Caesarean section takes about 30 percent of the total number of births per year in the country. The motto “once a cesarean is always a cesarean section” for many women, for one reason or another, who have received a scar in the uterus, becomes a subject of serious discussion and consideration of the situation.
Should I give birth to a second and third child? As you know, a cesarean section is a bulky and quite serious operation, and many women are limited to two or three pregnancies, but what to do if a pregnancy with three scars in the uterus is necessary and desirable?
What happens if the result of previous pregnancies that ended in a cesarean is tragic and the patient did not realize that she was a mother or wanted a large family?
It is necessary to address this problem with all seriousness and responsibility, and then the desired child will be born.
Where to start
Well, of course, with a thorough preparation for future conception. First, it is necessary to assess the age of the patient and the general diseases of her body.
Naturally, uterine fibroids, adenomyosis, the insufficiency of the hormonal background, all this can lead to an obviously mistaken connection of the embryo.
Inflammatory uterus and appendages diseases, abortions, abortions with scraping pregnancies not develop before, also worsen the condition of the uterine wall, the inner layer (endometrium) and, consequently, the scar.
Concomitant diseases, such as hypertension, diabetes and thyroid disease, should be adjusted in time.
It is not important to know where the scar is located in the uterus and how the incision was made, how it went postoperative after previous caesarean operations, if there was inflammation, insolvency points, thinning scars during previous pregnancies.
Similarly, the scar in the uterus is not in the lower segment, but, say, bodily or in the form of an inverted “T”, most likely does not allow the uterus to stretch completely without damaging it.
It is also important to know what type of suture material was sutured and what type of suture was placed over the uterus.
It is necessary to prevent the development of adhesions after surgery. For this, there are medications, absorbable adhesions, physiotherapy treatments, physiotherapy.
It has been proven that with a double seam, healing is better with fewer complications than with a single seam.
Evaluation of the suture by ultrasound.
Before planning the baby, you need to perform an ultrasound examination of the uterine scar Doppler (to assess the condition of the vessels feeding the fabric of this area), because with the growth of the uterus, the scar will have to grow and stretch.
This is necessary to avoid rupture of the uterus along the scar (one of the most terrible complications of pregnancy with a scar in the uterus).
If the doctor during examination revealed a tissue site failure scar or thinning, then you need to assess the situation by hysteroscopy (ie look inside the uterus with the “eye” of the camera) and, if necessary , perform a plastic surgery in the uterus before pregnancy.
The plastic scar in the uterus gives good results in the future when carrying out the pregnancy.
The dangers of early pregnancy.
When pregnancy occurs, it is necessary to carefully monitor the insertion site of the egg, since it is not uncommon for the egg from attaching to the area of the scar, then pregnancy may be complicated by an unpleasant diagnosis as increased placenta , and unfortunately, this may lead to the extirpation of the uterus or its extensive Parcel in the future.
Therefore, in case of a clear violation of the coupling of the ovule, a woman may be asked to interrupt a pregnancy by vacuum aspiration, but this is always at the discretion of the patient.
Observation during pregnancy.
Performing a pregnancy with a scar in the uterus is always a high risk, and the patient, who has 4 caesarean sections, must be under the vigilant supervision of the obstetrician-gynecologists.
A necessary interval between operations is considered one and a half to five years. It is during this time that the scar heals enough, but still has not time to transform into thick connective tissue.
The record of such a patient must be early, because the place of attachment of the embryo is an important factor.
It is necessary to strictly control the development of the placenta, since not only is the danger of the invasion of the placenta in the uterine wall, but also the malnutrition of the fetus through the placenta, that is, placental disorders.
The first three months of pregnancy can be characterized by complications such as the threat of spontaneous abortion, which must be treated quickly with antispasmodic drugs, hormones.
Ultrasound with such a complex pregnancy is performed more often than normal women. In the revelation of a thinning of a scar, immediate hospitalization is shown in the pathology department of pregnant women.
In the normal course of pregnancy, the patient is offered to go to the hospital after 37 weeks, all for the same evaluation of scars and the choice of the date of delivery, taking into account all the risks.
An unfavorable factor for pregnancy with three scars in the uterus is a large fetus, polyhydramnios, twins.
What to look for?
What should alert women during pregnancy? Of course, the most terrible complication is the rupture of the uterus.
But the rupture along the scar is usually carried out without bleeding, since the scar region is not as rich in blood vessels as the rest of the uterus.
In most cases, there is anxiety, pain in the abdomen, sometimes with cutting or shooter, in a particular place or in the lower part of the abdomen as a whole. It can cause nausea, vomiting, diarrhea, bleeding from the genital tract.
Basically, a child who experiences hypoxia begins to suffer, because the integrity of the uterus and the supply of oxygen through the placenta are altered. All this, of course, an indication for emergency delivery.
4th cesarean section
Given the high technical complexity, for an operation of this type, the most experienced obstetrician-gynecologist with a high level of operative equipment is involved.
This is a violation of the anatomy in the structure of the uterus, the failure of the scar in the uterus, the difficulties in sewing the wound.
Quite often, the development of pronounced varicose changes in the vessels of the uterus and neovascularities that feed the scar, which can lead to an increase in blood loss and the formation of bruises.
The postoperative period also requires very active steps to achieve good healing of both the uterus and the tissues of the anterior abdominal wall.
And in the long term after surgery, resorption and restoration therapy is required. The uterus is an important reproductive organ of a woman, not only to carry a child, but also to maintain hormonal function.
Therefore, one should not neglect careful recovery after surgery and correction of possible complications.
The long-term observation of the patient by the gynecologist after the operation and the appropriate selection of contraception are necessary to eliminate unwanted pregnancies and subsequent interventions in the postoperative uterus.