Incidence of Scar Dehiscence Found Intraoperatively in Anemic Women Undergoing Repeat Cesarean Delivery.

Introduction: Cesarean delivery is defined as the birth of a fetus through an incision on the abdomen and uterus. Uterine dehiscence generally refers to an incomplete, and frequently a clinically occult, uterine scar separation where the serosa remains intact. This study estimates the incidence of intraoperative finding of scar dehiscence in anemic women undergoing repeat cesarean delivery. Aim: To estimate the incidence of intraoperative finding of scar dehiscence in anemic women undergoing repeat cesarean delivery. Materials and Methods: Data taken from the records for the past 5 years in the parturition register maintained in the labor room of our institution. Study design: Retrospective study. Sample size: All women who underwent repeat cesarean delivery in the past 5 years. Results: In the study 81.5% had 1 previous LSCS, 18.1% had 2 previous LSCS and 0.4% had 3 previous LSCS. 72.2% had no anemia. 12.3% had mild, 13.7% had moderate and 1.8% had severe anemia. Among subjects without anemia, 33.2% had scar dehiscence, among subjects with mild anemia 46.4% had scar dehiscence, among subjects with moderate anemia 72.6% had scar dehiscence and among subjects with severe anemia 87.5% had scar dehiscence. Anemic subjects had 3.26 times higher incidence for scar dehiscence compared to non-anaemic subjects intraoperatively. With increase in severity of anemia there was an increase in incidence of scar dehiscence. Discussion: The rate of Cesarean delivery has considerably increased during the past few decades. Cesarean delivery can lead to many acute and chronic complications and one of them is scar dehiscence. Anemia in pregnancy is a common condition found in the practice of obstetrics. India contributes to about 80% of maternal deaths due to anemia in South Asia. Iron deficiency anemia is the most common form of anemia seen and iron deficiency has been shown to result in impaired collagen synthesis. The impaired collagen synthesis can impair the healing of the uterine scan and lead to complications such as scar dehiscence in subsequent pregnancies. Conclusion: Reduced integrity of the uterine scar may be a consequence of an iron deficient state and timely identification and treatment of anemia in an ongoing pregnancy may be important to improve the integrity of the cesarean scar and in turn reduce the rate of cesarean scar dehiscence. [ABSTRACT FROM AUTHOR]