title: Unusual late complications after two previous cesarean deliveries: a case report.
abstract: BACKGROUND
  Women with multiple previous cesarean deliveries (CDs) risk the development of uterine synechiae and ventral fixation of the uterus to the abdominal wall.
  
  
  METHODS
  A para 2, gravida 2 women who had two prior CDs experienced prolonged menstrual bleeding with persistent cramps, both of which became more severe after insertion of an intrauterine contraceptive device that was subsequently removed. Pelvic ultrasound revealed an enlarged uterus with fibroids. After a failed attempt to perform a dilation and curettage because of uterine synechiae, the patient underwent a total abdominal hysterectomy. During surgery, the gynecologist observed a total dehiscence of the previous uterine incision, with ventral fixation of the uterus to the lower anterior abdominal wall and marked elongation of the portio cervix.
  
  
  CONCLUSIONS
  Dysmenorrhea in a patient with multiple previous CDs, mainly of the classical type, should be carefully evaluated and, in addition, when such patient requires a dilation and curettage, the possibility of cervical stenosis and uterine synechiae should be kept in mind. Having had a number of previous CDs may have an adverse impact on the uterine complication rate.
authors.affiliation: Department of Obstetrics and Gynecology, Little Company of Mary Hospital, Evergreen Park, Illinois 60805, USA.
authors.forename: Amédée C
authors.initials: AC
authors.lastname: Mathelier
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000473:pathology; D002585:Cesarean Section / Q000009:adverse effects*; D004412:Dysmenorrhea / Q000209:etiology; D005260:Female; D006175:Gynatresia / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000150:complications* / Q000601:surgery; D008595:Menorrhagia / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000150:complications* / Q000601:surgery