Uterus Dehiscence - Symptoms, Causes, Treatment, After Birth & Abortion

Uterus Dehiscence:

• What is Uterus Dehiscence?
• Symptoms
• Causes
• Treatment
• Uterus Dehiscence After Birth
• Uterus Dehiscence After Abortion

What is Uterus Dehiscence?

Uterus dehiscence refers to the partial separation or thinning of a previously healed uterine scar, most commonly from a prior cesarean section (C-section). Unlike a full uterine rupture, dehiscence does not involve complete tearing of all uterine layers. The outermost layer (serosa) remains intact, which usually prevents severe bleeding or fetal distress during pregnancy. Because of this, uterus dehiscence is sometimes called a “silent rupture” due to its subtle symptoms.

This condition is typically detected incidentally during a repeat C-section or imaging and often causes fewer symptoms compared to rupture. However, it remains a significant clinical concern because it increases the risk of uterine rupture in future pregnancies. Understanding how dehiscence occurs helps guide safe delivery planning, especially for individuals attempting vaginal birth after cesarean (VBAC).

Symptoms

Symptoms of uterus dehiscence are usually mild or absent, which is why many cases go undiagnosed until delivery. Some individuals may experience vague abdominal pain, uterine tenderness, or spotting during pregnancy. These symptoms are often nonspecific and can mimic other pregnancy-related discomforts.

In rare cases, if the dehiscence worsens or approaches rupture, symptoms may include persistent abdominal pain, sudden worsening uterine tenderness, contractions, or changes in fetal movement. Severe cases may present with maternal tachycardia or low-grade fever. Any concerning symptoms in people with a prior C-section scar should prompt medical evaluation to rule out dehiscence or rupture.

Causes

The primary cause of uterus dehiscence is inadequate healing of a previous uterine incision. The most common risk factor is a prior C-section, especially if performed under urgent conditions or involving classical (vertical) incisions. Other causes include:

• Multiple prior cesarean deliveries
• Short interval between pregnancies (less than 18 months)
• Infection at the surgical site after a previous C-section
• Poor scar formation due to medical conditions (e.g., diabetes, connective tissue disorders)
• Excessive uterine stretching (multiple gestation or polyhydramnios)
• High-dose uterine stimulants or induction medications

These factors weaken the uterine wall over time, increasing the chance that the scar may thin or partially separate during pregnancy or labor.

Treatment

Treatment depends on when uterus dehiscence is discovered and its severity. If detected during pregnancy, doctors usually recommend close monitoring, activity modification, and avoidance of labor induction. In some cases, early planned C-section may be necessary to reduce the risk of rupture.

When discovered during a repeat C-section, the surgeon typically repairs the defect by re-closing and strengthening the uterine incision. Individuals with a history of uterine dehiscence are usually advised against VBAC in future pregnancies. Ongoing counseling, scar monitoring, and safe delivery planning are key components of long-term management.

Uterus Dehiscence After Birth

Uterus dehiscence diagnosed after birth usually occurs when the uterine incision fails to heal properly. After a C-section, the uterus is expected to contract and repair itself. However, infection, tension on the incision, or underlying medical conditions can interfere with normal healing.

Symptoms after birth may include persistent abdominal pain, fever, foul-smelling discharge, heavy bleeding, or signs of infection. Diagnosis may require ultrasound or CT imaging. Treatment often includes antibiotics, uterotonic medications, and in some cases surgical repair. Severe dehiscence may require hospitalization and close monitoring.

Uterus Dehiscence After Abortion

Although rare, uterus dehiscence can occur after a surgical abortion—especially if instruments inadvertently injure a previous scar or if infection develops post-procedure. Individuals with a history of C-section are at slightly higher risk due to scar weakness.

Signs may include pelvic pain, fever, abnormal bleeding, or discharge. Prompt evaluation is essential to prevent progression to rupture or severe infection. Treatment may involve antibiotics, pain management, and in severe cases, surgical repair of the uterine wall. Follow-up imaging may be recommended to ensure proper healing.