April 5th, 2020

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Term Delivery in a Woman with Severe Uterine Dehiscence After a Previous Cesarean Section: A Case Report
Authors:  Fengli Chi, M.D., Kunming Li, M.D., Jing Sun, B.S., and Tony Duan, M.D.
BACKGROUND: Cesarean section is the most frequently performed obstetrics operation. It can be associated with short- and long-term risks, one of which is uterine scar dehiscence. Women with uterine scar dehiscence often fear pregnancy because they are advised it may increase the risk of uterine rupture. It is generally recommended that women undergo transvaginal or laparoscopic re-
pair of the uterine dehiscence before any future pregnancies.

CASE: A 32-year-old woman with a previous transverse lower-segment cesarean section complicated by severe uterine dehiscence, diagnosed by MRI before pregnancy, was treated with expectant management during a subsequent pregnancy. She was asymptomatic during pregnancy until term delivery with expectant management.

CONCLUSION: We recommend that patients with severe uterine dehiscence undergo transvaginal or laparoscopic repair before attempting another pregnancy. However, if they become pregnant without repair of the dehiscence, they can be managed conservatively with routine surveillance and intermittent monitoring by ultrasound to term unless there is an emergency.
Keywords:  cesarean section; postcesarean section; surgical wound dehiscence; ultrasonography, prenatal; uterine rupture; uterine scar
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