Abstract
Caesarean section is the most common obstetric operation associated with short and long term risks, one of which is uterine scar dehiscence. In this case report we describe four cases of in vitro fertilization and embryo transfer (IVF+ET) treatment where the embryo was transferred into the uterus with known scar dehiscence in the lower uterine segment after a previous Caesarean section (SC). All transfers of embryos were ultrasound guided directly into the middle of uterine cavity. All resulting pregnancies continued without problems related to the dehiscent scar and babies were delivered in the third trimester by elective/emergency SC. Our cases suggest that IVF+ET can be offered as an infertility treatment option despite a dehiscent scar in the lower uterine segment after previous SC.
Highlights
Caesarean section is the most frequent obstetric operation performed for various reasons such as late pregnancy or during unsuccessful vaginal delivery
Patient No IV A 35 year old obese (BMI 34) woman asked for transfer of cryopreserved embryos from a previous successful In vitro fertilization (IVF) cycle when an emergency SC had to be performed for preeclampsia (PET) in a twin pregnancy in the 33rd gestational week
The ascending part is represented by the uterine artery itself, which is intensely winding along the edge of the uterus up to the uterine horns
Summary
Caesarean section is the most frequent obstetric operation performed for various reasons such as late pregnancy or during unsuccessful vaginal delivery. It is wellknown that different surgical approaches e.g. blunt vs sharp dissections, transverse lower uterine segment incision vs other incisions, single vs double layer uterine closure, continuous vs interrupted suture of the uterus can markedly influence the healing process[1]. Conditions such as emergency SC and infection can affect healing of the uterus even more[2]. In this report we describe our approach to four women who were referred to IVF treatment because of secondary infertility for various reasons and who previously delivered by one SC (three patients) or two SC (one patient) In all these cases, the dehiscent uterine scar was detected during the infertility evaluation. The loss of more than 50% of myometrium at the scar level was classified as severe[11]
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