Dehiscent scar in the lower uterine segment after Caesarean section and IVF infertility treatment: A case report

Abstract

Aims. Caesarean section is the most common obstetric operation associated with short and long term risks, one of which is uterine scar dehiscence. In this case report we describe four cases of in vitro fertilization and embryo transfer (IVF + ET) treatment where the embryo was transferred into the uterus with known scar dehiscence in the lower uterine segment after a previous Caesarean section (SC). Methods. All transfers of embryos were ultrasound guided directly into the middle of uterine cavity. All resulting pregnancies continued without problems related to the dehiscent scar and babies were delivered in the third trimester by elective/emergency SC. Results. Our cases suggest that IVF + ET can be offered as an infertility treatment option despite a dehiscent scar in the lower uterine segment after previous SC.

Prevalence, definition, and etiology of cesarean scar defect and treatment of cesarean scar disorder: A narrative review

“…In recent decades, many studies have been conducted on cesarean scar defects (CSD), which may lead to gynecological symptoms, such as abnormal uterine bleeding (AUB), spotting, dysmenorrhea, chronic pelvic pain, dyspareunia, and secondary infertility. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 Furthermore, they showed that the most common descriptor of CSD‐associated AUB was “brown discharge.” Additionally, CSD is described by other terms in the literature, such as isthmocele, 7 , 13 , 14 , 15 cesarean scar dehiscence, 16 , 17 uterine diverticulum, 18 , 19 niche, 20 , 21 , 22 uterine transmural hernia, 23 and cesarean scar pouch. 24 , 25 Although many terms express the lack of the myometrium in the anterior wall of the uterine isthmus due to CS, they are collectively referred to as CSD in this review.…”

“…CSD-associated AUB was "brown discharge." Additionally, CSD is described by other terms in the literature, such as isthmocele, 7,[13][14][15] cesarean scar dehiscence, 16,17 uterine diverticulum, 18,19 niche, [20][21][22] uterine transmural hernia, 23 and cesarean scar pouch. 24,25 Although many terms express the lack of the myometrium in the anterior wall of the uterine isthmus due to CS, they are collectively referred to as CSD in this review.…”

“Slow” Cesarean Section by Inconsistent Corporal Scar (Clinical Case)

“…Увеличившееся за последние 10 лет как в России, так и во всем мире количество операций кесарева сечения несет определенные риски в послеоперационном периоде (гематомы и кровоизлияние, инфекция, тромбоз яичниковой вены, расщепление матки и разрыв) [1,2] при планировании и вынашивании последующих беременностей, в том числе увеличение количеств рубцовых эктопических беременностей, placenta accreta [3][4][5][6][7] и аномально расположенную плаценту [8]. В России частота кесарева сечения составляет 16-27 % [9], наибольшее число оперативного родоразрешения происходит на III уровне 35-40 %, а в специализированных научных центрах может доходить до 70 %.…”