Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014 Dec; 158(4):654-658. 654 Dehiscent scar in the lower uterine segment after Caesarean section and IVF infertility treatment: A case report Radka Filipcikova a,# , Ivana Oborna b,c,# , Jana Brezinova a,d , Marcela Bezdickova a , Stanislav Laichman a , Martin Dobias e , Zdenka Blazkova a , Blazena Hladikova c , Dalibor Pastucha f Aims. Caesarean section is the most common obstetric operation associated with short and long term risks, one of which is uterine scar dehiscence. In this case report we describe four cases of in vitro fertilization and embryo transfer (IVF + ET) treatment where the embryo was transferred into the uterus with known scar dehiscence in the lower uterine segment after a previous Caesarean section (SC). Methods. All transfers of embryos were ultrasound guided directly into the middle of uterine cavity. All resulting pregnancies continued without problems related to the dehiscent scar and babies were delivered in the third trimester by elective/emergency SC. Results. Our cases suggest that IVF + ET can be offered as an infertility treatment option despite a dehiscent scar in the lower uterine segment after previous SC. Key words: uterine anatomy, lower uterine segment, scar dehiscence, IVF, transfer of embryo Received: July 3, 2012; Accepted wiht revision: January 4, 2013; Available online: February 14, 2013 http://dx.doi.org/10.5507/bp.2013.001 a Department of Anatomy, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic b Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University Olomouc c Fertimed Olomouc d Arleta IVF, Kostelec nad Orlici e Department of Forensic Medicine and Medical Law, Faculty of Medicine and Dentistry, Palacky University Olomouc f Neonatal Unit, Faculty of Medicine and Dentistry, Palacky University Olomouc # The authors contributed equally to the work Corresponding author: Ivana Oborna, e-mail: ivana.oborna@upol.cz INTRODUCTION Caesarean section is the most frequent obstetric op- eration performed for various reasons such as late preg- nancy or during unsuccessful vaginal delivery. Worldwide, numbers of SC are steadily increasing with improvements in surgical and anaesthetic techniques and, routine use of antibiotic and antithrombotic prophylaxis. It is well- known that different surgical approaches e.g. blunt vs. sharp dissections, transverse lower uterine segment inci- sion vs. other incisions, single vs. double layer uterine closure, continuous vs. interrupted suture of the uterus can markedly influence the healing process 1 . However, conditions such as emergency SC and infection can affect healing of the uterus even more 2 . Like all operations, SC can be associated with short and long term risks, one of which is uterine scar dehis- cence. This may present as an acute event during the an- tenatal, intrapartum or postpartum period 3 . Women with a dehiscent lower segment scar are also at higher risk of implantation in the scar 4 , placenta accreta development or placenta praevia 5 . Uterine scar dehiscence can also cause prolonged menstrual bleeding if the defect serves as a reservoir for blood 6 . Many authors suggest evaluating the lower uterine seg- ment in late pregnancy to support the physician’s decision on SC or vaginal delivery, and to explain or justify such decision to the patient 7-9 . Other authors believe the assess- ment of scar defect should be done on the non-pregnant uterus, either by ultrasonography, sonohysterography or MRI (ref. 10-13 ). There is no clear agreement for dealing with such as- ymptomatic dehiscence when it is found on the non-preg- nant uterus in case the woman plans another pregnancy in the future. Donnez et al. 12 described successful lapa- roscopic repair of dehiscent uterine scar in three symp- tomatic women. Others prefer the transvaginal approach, but no proof of its necessity or utility has been found 14 . In this report we describe our approach to four women who were referred to IVF treatment because of secondary infertility for various reasons and who previously delivered by one SC (three patients) or two SC (one patient). In all these cases, the dehiscent uterine scar was detected during the infertility evaluation. The ultrasound description of the lower uterine seg- ment of the non-pregnant uterus was done according to Ofili-Yebovi et al. The uterus was examined in the lon- gitudinal plane with identification of the internal os, the depth of the scar and the thickness of the adjacent myo- metrium. The loss of more than 50% of myometrium at the scar level was classified as severe 11 .