Incomplete Cesarean Scar Rupture
A 30 year-old woman with a prior ectopic pregnancy (EP) and a cesarean section delivery, respectively 4 and 2 years earlier, was admitted with the complaints of uterine contractions and lower abdominal pain in Royan Institute in Tehran, Iran. In her previous pregnancy, she had become pregnant by IVF and had undergone cerclage placement and then had cesarean section delivery by transverse Pfannenstiel skin incision.\nShe had conceived naturally in her current pregnancy, without any assisted reproductive technology (ART) treatment. She had no cerclage, the patient experienced uterine contractions and lower abdominal pain in the 24th week of gestation. Her suprapubic scar was painful on palpation.\nWe performed ultrasonography using an Accuvix XQ machine (Madison Co. Ltd., Korea) with a 3–5 MHZ convex probe and a 3D, 4–8 MHZ transvaginal probe. At first, we performed a transabdominal sonography, which was suspicious of cesarean scar rupture; therefore, we further evaluated the cervical canal and cesarean scar by transvaginal sonography. Ultrasonography revealed a fenestration 17 mm in diameter in the scar (). Three dimensional ultrasonography of the uterine isthmus confirmed the fenestration ().\nThe patient and her spouse decided to continue the pregnancy; therefore, she was under conservative treatment and was restricted to complete bed rest (CBD) at home. Accordingly, controlled sonography of the cesarean scar defect was done every 10 to 14 days until the 34th week of gestation. At the onset of uterine contractions, emergency cesarean delivery was done at the 34th week of gestation. There was no fetal or maternal morbidity following delivery.