title: Cesarean scar dehiscence as a cause of hemorrhage after second-trimester abortion by dilation and evacuation.
abstract: Women who have had a cesarean section have a risk of uterine rupture when undergoing a second-trimester pregnancy termination. Beyond the first trimester, uterine rupture has been associated with the use of labor-induction agents and, less often, a placenta accreta. Scar dehiscence, a less disruptive form of scar separation, has not been reported with dilation and evacuation abortion. We present two cases of uterine scar dehiscence causing serious bleeding after otherwise uncomplicated dilatation and evacuation procedures. Neither case was associated with uterine contractions, an iatrogenic perforation or placenta accreta. Uterine scar dehiscence, a surreptitious process, can be the cause of hemorrhage after uncomplicated dilatation and evacuation.
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University Feinberg Medical School, Chicago, IL, USA. chicago@fpamg.net
authors.forename: E Steve
authors.initials: ES
authors.lastname: Lichtenberg
authors.forename: Marilynn C
authors.initials: MC
authors.lastname: Frederiksen
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D016063:Blood Loss, Surgical; D002585:Cesarean Section / Q000009:adverse effects*; D004107:Dilatation and Curettage / Q000009:adverse effects*; D005260:Female; D020073:Gravidity; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D013529:Surgical Wound Dehiscence / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016216:Ultrasonography, Prenatal; D014592:Uterine Hemorrhage / Q000209:etiology* / Q000601:surgery; D014597:Uterine Rupture / Q000209:etiology*