2025 FSA Podium and Poster Abstracts

The provided image illustrates a 31-year-old G5P4004 woman scheduled for repeat cesarean delivery (CD). She had 4 prior CD, anterior placenta, and suspected placental accreta, which was intra-operatively diagnosed as uterine dehiscence (UD). Most UD cases are asymptomatic with no bleeding(1), and lack of standard diagnostic protocol makes their evaluation and management challenging(2).

UD is a partial division of the uterus that does not affect all three layers (endometrium, myometrium, and perimetrium)(1). It is more common with each additional prior CD(2). With CD rates increasing from 5% to 30% in the past 35 years(2), this condition merits attention.

UD may lead to a uterine window," a thin uterine wall segment that reveals the fetus through the myometrium(1). Often undiagnosed due to the lack of a diagnostic protocol, it can be identified intraoperatively during repeat CD or antenatally between pregnancies on transvaginal ultrasound(2). A study of patients with prior CD (n=21,420) found an incidence of 10.1% for UD and 2.8% for uterine rupture, which is UD's most concerning complication(3).

Uterine rupture increases maternal and neonatal morbidity(1). Its potential for severe impact on patient hemodynamic stability necessitates maintaining clinical suspicion for this complication in patients with prior CD presenting with abnormal imaging.

The preoperative misdiagnosis of a uterine window as placenta accreta spectrum demands additional resources such as more invasive monitoring, blood product availability, and multiservice involvement, all of which could be avoided with more accurate diagnostic tools. This underscores the necessity for advanced diagnostic modalities for uterine dehiscence and windows(2).