Incidence and Risk Factors of Uterine Scar Dehiscence Identified at Elective Repeat Cesarean Delivery: A Case-Control Study

Abstract

Background: The aim of this study was to determine the rate of uterine scar dehiscence among women undergoing elective repeat cesarean delivery and to investigate associated risk factors. Methods: This was a retrospective case-control study of patients with previous one or more lower segment transverse cesarean incisions giving birth by elective repeat cesarean delivery at two tertiary-care centers over a period of 1 year. Demographic data, previous and current obstetric events were recorded and compared among women with or without uterine scar dehiscence. Results: Among 588 patients included in this study, 27 cases of uterine scar dehiscence were identified with an incidence of 4.6%. This rate was not affected by maternal age, parity, co-morbidity, twin gestation, preoperative labor or previous preterm cesarean delivery. Factors significantly associated with uterine scar dehiscence were “preterm delivery” (OR: 2.76, 95% CI: 1.18 - 6.42), “tertiary cesarean delivery or higher” (OR: 2.56, 95% CI: 1.14 - 5.75) and “inter-delivery interval ≤ 24 months” (OR: 2.38, 95% CI: 1.04 - 5.44). No immediate adverse maternal or neonatal complications were noted. Conclusions: Uterine scar dehiscence is not uncommon among women undergoing elective repeat cesarean delivery. Increased risk was associated with preterm delivery, tertiary cesarean delivery or higher and short inter-delivery interval of ≤ 24 months. J Clin Gynecol Obstet. 2018;7(2):37-42 doi: https://doi.org/10.14740/jcgo481w