Uterine Dehiscence: Laparoscopic Uterine Repair in Early Pregnancy

Abstract

<h3>Study Objective</h3> This is a video demonstrating a case of complete uterine dehiscence in early pregnancy. The objective of this video is to describe the approach to complete uterine dehiscence in the first trimester, review current literature and to demonstrate surgical uterine repair in early pregnancy to facilitate a term live birth. <h3>Design</h3> Compilation of anatomy schematics, medical imaging and surgical video clips that introduces a case of complete uterine dehiscence, the workup and imaging involved in counselling followed by demonstration of a laparoscopic surgical repair. <h3>Setting</h3> Tertiary Care Academic Center. <h3>Patients or Participants</h3> This video is a case presentation of a single patient encountered in our clinical practice. Surgical video and medical images have been extracted from this patient's chart after consent was obtained. <h3>Interventions</h3> Anatomy schematics and dissection video clips demonstrating the diagnosis, anatomy and surgical intervention while repairing the caesarean scar defect in this patient. <h3>Measurements and Main Results</h3> The video shows the diagnosis of alarge 2.6cm uterine scar defect in early pregnancy and through ultrasound guided surgical repair we are able to demonstrate that there is restoration of approximately 8mm of myometrial thickness across the defect on follow up. This case resulted in a term live birth delivery via caesarean section. <h3>Conclusion</h3> With an increased number of caesarean sections and improved quality of ultrasound imaging, we are seeing an increase inincidental findings of caesarean scar defects. The risk of spontaneous pre-labour uterine rupture remains unknown as there is a literature gap in this area regarding the appropriate standard of care. In this video we demonstrate that ultrasound guided laparoscopic repair is possible; however, further studies are required to establish safety and efficacy of the approach.