Uterine Dehiscence and Subsequent Pregnancy Management: A Review of the Literature

Abstract

Importance Uterine dehiscence is a separation of the uterine musculature with intact uterine serosa. Uterine dehiscence can be encountered at the time of cesarean delivery, be suspected on obstetric ultrasound, or be diagnosed in between pregnancies. Management is a conundrum for obstetricians, regardless of timing of onset. Evidence Acquisition A literature search was undertaken by our research librarian using the search engines PubMed, CINAHL, and Web of Science. The search term used was “uterine dehiscence.” The search was limited to the English language, and there was no limit on the years searched. Results The search identified 152 articles, 32 of which are the basis for this review. Risk factors, treatment, and management in subsequent pregnancies are discussed. The number of prior cesarean deliveries is the greatest risk factor for uterine dehiscence. Unrepaired uterine dehiscence can cause symptoms outside of pregnancies and may require repair for alleviation of these symptoms. Dehiscence should also be repaired prior to subsequent pregnancies. Conclusion and Relevance Planned delivery prior to the onset of labor with careful monitoring of maternal symptoms is the preferred management strategy of women with prior uterine dehiscence. Careful attention should be paid to the lower uterine segment thickness when ultrasonography is performed in women with prior cesarean delivery. Relevance Statement An evidence-based review of uterine dehiscence in pregnancy and how to manage subsequent pregnancies following uterine dehiscence. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to identify the risks of pregnancy following uterine dehiscence; explain treatment of uterine dehiscence; and describe symptoms of unrepaired uterine dehiscence.

Spontaneous cesarean scar dehiscence during pregnancy: A case report and review of the literature

“…In a cesarean section, the fetus may visible through the perimetrium. 9,11 In our case, the uterine layers were separated, but the defect was covered by fetal membranes. The fetus was visible through the defect.…”

“… 9 Unlike in the case of uterine rupture, it does not involve uterine serosa or fetal membranes and is not associated with intra-abdominal hemorrhage. 10 , 11 It can be encountered at the time of cesarean delivery or be suspected on obstetric ultrasound examination during pregnancy. In a cesarean section, the fetus may visible through the perimetrium.…”

Severe Complications of Uterine Dehiscence Post-Lower Segment Cesarean Section: A Case Report Emphasizing the Importance of Timely Diagnosis and Intervention

“…Additionally, ultrasonography should be used to assess lower uterine segment thickness in women with prior cesarean deliveries. This evidence-based review is relevant for health-care professionals involved in managing uterine dehiscence in pregnancy and subsequent pregnancies [ 21 ].…”

Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium—Part I: Obstetric (Non-Fetal) Complications

“…Uterine dehiscence (UD) refers to an incomplete separation of the myometrium at the site of a previous scar that preserves peritoneal serosa and amniotic membranes, allowing visibility of the fetus through the perimetrium: this is a much more frequent and often asymptomatic condition, which rarely results in life-threatening complications [ 83 ]. The incidence of uterine dehiscence is unknown, because it may not be recognized in the setting of a successful vaginal delivery without assessment of the lower uterine segment [ 84 ].…”