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Uterine rupture vs dehiscence

Published:November 27, 2015DOI:https://doi.org/10.1016/j.ajog.2015.11.025
      To the Editors:
      Because we should all be precise with the nomenclature that we use, I want to bring attention to the article by Greenwald et al,
      • Greenwald S.R.
      • Gonzalez J.M.
      • Goldstein R.G.
      • Rosenstein M.G.
      Asymptomatic uterine dehiscence in a second trimester twin pregnancy.
      in that the authors use the term dehiscence in the title, yet they use the term asymptomatic second-trimester rupture in the text. Gynecologists well know that the clinical situation in which a patient has a uterine rupture, the patient commonly exhibits signs of intraabdominal hemorrhage, often with hypotension, tachycardia, and rebound abdominal tenderness. In contrast, however, when a dehiscence is seen in a patient (or a uterine window, as it is sometimes called), typically at the time of a repeat cesarean delivery, it is not too disturbing a finding because the patient is virtually always asymptomatic.
      Using these terms interchangeably may be confusing to the reader, although these terms have been previously defined.
      • Fox N.S.
      • Gerber R.S.
      • Mourad M.
      • et al.
      Pregnancy outcomes in patients with prior uterine rupture or dehiscence.
      We may need to pay special attention to uterine rupture (and its associated risk factors, such as a vaginal trial of labor), whereas the identification of a uterine window is typically not clinically apparent and does not require any special emergency attention. Because the integrity of the uterine wall may be relevant to the choice for a vaginal trial of labor, it has been suggested that sonographic assessment could be considered.
      • Roberge S.
      • Boutin A.
      • Chaillet N.
      • et al.
      Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect.
      It is my opinion that semantics are very important.

      References

        • Greenwald S.R.
        • Gonzalez J.M.
        • Goldstein R.G.
        • Rosenstein M.G.
        Asymptomatic uterine dehiscence in a second trimester twin pregnancy.
        Am J Obstet Gynecol. 2015; 213: 590.e1-590.e2
        • Fox N.S.
        • Gerber R.S.
        • Mourad M.
        • et al.
        Pregnancy outcomes in patients with prior uterine rupture or dehiscence.
        Obstet Gynecol. 2014; 123: 785-789
        • Roberge S.
        • Boutin A.
        • Chaillet N.
        • et al.
        Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect.
        Am J Perinatol. 2012; 29: 465-471

      Linked Article

      • Asymptomatic uterine dehiscence in a second-trimester twin pregnancy
        American Journal of Obstetrics & GynecologyVol. 213Issue 4
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          A 22-year-old woman with dichorionic-diamniotic twins and a history of cesarean delivery for breech presentation presented for routine anatomy ultrasound. She was found to have a 2-cm defect in the lower uterine segment at the cervical junction, likely at the site of her previous hysterotomy (Figure 1). On endovaginal scan, there was sludge within the defect that extended through the myometrium, covered only by serosa. A fetal foot intermittently kicked through the defect (Video). Magnetic resonance imaging confirmed the dehiscence at least 3 cm from the inferior margin of her anterior placenta adjacent to the normal-appearing bladder; there was no maternal free fluid (Figure 2).
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      • Reply
        American Journal of Obstetrics & GynecologyVol. 214Issue 3
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          We thank Dr Levine for his thoughtful response to our article,1 and we agree with the importance of semantics in the medical literature. The distinction between a symptomatic uterine rupture vs an asymptomatic dehiscence does indeed have important clinical ramifications.2
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