Bad scar on the uterus after caesarean. Thin scar on uterus after caesarean section

Recovery after childbirth is often difficult, even if it happened naturally. After caesarean section to various postpartum problems postoperative ones are added, the main of which is a scar on the uterus. During the operation, the abdominal cavity and the muscular organ itself are dissected. The process of tissue healing does not always proceed normally. The condition of the scar is of particular importance for women planning to conceive again after a cesarean.

What is a scar on the uterus after cesarean

A scar on the uterus is a formation that consists of fibers of the myometrium (upper muscle layer) And connective tissue. It occurs in the process of dissection of the organ, followed by the restoration of its integrity by stitching.

Today, with a caesarean section, a transverse incision is most often practiced in the lower part of the uterus. There is a minimum of blood vessels in this segment, which contributes to the speedy healing. Due to the use of modern synthetic absorbable threads, the edges of the wound are fixed for a long time, which is also important for the formation of a correct scar.

The healing of the scar on the uterus after cesarean goes through a series of stages:

1. Formation primary seam bright red color with sharp edges. At the same time, it is very painful for a woman to move (first week).
2. Thickening of the scar: it turns pale and hurts less (next three weeks).
3. The color of the scar becomes pale pink, it is almost invisible, it becomes elastic due to the production of collagen (within a year after the operation).

This is a normal course of regeneration - in this case, a scar is formed, which is called wealthy. It can contract and stretch well (which is very important during subsequent pregnancy and childbirth), since it consists of smooth muscles and a narrow layer of connective tissue. In such a scar there are vessels of large and medium size.

In medical practice, there are rare cases of complete remusculation of the uterine scar, when it cannot even be detected. Of course, this is an ideal option for the upcoming pregnancy and childbirth.

With an unfavorable outcome of healing, an inconsistent scar is formed (this often happens with a longitudinal incision). It is inelastic, unable to contract, because it consists for the most part from connective tissue (muscular is underdeveloped). The scar may have thickening and depressions (niches), swelling, blood vessels in it are intertwined in a chaotic grid. In the process of uterine growth during pregnancy, such a scar will inevitably become thinner and may even tear. And it is impossible to stop this process. Insolvent scar has certain thickness parameters - more than 1 cm or less than 3 mm.

At all, human body not very well adapted to regeneration. In response to any damage, first of all, fibroblasts react - cells that cover the defect with connective tissue instead of the original one. However, this tissue is not able to fully replace the muscle, for example, in the uterus. The cells of the myometrium (the upper muscular layer of the uterus) divide at a slower rate than fibroblasts, therefore, when cut, a scar is inevitably formed at the site of fixation of the edges.

Factors leading to scar failure

The risk of formation of a pathological suture after cesarean is increased by the following factors:

1. Emergency operation.
2. Poor adherence to aseptic and antiseptic rules during cutting and suturing. Infections also negatively affect the healing process.
3. Serious blood loss during the operation.
4. Significant trauma to the uterus, the transition of the incision into a gap (then the scar can also affect the cervix).
5. Intrauterine manipulations after caesarean section during the year (especially curettage of blood clots or abortion by this method).

Video: professor (obstetrician-gynecologist) talks about the scar after cesarean and the factors affecting its healing

Features of pregnancy and childbirth

First of all, a woman should always try to give birth on her own: after all, today many expectant mothers choose operative delivery, even if there are no direct indications for it.

After surgery, the next pregnancy can be planned only after two years. Don't drag it out too much - more four years, since the scar on the uterus will lose elasticity even more over the years.

At the planning stage, a woman needs comprehensive examination with the aim of complete diagnosis scar condition. After all, its failure can lead to various complications - the pathology of the course of pregnancy:

1. Ingrowth into the connective tissue of the chorionic villi and subsequent accretion of the placenta. If the embryo is attached directly to the scar area, then gynecologists often recommend that the woman terminate the pregnancy (usually by vacuum).
2. Spontaneous miscarriage on early term, threatened miscarriage, premature birth.
3. Incorrect location of the placenta: low, marginal or complete presentation.
4. Large blood loss during childbirth.
5. Rupture of the uterus.

Photo gallery: complications during pregnancy and childbirth associated with a scar on the uterus

A scar on the uterus often leads to an abnormal attachment of the placenta A scar on the uterus can lead to large blood loss during childbirth Due to the rupture, the fetus may completely or partially go into abdominal cavity women

Uterine rupture is the most severe complication pregnancy, which can provoke a scar. This dangerous condition is preceded by the following alarming symptoms:

1. Tension of the muscles of the uterus.
2. Arrhythmic contraction of the uterus.
3. Pain when touching the abdomen.
4. Malfunctions in the fetal heart rate (due to oxygen starvation).

