wang et al., ...
Steri-strips are commonly used to keep the c-section incision closed and clean above the stitching. The use of steri-strips can help minimize the extent of any c-section scarring because the strips keep the outer skin layers tight, clean, and protected from the sun during the healing process.
Definitely see your physician! Sometimes portions of surgical wounds fall apart, or "dehisce." I would recommend keeping a clean dry gauze over the wound. There is no need to put any ointments in the wound itself. The best thing you can do is to allow the area to drain.
It takes about six weeks to recover from a C-section, but each person's timeline will be different. An incision — typically a horizontal cut made in your lower abdomen — can take weeks to heal. During that time, it's recommended that you avoid lifting anything heavier than your baby.
With a cesarean birth, lifting too heavy too soon can cause your incision (either external or internal) to open, rupture, or cause other serious medical issues.
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.
“So, every patient is different and every case is unique. However, from the current medical evidence, most medical authorities do state that if multiple C-sections are planned, the expert recommendation is to adhere to the maximum number of three.”
The dehiscence of a fresh caesarean section may be associated with an acute infection. Infectious necrosis and endomyometritis may be also present [5]. In our case, margins were unhealthy and culture report showed E. coli.
We find that chronic c-section scar pain has myofascial layers (abdominal muscles, connective tissue, nerves, blood vessels) that often have adhesions and are not able to slide and glide properly. The result is tension and stiffness in the scar tissue and nearby structures.