Cesarean scar dehiscence and irregular uterine bleeding

BACKGROUND: Abnormal uterine bleeding is a frequent symptom in gynecology, caused by functional as well as by anatomic genital tract abnormalities. CASE: An endocervical diverticulum was diagnosed in a patient with secondary infertility, intermenstrual bleeding, and a prior cesarean delivery. Dehiscence of the cesarean scar was visualized by ultrasound, hysterosalpingogram, and hysteroscopy. The defect was repaired and the bleeding stopped. A spontaneous pregnancy occurred but ended in premature delivery at 17 weeks' gestation. Recurrence of chronic bleeding led to a hysterectomy 6 months later. CONCLUSION: Uterine scar defects may be associated with intermenstrual bleeding in women with a previous cesarean delivery.