Postpartum uterine scar dehiscence leading to secondary PPH: Unusual sequelae: A case report

Abstract

Incidence of Caesarean sections is increasing in the World and Obstetricians are becoming more inclined to offer trial of vaginal birth following a single uncomplicated Caesarean section due to growing recognition of high morbidity associated with repeat abdominal surgeries, and relative rarity of complications of Caesarean scar defect (CSD) after subsequent vaginal deliveries. The diagnosis of CSD such as uterine scar dehiscence in postnatal period still remains elusive due to its vague presentation. An incorrect diagnosis or delay in diagnosis can lead to unnecessary interventions or delay in the management of patient symptoms. CSD is a complication of caesarean section with implications for abnormal uterine bleeding. Most CSD cases are discovered incidentally or with the development of menstrual changes. CSD rarely have a longer latency period, resulting in postpartum presentation of bleeding and abdominal pain. Secondary postpartum haemorrhage due to partial or complete dehiscence of uterine wound after caesarean section is unusual. This is a patient with secondary postpartum haemorrhage following uterine dehiscence after VBAC. Conservative management failed to control the bleeding, and patient eventually needed hysterectomy. All women having significant PPH following caesarean should undergo evaluation for any defect in the scar. Sometimes, Scar dehiscence has been diagnosed and repaired after many years of caesarean section in women with persistent abnormal bleeding. Hence, this condition may have long-term implication if missed postpartum.