Lower Uterine Section Transverse Incision Defect and Ectopic in the Cesarean Section Scar: A Case Presentation and Review of The Literature

Abstract

Introduction Low uterine segment transverse Cesarean Section is the most frequently performed surgery in obstetrics with a reported frequency of 31.9% of deliveries in the USA reported by the CDC [1]. While Cesarean Section is an indispensable tool in Obstetrics, like all surgical procedures it carries risks. As a procedure performed in young and for the most part healthy women, the incidence of severe morbidity and mortality is relatively low, approximating 2.9% [2] nevertheless we are recently identifying additional risks, such as that of Post-Cesarean Syndrome [3-7]. That has been defined broadly as symptoms resulting from the presence of a defect in the lower uterine segment (Lower Uterine Segment Transverse Incision Defect, LUSTIDs). Such symptoms can be pain, bleeding [7] and dysmenorrhea [6]. In addition, the likelihood of a larger defect increases with retro flexion and repeat cesarean deliveries [6]. Such cases are also identified at the time of delivery and the thickness of the remaining lower uterine segment wall is a determinant of the likelihood of complications during labor. In a more recent identified expression of LUSTIDS is infertility, as documented by failure to conceive in the absence of any other cause of infertility [3,8]. We present a case series of patients with LUSTIDS, starting with a Cesarean Section Ectopic managed with primary intent repair at the time of Hysterotomy. ABSTRACT The aim of this paper is to present the first patient where a lower uterine segment transverse incision defect that led to a cesarean section scar ectopic pregnancy was repaired at the same time with Hysterotomy for removal of her persistent ectopic pregnancy. We also reviewed the literature.