Directly to the rupture of the body indicate the following signs:

1. Sharp and severe pain in the uterus.
2. Decrease in pregnancy blood pressure.
3. Vomit.
4. Stopping labor activity (if the gap occurs during childbirth).

When the uterus ruptures, a woman needs an urgent caesarean section.

Of course, many women are interested in whether natural childbirth is possible after a cesarean section if there is a scar on the uterus. This is quite realistic under several favorable circumstances (simultaneously):

1. The woman had only had one caesarean section in the past.
2. The placenta is well located - outside the scar area.
3. No concomitant diseases- Indications for caesarean section.
4. Correct head position of the fetus.

At the beginning of such natural childbirth, a woman is shown taking antispasmodics, sedatives, as well as anti-hypoxia in the fetus, improving fetoplacental blood flow. Delivery, as a rule, takes a long time, since they should be carried out very carefully, without any stimulant drugs. If the cervix opens slowly, without external intervention, then the risk of makti rupture will be minimal. Also, the condition of the fetus is constantly monitored and conditions are created for carrying out, if necessary, an emergency caesarean section.
Under certain circumstances, natural childbirth after caesarean is quite possible.

There are a number of contraindications when, if there is a scar on the uterus, natural childbirth is impossible:

1. Lengthwise cut. The probability of discrepancy in this case is quite high.
2. The woman has had two or more caesarean sections in the past.
3. In past births, there was a uterine rupture.
4. The scar is insolvent with a predominance of connective tissue.
5. A woman in labor has a narrow pelvis: stress during the passage of the fetus can provoke a rupture (especially if the fetus is large).

Video: scar on the uterus after cesarean during a subsequent pregnancy

Diagnostic methods

To date, there are a number of diagnostic methods that can determine the condition of the scar on the uterus even at the stage of pregnancy planning, which, of course, helps to reduce the percentage of unfavorable outcome of gestation:

1. Ultrasonography. It determines the thickness of the scar, the ratio of muscle and connective tissue in it, the existing niches and thickenings. Ultrasound is best done twice. The first is immediately after the end of menstruation (day 4-5 of the cycle). The endometrium is still very thin at this time, and the underlying tissue can be well assessed. The second study is carried out on the 10-14th day. If an ultrasound is diagnosed as "insolvency of the scar", then additional procedures- hysterography and MRI.
2. X-ray hysterography makes it possible to examine the relief of the scar. Introduced into the uterus special agent, which absorbs X-rays. The result is a contour drawing of the organ cavity.
3. MRI allows you to assess the consistency, elasticity of the scar, to identify the percentage of connective tissue in it.

Surgical treatment of an incompetent scar in the uterus

If a woman planning a pregnancy is diagnosed with an “incompetent scar”, this is not yet an obstacle to bearing a child. Possible surgery(plastic), the purpose of which is the excision of scar tissue with the imposition of new sutures.

There are no medical or any other schemes for eliminating an inconsistent scar on the uterus.

The operation is performed by an open method, since the uterus is located behind the other internal organs. In addition, this allows you to assess the degree of bleeding, and it is inevitable during surgery, especially since the uterus has a very good blood circulation. During the operation, the surgeon excises all the connective tissue, and then stitches the muscles in layers.

As for the laparoscopy method, it is difficult to control the amount of blood lost with its help, it is difficult to sew the walls of the uterus. However, such operations are practiced at the Moscow Center for Clinical and Experimental Surgery (their developer is Konstantin Puchkov, Dr. medical sciences, professor, director of this center). Moreover, during one operation it is possible not only to correct the scar, but also, for example, to remove uterine myoma. The advantage of the method is minimal tissue damage, the absence of a scar on the woman's skin and fast rehabilitation.
Laparoscopic method minimal tissue damage

Therapy after surgery includes taking antibacterial and hormonal drugs. In the first days after surgery, body temperature may rise, a woman often feels pain in the uterus. Small bleeding from the genital tract lasting 6-12 days is normal.

If the operation was open, then the patient can wash only after removing the external sutures. While in the hospital, the seam is treated with an antiseptic solution.

Ultrasound is mandatory before discharge from the hospital: it allows you to evaluate the healing process. The procedure will be carried out further at certain time intervals.

Within two years after plastic surgery a new wealthy scar should form, and the woman will be able to safely endure and give birth to a baby. It is better to coordinate pregnancy planning with the attending physician, who will confirm the good quality of the scar.

