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E2135. Escape Womb: Imaging of Cesarean Section Complications
Authors
  1. Heba Albasha; University of Cincinnati
  2. Jesse Hinton; University of Cincinnati
  3. Juliana Tobler; University of Cincinnati
  4. Kyuran Choe; University of Cincinnati
Background
As one of the most common surgical procedures in the United States, Cesarean section (C-section) is performed in approximately one-third of all births. Complications are uncommon, but imaging can add significant diagnostic value.

Educational Goals / Teaching Points
The goal of this exhibit is to familiarize radiologists with the normal postoperative imaging appearance of the uterus, as well as the temporal distribution and imaging appearance of a broad spectrum of early and late C-section complications. Using a case-based approach, the various C-section complications will be presented, with a discussion of the background, key imaging findings, and management of these complications. Appropriate modality selection for problem-solving and diagnosis of C-section complications will also be reviewed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In the immediate postoperative period, the most common complications include infection and postoperative fluid collections, including hematoma and less commonly urinoma. Uncommon complications include uterine dehiscence and pseudoaneurysm. Due to the rate of C-sections, complications in subsequent pregnancies are more frequently seen. Abnormal implantation of a subsequent pregnancy in the uterine scar can lead to a C-section scar ectopic. The spectrum of a morbidly adherent placenta (placenta accreta spectrum) is most commonly associated with placenta previa and is best evaluated by magnetic resonance imaging. Thinning of the uterine wall at the site of the C-section scar can be extreme and is termed a uterine window. Abnormal implantation of endometrial tissue can also be seen following C-section, leading to endometriosis in the C-section scar in the abdominal wall and soft tissues. Other processes can also extend into the uterine scar, including tumor.

Conclusion
There are an array of early and late complications after C-section, and with the high number of C-sections performed, understanding and recognizing such complications on imaging is essential.