A Growing Concern: Cesarean Scar Defect and Massive Uterine Bleeding

Cesarean Scar Defect (CSD) is the formation of a diverticulum at the site of the old caesarean incision [1]. With a rising cesarean sections being performed, the complications caused by CSDs has attracted more and more attentions. These include conditions such as scar pregnancy, placenta accreta, placenta previa, and uterine rupture in subsequent pregnancies [2,3]. The CSD is also associated with abnormal bleeding, dysmenorrhea, pelvic pain, adenomyosis, infertility, abscess formation, post-coital bleeding during the non-pregnant state [4-6]. Of note, the most common clinical symptom is abnormal bleeding, and the correlation with CSDs has been well established. The typical presentation is intermenstrual or postmenstrual spotting, lasting for 2 to12 days. A CSD woman had recurrent life threatening bleeding during her menses only recently being described [7] which was diagnosed CSD and local arterial hemorrhage by hysteroscopy and was managed with laparoscopic correction (Figure 1) of caesarean scar dehiscence?