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Expectant Management of Uterine Dehiscence in the Second Trimester of Pregnancy

Hamar, Benjamin D. MD; Levine, Deborah MD; Katz, Naomi L. MD; Lim, Kee-Hak MD

CASE REPORTS
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BACKGROUND Uterine dehiscence and rupture are serious complications of pregnancy after a cesarean delivery. Management of uterine dehiscence diagnosed in second trimester can be controversial.

CASE A woman with a previous cesarean delivery was diagnosed with a uterine dehiscence at 20 weeks in the area of her prior cesarean incision. Although she was counseled regarding risks to herself and the fetus, she decided to continue the pregnancy. She was, therefore, managed expectantly until 31 weeks and delivered by cesarean because of fetal heart rate decelerations. The infant did well and was discharged home at 3 weeks of age. The patient remained asymptomatic after delivery.

CONCLUSION With close monitoring, expectant management of uterine dehiscence diagnosed in the second trimester is possible.

Department of Obstetrics and Gynecology and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Address reprint requests to: Kee-Hak Lim, MD, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; E-mail: khlim@caregroup.harvard.edu.

Received August 9, 2002. Received in revised form September 27, 2002. Accepted October 24, 2002.

© 2003 The American College of Obstetricians and Gynecologists