Cesarean scar defect hematoma after surgical abortion

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Latest years significant increase in cesarean deliveries produced a wide range of complications following the procedure, and they can be divided into early and late ones. We illustrate herein one surprising hematoma superimposed on the most common complications following cesarean section - the cesarean scar defect [1]. We report the case of a 35-year-old woman that presented with substantial vaginal bleeding and pelvic pain. She declared she had a prior surgical abortion for an 11 weeks pregnancy three weeks earlier and two C-section births (8 and respectively 5 years ago). We noticed a complex heterogeneous, 3,1/3,3 cm wide mass occupying the cesarean scar on ultrasound (Figure 1). The collection modified the normal uterine anatomy and protruded towards the left ligament (Figure 2), with no free fluid in the pouch of Douglas. We believed the hematoma could result from a blunt maneuver in the context of the surgical abortion [2]. As the patient was clinically stable, a conservative approach was considered. She received antibiotics and a daily sonographic scan of the pelvic area. The patient was discharged after five days in good health.

As a late complication of cesarean-delivery, the scar defect may become important for the gynecologic future of a woman, whether it is the case of pregnancy and choosing a birth modality or irregular bleeding caused by the niche. This case is a perfect example of a peculiar evolution in a woman with a history of C-sections.