Incompetent scar on the uterus

Currently, the number of caesarean sections is steadily increasing, which in turn increases the percentage postoperative complications. One of these complications is formation of an inconsistent scar on the uterus. Most often, when signs of insolvency of the scar on the uterus after cesarean section are detected, the patient is advised to abandon the planning of subsequent pregnancies in order to avoid a number of formidable obstetric complications.

In a situation where the uterine scar is incompletely formed, laparoscopic reconstructive metroplasty (excision of pathological tissues in the scar zone with the formation of a new full-fledged suture) can be considered the only effective method solution of the problem, which allows to restore the reproductive potential in this group of patients.

"Manual suture in endoscopic surgery", K. V. Puchkov, D. S. Rodichenko

Patent. Method of laparoscopic myomectomy

Among the risk factors for the formation of an incompetent scar on the uterus, the development of postpartum endometritis (85%) and performing a caesarean section emergency indications (15%).

Diagnosis of an incompetent scar on the uterus is carried out with transvaginal ultrasound examination pelvic organs, hydrosonography and hysteroscopy. In the majority of patients (70%), the presence of a niche in the scar zone is determined; in 30%, the thickness of the myometrium is from 1.5 to 2.5 mm. Also, in the scar zone, an endometrioid infiltrate can be determined, which requires prompt removal.

To determine the depth of the lesion and the length of the incompetent scar, as well as the choice of the right tactics surgical treatment must be sent to my personal e-mail address [email protected] [email protected] copy Full description Ultrasound of the pelvic organs, if possible, MRI of the small pelvis and hysteroscopy data, indicate the age and main complaints. Then I can give a more accurate answer for your situation.

Treatment of an incompetent scar on the uterus

To correct an inferior scar on the uterus, women are offered an open (laparotomic) operation. This is due to the location of the modified scar in an area under the bladder that is “uncomfortable” for the surgeon. Excision of the scar in this area is accompanied by severe bleeding due to the good blood supply to this area of ​​the uterus. This complication often leads to blood transfusion during surgery.

For this reason, laparoscopic correction of a pathologically altered scar often takes place with more blood loss than open surgery, lasts longer and is associated with quite high risk conversions - switching to open operation. Such difficult conditions with laparoscopy, the surgeon forms a less reliable suture on the wall of the uterus than with open surgery.

I have been actively looking for ways to resolve this issue. As a result of 10 years of work, I have developed author's technique of laparoscopic surgery for the correction of insolvency of the scar on the uterus (metroplasty) which allows, in our opinion, to successfully solve all the problems described above. At the same time, an operation to excise pathological tissues in the scar zone with the formation of a new full-fledged suture is performed by laparoscopic access without blood loss, with reliable stitching of the uterine wall, and the absence of adhesions in the pelvic area, which is very important for maintaining the patient's ability to conceive independently, the course of pregnancy and subsequent births.

The advantages of laparoscopic reconstructive metroplasty are obvious:

• reduction of the invasiveness of the operation - instead of an incision in the anterior abdominal wall- 3 punctures 5-10 mm;
• cosmetic effect;
• reduced risk of adhesion formation;
• fast recovery.

The essence of the method is as follows:

At the first stage, I perform laparoscopy and, after isolating the uterine vessels, temporarily block the blood flow in them with soft vascular atraumatic clamps (RF Patent for Invention No. 2407467).

After opening the vesicouterine fold of the peritoneum and bringing down the urinary tract, using a monopolar electrode of the "needle" type, I excise pathologically altered scar tissue. To do this, I use the device for dosed electrothermal tissue ligation "LigaSure" (USA). This stage is performed under the control of hysteroscopy. The surgical field in such conditions is absolutely “dry”, I can clearly see the border of the pathological scar and healthy tissue, as well as all layers of the uterine wall.

If, in addition to the failed scar, I have other diseases, can they be cured during one operation?

The answer to this question is: yes, but the terms need to be clarified. Several operations can be performed, sometimes by three or four or even five surgeons, but there will be one general anesthesia, and you will be hospitalized in the clinic only once. Operations of this kind that are performed simultaneously are called simultaneous operations.

In many patients, an incompetent scar on the uterus is combined with other gynecological (myoma, endometriosis, etc.) and non-gynecological diseases that require surgical treatment. For example, nodal changes in thyroid gland, hernia esophageal opening diaphragms, nodes in the mammary glands, hernia, hemorrhoids, varicose disease veins of the legs and a number of others. The techniques of minimally invasive surgery that I use make it possible to perform two, and sometimes three operations at the same time during one anesthesia by a team of several surgeons.

Is it possible to communicate with your patients who have already been operated on if I have not yet made a decision?

