Rare complications of cesarean scar

Abstract

Cesarean scar pregnancy (CSP) and cesarean scar dehiscence (CSD) are the most dreaded complications of cesarean scar (CS). As the incidence of CS is increasing worldwide, so is the incidence of CSP, especially in cases with assisted reproduction techniques. It is of utmost importance to diagnose CSP in the early first trimester, as it can lead to myometrial rupture with fatal outcome. On the other hand, CSD may be encountered during pregnancy or in the postpartum period. CSD in the postpartum period is very rare and can cause secondary postpartum hemorrhage (PPH) leading to increased maternal morbidity or even death if not diagnosed and managed promptly. Both complications can be diagnosed on ultrasonography (USG) and confirmed on magnetic resonance imaging (MRI). These two conditions carry high morbidity and mortality. In this article, we highlight the role of imaging in the early diagnosis and management of these conditions.

Keywords: Cesarean scar dehiscence; cesarean scar pregnancy; magnetic resonance imaging; ultrasonography.

Figure 1A

TAS showing the gestation sac (black arrow) with embryo in the lower uterine segment and myometrial thinning (open arrows). Note the endometrial cavity (white arrow) is empty

Figure 1B

TVS showing the gestation sac (long white arrow) in the lower uterine segment with thinning of the anterior myometrium (open arrows). Note the empty endometrial cavity which is displaced posteriorly (small white arrow)

Figure 2

Sagittal T2WI MRI showing the relationship of the gestation sac (long black arrow) with the empty endometrial cavity (short black arrow) and urinary bladder. Open arrows show myometrial thinning between the urinary bladder wall and gestational sac

Figure 3

TVS showing the heterogeneous hypoechoic collection (white arrow) anterior to the uterus (open arrow). It is communicating with the endometrial cavity through myometrial defect (black arrow)

Figure 4A

Sagittal T1WI MRI shows a heterogeneous hyperintense collection (black arrow) anterior to the uterus (open arrow). It is communicating with the endometrial cavity through myometrial defect (white arrow) which is better seen on MRI

Figure 4B

Axial T2WI MRI shows heterogeneous hyperintense collection (long white arrow) anterior to the uterus (short white arrow). Note mild free fluid in the peritoneal cavity (black arrow)