Intra-operative Diagnosis of Lower Segment Scar Dehiscence in a Second Gravida After One Previous Lower Segment Cesarean Section: Should We Advocate for Routine Antenatal Uterine Scar Thickness Testing?

Autor: Eleje GU; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria.; Effective Care Research Unit, Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Nigeria., Udigwe GO; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria.; Effective Care Research Unit, Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Nigeria., Okafor CG; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Njoku TK; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Okoro CC; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Onyejiaka CC; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Igbodike EP; Department of Obstetrics and Gynecology, Havana Specialist Hospital, Surulere, Lagos, Nigeria., Ekwebene OC; Department of Epidemiology and Biostatistics, East Tennessee State University, Johnson City, TN, USA., Nwankwo EU; Rural Community Clinical School, School of Medicine, Deakin University, VIC, Australia., Okolie PC; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Egwuatu EC; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Nkesi JC; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Okafor OC; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Okeke CM; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Malachy DE; Effective Care Research Unit, Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Nigeria., Dimgba OO; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Okeke NC; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Okeke KC; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Nwadili BK; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Ugwuoroko HC; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Madubuko CC; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria., Onyejiaku LC; Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB, Nnewi, Anambra State, Nigeria.
Jazyk: angličtina
Zdroj: Clinical medicine insights. Case reports [Clin Med Insights Case Rep] 2023 Mar 29; Vol. 16, pp. 11795476231164379. Date of Electronic Publication: 2023 Mar 29 (Print Publication: 2023).
DOI: 10.1177/11795476231164379
Abstrakt: Background: Uterine dehiscence is a separation of uterine musculature with intact uterine serosa. It can be encountered at the time of cesarean delivery, suspected on obstetric ultrasound or diagnosed in-between pregnancies. The antenatal diagnosis may occasionally elude the Obstetricians. This particular case demonstrates an intra-operative diagnosis of uterine dehiscence with missed antenatal ultrasound diagnosis in an asymptomatic woman.
Case Presentation: She was a 32-year-old Nigerian second gravida who booked for antenatal care at 32 weeks of gestation following a referral from her attending Obstetrician from a neighboring state due to relocation. She had 3 antenatal visits and 2 antenatal ultrasound investigations without uterine scar thickness report. She subsequently had elective Cesarean section (CS) at a gestational age of 38 weeks plus 2 days due to persistent breech presentation on a background of a previous lower segment CS scar. There was no previous uterine curettage prior to or after the previous lower segment CS scar and there was no labor pains prior to the elective CS. The surgery was successful with intra-operative findings of moderate intra parietal peritoneal adhesions with rectus sheath and obvious uterine dehiscence along the line of the previous CS scar. The fetal outcomes were normal. Immediate post-operative condition was satisfactory and the woman was discharged on a third-day post operation.
Conclusion: Obstetricians are charged to maintain a high index of suspicion when managing pregnant women with history of emergency CS in order to avert the adverse consequences of uterine rupture from asymptomatic uterine dehiscence. Based on this report, it may be useful to routinely assess the lower uterine segment scar of women with previous emergency CS using the available ultrasound facilities. However, more studies are needed before advocating for routine antenatal uterine scar thickness testing following emergency lower segment CS in low and middle-income settings.
Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
(© The Author(s) 2023.)
Databáze: MEDLINE
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