Fetal Extrusion Through Dehiscence Caesarean Scar Confirmed by MRI: A Case Report and Review

Background: Uterine scar dehiscence is a rare, life-threatening complication seen among women with a history of Caesarean section (C-section). Early diagnosis is critical to prevent its complications. While ultrasound (US) is the standard investigative tool, it can sometimes be inconclusive, posing diagnostic challenges. MRI is pivotal in differentiating a dehiscent scar from other pathologies, especially when ultrasound is unsatisfactory. Case presentation: A 32-year-old pregnant woman in her 21st week of gestation, G3P2A0, with both deliveries by C-section, presented with a diagnosis of fetal demise confirmed by US. She underwent medical termination with a high dose of misoprostol tablets. At a private hospital, she complained of worsening lower abdominal pain and tenderness. The transabdominal US revealed a bulky uterus with a heterogeneous mass composed of macerated fetal parts and placenta emerging through the left lower uterine segment near the scar site. To confirm the diagnosis, MRI showed a large, non-enhancing structure measuring 90 × 90 mm, communicating with the uterine cavity through the C-section scar, supporting the diagnosis of uterine dehiscence and hematoma formation. Emergency laparotomy confirmed the diagnosis of uterine dehiscence with extrusion of macerated fetal tissue through the defect. Surgical repair was performed, and the postoperative period was uneventful. Conclusion: This case reinforces the cautious use of uterotonic drugs, such as misoprostol, in patients with repeated C-sections. MRI was a valuable adjunct in confirming the diagnosis when US findings were inconclusive. A multidisciplinary approach, utilizing judicious imaging tools, especially MRI in complex cases, and timely intervention, is crucial for preventing life-threatening outcomes and preserving patient fertility.