Hello dear women! My name is Elena. I am 38 years old. I have two children (18 years old and 13 years old). Two sons. I prayed for a very, very long time, persuading my husband (as long as my age allows, strength, etc.) to decide on a third pregnancy, because I really want a daughter. But if a son is also a great joy ... And now - the husband gave the go-ahead. After that I took a closer look. Has received ok doctors and has become pregnant. I am currently 9 weeks pregnant. The first two pregnancies ended...

Discussion

Hello. I gave birth to a third child and three cops. Between the second and third daughter the difference is exactly 2 years. Before that, the 2nd CS went well. But I won’t forget the 3rd one. Because they did an anesthetic in the spine. And after it it was very hard to go.

I am a mother of two cesareans, for me the second pregnancy was a risk. I don't understand this "Mother heroine" trend. Why this risk? Why the third child after 2 ks? You are putting at risk not only the future baby, but also yourself. Think about older children for a moment. Will they be happy with their mother, an invalid or orphan? I don't understand this selfishness. I'm happy for large families but not at this price! What about anesthesia? After the second leg, my right leg was taken away! And after the first one, my toes went numb! The neurologist said that they hurt ganglion. What about post-operative period? Everything hurts, the seam pulls, you can’t really take care of yourself, next to a newborn and an older child! It's better to pay attention to the elders, and not beat your heel in the chest, shouting to everyone that you are cool after 3 ks!

In order for the scar on the uterus to turn out to be full-fledged, it is necessary to withstand the time after a cesarean section, CME or perforation of the uterus. The optimal rest period is at least 2 years. In order to avoid curettage of the uterus in the postoperative period, protection is mandatory; it can be both hormonal contraception and mechanical (a condom in combination with spermicides). Early application intrauterine contraception(spiral) not welcome....

Hello! No one knows a normal scar on the uterus by the end of pregnancy, how much is it? Or where does the insolvent begin? Has anyone had pain in the area of ​​the scar? How can this manifest itself? Sorry for another cockroach...

Therefore, it is better to think about a brother or sister for your first child after this time. Obstetricians have not yet come to a consensus on the possibility of spontaneous childbirth in patients who have undergone a previous caesarean section and have a scar on the uterus. As a rule, a scar on the uterus is in itself an indication for a second caesarean section. But sometimes there are exceptions. In any case, if you would like to give birth on your own, this problem is solved individually, depending on your state of health, on the condition of the scar (it is assessed according to ultrasound), on the course postoperative period and many other circumstances. Elena Nesyaeva Obstetrician-gynecologist, obstetrics clinic...

Discussion

I had a caesarean section in October of this year. This is my second birth, the first also ended in a caesarean (facial presentation). But with the second could not be determined. According to all indications, she should have been herself, she was waiting for the term, they put her in the maternity hospital in advance, for observation. For three days I waited for a doctor's examination, for some reason he avoided me. When, nevertheless, he examined it, he said that it was a caesarean section. When I asked "why?" no one answered. All ultrasounds were good, according to the last one the child was lying head down. When I came to my senses after the operation, I was in shock. I was slaughtered like a pig. The first cesarean - a seam of 6 cm, and a child of 3650 g; the second - the seam is 10 cm, and the child is 3150 g. Again, no one answered the questions! At discharge, the stitches were removed, they pulled so that the threads with pieces of skin were pulled out, the bandage was in the blood. And in the conclusion they wrote "facial presentation" although this was not even close. And one more thing: on the second day, none of the nurses and doctors came to me. There was a payroll. The child was left with me from birth. And no one cares that I'm a cesarean. With pain and tears, I crawled out of bed, bent almost in half, with a child in my arms, who did not cry, but yelled, crawled into the corridor to call the nurse ... It was terrible !!! Now you understand that if there are no connections, even money will not help.

Hello to all moms! Today my daughter is a year old! Time flies!!! My birth was by CS. Hardly anyone had such an "interesting" pregnancy as I did. Looks like I stood out alone in all of Russia. And the fact is that during pregnancy (more precisely, the 5th month flowed then), I had an accident. I will say for sure that it is contraindicated for pregnant women to drive long distances. I got distracted, a bump, rain, turn, the speed went off scale and ... a ditch, a pine, as a result, a hospital. She broke her spine, and even with a displacement, a liver injury. Thank God, the baby in her tummy is alive and well (she had a little increased heart rate, apparently due to my excitement). Then, motionless lying for 4 months. The daughter was ill, despite the requests of doctors and relatives to get rid of the child and undergo an operation to restore the spine. All the while lying down, she did not lose optimism and faith in herself and the baby. At the 9th month, I learned to walk for two weeks and ... got up !!! Then the hospital, cesarean. Now, as usual, in a day I’ll sit down for half an hour at most! And my daughter is active, you see, she lay for 4 months in my stomach))) And during all this time I thought about a happy future! A happy future is healthy children and a mother on her feet and a family in general! Give birth, do not despair in any situation! The main thing is to believe that everything will be fine! And follow your heart! By the way, now (a year after birth) we are trying to conceive a second child ...
Moms!!! Take care of yourself and your kids!!!

