Michel E Rivlin1, C Shannon Carroll, John C Morrison. 1. Department of Obstetrics and Gynecology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216-4505, USA.
Abstract
OBJECTIVE: To establish the clinical features of patients with necrosis of the uterine incision after cesarean delivery because of the paucity of modern reports in the literature. STUDY DESIGN: Over a 4-year period, the records of 6 patients with this complication were reviewed. RESULTS: Three patients presented within 48-72 hours of delivery with clinical features very similar to those of bowel perforation. One patient had fascial dehiscence on day 5 after delivery. Two cases presented 2 and 6 weeks after delivery with postpartum hemorrhage without peritoneal findings. Diagnosis was not made prior to surgery in any case. All patients recovered after hysterectomy. CONCLUSION: While the major risks with this uncommon but important complication are serious infectious morbidity and mortality, in our patients these risks were avoided but at the cost of hysterectomy in a group of young women of low parity. More data in the future might establish a basis for rational management, possibly including conservative surgery in selected cases.
OBJECTIVE: To establish the clinical features of patients with necrosis of the uterine incision after cesarean delivery because of the paucity of modern reports in the literature. STUDY DESIGN: Over a 4-year period, the records of 6 patients with this complication were reviewed. RESULTS: Three patients presented within 48-72 hours of delivery with clinical features very similar to those of bowel perforation. One patient had fascial dehiscence on day 5 after delivery. Two cases presented 2 and 6 weeks after delivery with postpartum hemorrhage without peritoneal findings. Diagnosis was not made prior to surgery in any case. All patients recovered after hysterectomy. CONCLUSION: While the major risks with this uncommon but important complication are serious infectious morbidity and mortality, in our patients these risks were avoided but at the cost of hysterectomy in a group of young women of low parity. More data in the future might establish a basis for rational management, possibly including conservative surgery in selected cases.