Silent complete uterine dehiscence at repeat caesarean section: a case report

Abstract

Uterine scar dehiscence is a rare but potentially life-threatening complication typically associated with prior caesarean deliveries. While most cases present with abdominal pain or abnormal foetal monitoring, silent complete dehiscence is rare and often only detected intraoperatively. Risk factors include multiple prior caesarean sections and short inter-delivery intervals. We report the case of a 32-years-old gravida 4 para 3 female with a history of three previous caesarean sections. She presented for elective repeat caesarean section at term. Antenatal assessments were unremarkable and she reported only minor urinary symptoms. Intraoperatively, a complete uterine dehiscence was identified, characterised by a full-thickness separation of the uterine wall without serosal involvement. This was complicated by a 7 cm bladder laceration. The bladder injury was promptly repaired and the patient received postoperative management including indwelling catheterisation, antibiotic therapy and urology follow-up. Her recovery was uneventful. This case underscores the importance of maintaining a high index of suspicion for uterine dehiscence in patients with multiple prior caesarean deliveries, even in the absence of symptoms. Early recognition and prompt surgical management are crucial to prevent severe maternal morbidity.