Uterine scar dehiscence in previous caesarean section and their foetomaternal outcome at a tertiary care centre

Abstract

The escalating rates of caesarean sections (CS) globally have intensified concerns regarding associated complications; including uterine scar dehiscence (USD) i.e., characterized by incomplete separation of the uterine scar from a prior CS, poses significant risks to maternal and foetal health. This retrospective study aimed to identify risk factors contributing to USD and assess its impact on foeto-maternal outcomes. A retrospective study was conducted on pregnant women diagnosed with USD who underwent repeat CS with a prior lower segment caesarean section (LSCS) at a tertiary obstetrics and gynaecology department from March 2022 to March 2024. Maternal demographic and clinical characteristics were scrutinized, with emergency LSCS performed on 83.33% of women, highlighting the urgency associated with USD. Notably, maternal age, shorter inter-pregnancy intervals (<18 months) and a history of multiple LSCS (68.3%) emerged as significant risk factors for USD. Additionally, certain maternal co-morbidities, including hypertensive disorders (11.6%), foetal growth restriction (11.6%), and previous preterm birth (16.6%), showed causal associations with USD. Foeto-maternal outcomes were adversely affected, with notable occurrences of preterm birth, low birth weight, and neonatal distress, necessitating NICU admission. This study contributes valuable insights into the complex interplay between maternal characteristics, clinical factors, and adverse outcomes associated with USD in women with prior CS. The findings emphasize the need of targeted interventions, including risk assessment, careful monitoring, and timely interventions, to mitigate the risks associated with USD and improve foeto-maternal outcomes.