During emergency laparotomy for suspected scar complications, the surgeon finds separation of the previous lower segment incision with bulging membranes visible through the defect, but the overlying serosa and broad ligament are intact and there is no bleeding. How is this finding classified?

• A Uterine rupture with extrusion of the conceptus
• B Isthmocele with contained haematocele
• C Uterine scar dehiscence ✓
• D Couvelaire uterus

Explanation

Dehiscence is separation of the myometrial scar with intact visceral peritoneum, membranes remaining contained, minimal bleeding, and often no symptoms; it is frequently an incidental finding at repeat surgery. Uterine rupture, by contrast, is a full-thickness tear including the serosa with escape of fetal parts or blood into the peritoneal cavity and catastrophic haemorrhage. Couvelaire uterus refers to intramyometrial bleeding from abruption.

Reference: Williams Obstetrics, 26th ed.

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