Surgeons, including the obstetricians and family doctors who perform C-sections, use the term dehiscence to describe a wound that has separated at its margins. Since doctors close C-section wounds in multiple layers, a dehiscence can be complete, meaning extending through all layers of tissue, or partial, meaning that just the surface layers are affected. All women who suspect abdominal wound dehiscence should notify their doctors as soon as the complication occurs.
Signs and Symptoms
When skin wounds dehisce, they cause bleeding, swelling, redness, pain and fever. Patients who have not had their sutures removed may exhibit hanging threads from torn sutures or missing staples, when surgical staples are used. When uterine incisions dehisce, the skin scar usually remains intact, so doctors and nurses must rely on indirect clues—such as maternal shock and fetal distress, as evidenced by decreased fetal movement, heart rate and heart rate variability.
A 2010 study in the Archives of Gynecology and Obstetrics reported that 1.2 percent of C-Sections are complicated by dehiscence during the post-operative period. A 2007 study in Obstetrics and Gynecology put the prevalence of uterine rupture due to uterine scar dehiscence during subsequent pregnancy at 0.3 percent of deliveries.
Women who are overweight, smoke, take oral or intravenous steroids or suffer from chronic diseases such as diabetes, kidney disease and immune system are more likely to develop wound dehiscence after a C-Section than women without these risk factors. Coughing, straining with bowel movements and vomiting also make things worse.
Complications of dehiscence range from superficial infections and increased scar tissue, to peritonitis and uterine rupture. Peritonitis constitutes a life-threatening infection of the abdominal cavity, and necessitates admission to the hospital. Uterine rupture occurs when the suture lines across the uterus dehisce, usually in the setting of contractions during a subsequent pregnancy.
Patients can reduce their risk of dehiscence by following their doctors' instruction on activity restrictions, such as not driving, lifting objects greater than five pounds or performing abdominal exercise during the first few weeks after a C-section. Although nutritional causes of dehiscence are exceedingly rare, it also helps to maintain a balance diet, including a vitamin and mineral supplement, if necessary. Depending on the type of incision, during subsequent pregnancies an obstetrician may schedule a C-section shortly before term to avoid the risk of uterine rupture associated with spontaneous labor.
After dehiscence, the obstetrician cannot re-close the wound using sutures or staples. Instead, the wound must be allowed to fill in gradually. Patients may need to undergo surgical debridement, a process in which dead or infected tissue is dissected away with a scalpel. Oral or intravenous antibiotics may be prescribed to treat or prevent infections. Uterine rupture often requires a hysterectomy to control bleeding and save the patient's life.