Girls, tell me, has anyone done this procedure? Is it so that it is carried out only during full-term pregnancy, this week at 38, when the scar is stretched on the head and its condition can be assessed? Yes, and is it a common procedure like fetal ultrasound or is it something more complicated and you need to look for a very professional specialist?

And here is another article that Sabina cited: GYNECOLOGY GYNECOLOGY ULTRASONIC ULTRASONIC EXAMINATION OF THE LOWER SEGMENT TO ASSESS THE RISK OF UTERINE RUPTURE IN THE PRESENCE OF SCARS K. Suvorova K. Suvorova evidence that independent childbirth safer than repeat caesarean section. P. Rozenberg et al. link the risk of uterine injury during...

A scar on the uterus is a special formation, consisting of myometrial fibers and connective tissue, and located where the violation and further restoration of the integrity of the uterine wall during surgical intervention was performed. The planning and course of pregnancy with a scar on the uterus is somewhat different from a normal pregnancy.

The causes of a scar on the uterus are not limited to caesarean section. The integrity of the walls of the uterus can be broken during other operations: removal of fibroids, perforation of the uterine wall during curettage, rupture of the uterus during hyperstimulation of labor, various plastic recovery operations(removal of the uterine horn, removal of a tubal or cervical pregnancy along with a section of the uterine cavity).

Varieties of the scar

Of considerable importance is how the incision was made during caesarean section. A longitudinal incision, which is usually made for an emergency caesarean section, is more prone to leakage than a transverse incision in the lower uterus.

Planning a pregnancy with a scar on the uterus

Between the operation, due to which a scar was formed on the uterus, and pregnancy, doctors recommend maintaining a gap of two years - so much time is needed for the formation of a good scar. At the same time, too long a break is undesirable - longer than four years, since even very good scar may lose elasticity over the years due to atrophy muscle fibers. The transverse scar is less prone to such negative changes.

Scar assessment

You can assess the condition of the scar before planning using ultrasound, X-ray, hysteroscopy or MRI. Each method is valuable in its own way.

Pregnancy with a scar on the uterus

1. It is necessary to know that uterine scar during pregnancy can cause an incorrect location of the placenta: low, marginal or complete.
2. Possibly abnormal placental accreta varying degrees: to the basal layer, muscle, ingrowth into the muscle layer or complete germination up to the outer layer.
3. In the event that the embryo is attached to the scar area, doctors put unfavorable forecasts- the probability of termination of pregnancy is greatly increased.
4. During pregnancy, changes in the scar are most often monitored using ultrasound. At the slightest doubt, doctors recommend hospitalization and observation in a hospital until delivery.

Most dangerous complication there may be a rupture of the uterus at the site of the scar as a result of its thinning and overstretching. precede it most dangerous condition may characteristic symptoms, indicating the beginning of the divergence of the scar:

• Tension of the uterus.
• Sharp pain from touching the stomach.
• Strong arrhythmic uterine contractions.
• Bloody vaginal discharge.
• Violation of the fetal heartbeat.

After the gap is completed, the following are added:

• Very severe pain in a stomach.
• A sharp drop in blood pressure.
• Nausea and vomiting.
• Termination of fights.

The consequence of scar rupture can be acute oxygen starvation fetus, hemorrhagic shock mother in connection with internal bleeding, death of the fetus, removal of the uterus.

With a diagnosed rupture of the uterus along the scar, an emergency caesarean section is required to save the life of the mother and child.

Many people are concerned about whether natural childbirth with a scar on the uterus. If certain requirements are met, such births may be allowed: a single caesarean section in the past with a transverse incision, presumably a wealthy scar, normal placement of the placenta behind the scar area, the absence of any concomitant diseases or obstetric pathology, the head position of the fetus, the absence of a factor that caused the previous caesarean section. It is also important to monitor the condition of the fetus and the availability of all conditions for an emergency caesarean section in the event of critical situation in close proximity to the delivery room.

Contraindications to natural childbirth with a scar on the uterus are: cesarean section with a longitudinal incision on the uterus in history, narrow pelvis, placenta at the site of the scar, placenta previa, several scars on the uterus