Divergence of internal seams after cesarean. What to pay attention to

modern medicine today helps many women give birth to a child, and babies will be born. The fact is that there are situations, planned or urgent, that require surgical intervention in the process of childbirth. However, a caesarean section is a complete operation, so a serious drawback is the formation of a scar on the uterus. Indeed, in the process of childbirth, the doctor makes an incision not only in the abdominal cavity, but also in the reproductive organ of the woman in order to extract the fetus. As women's health is restored after the birth of a baby, doctors must monitor the formation of a scar and the healing of the suture. Rupture of the tissues of the reproductive organ can lead to a risk to the life of a young mother, so it is necessary to carefully monitor the health of a woman after a CS.

Scars on the uterus after cesarean section: types and features

The caesarean section has long been used in gynecology as a way to help a baby come into the world. In many cases, only thanks to surgical intervention, doctors save the life of not only the baby, but also the mother. After all, childbirth is a complex and unpredictable process, when at any time you may need emergency assistance and a quick extraction of the fetus.

CS is assigned to many expectant mothers as a planned operation. This occurs in situations where a woman has absolute contraindications to vaginal delivery or the fetus is located in the uterus not in the head presentation.

Doctors do not deny that after surgical delivery there is a risk of complications, as after any abdominal surgery. However, if we compare saving the life of a woman in labor and a baby, then postoperative consequences relegated to the background. In most cases, the recovery of the body goes well and quickly, and the young mother is happy to devote her time to caring for the baby.

Recently, more and more expectant mothers have been asking doctors on their own to be prescribed a CS, although they have no indications for delivery by surgical intervention. It's just that women don't want to experience pain during labor and natural childbirth. However, doctors warn that natural childbirth is much preferable for the health of the mother and baby, so if there is a chance to give birth to a baby on your own, you should not refuse it.

During an operative delivery, doctors use different techniques. First of all, this concerns the type of incision of the skin of the abdominal cavity and the tissues of the wall of the reproductive organ, through which the baby is removed. The type of incision largely determines the rate of recovery of the body after CS, as well as the possibility for a woman to give birth to another baby on her own or she will again have to undergo surgical delivery.

Longitudinal (corporal) scar

The vertical incision is considered classic: it was performed earlier during the CS operation. Modern doctors try to avoid a longitudinal incision of the uterus and abdominal cavity. Today, this type of incision is made only when minutes are counted and it is urgent to remove the fetus from the body of the woman in labor. It is the corporal incision that gives good access to the organs, so the surgeon can act quickly, which is very important during emergency delivery by surgical intervention.

The longitudinal incision on the abdominal wall is about fifteen centimeters long, and in the area of ​​the uterus, the doctor performs a vertical dissection throughout the body of the reproductive organ.

Doctors also distinguish some situations when, during surgical delivery, a woman in labor is made only a classic incision on the uterus:

• inability to access the lower uterine segment, the presence of adhesions or varicose veins veins in this area of ​​the reproductive organ;
• insolvency of the vertical scar that remained on the uterus after previous births;
• the fetus is in a transverse position;
• doctors need to save the baby first, because. the woman in labor dies and her life cannot be saved;
• after removing the baby, doctors need to remove the uterus.

Obstetrician-gynecologists distinguish negative sides corporal scar on the uterus:

• severe blood loss during surgery;
• the possibility of uterine bleeding in the first few days after CS;
• longer recovery period: the wound heals longer;
• the likelihood of scar divergence during subsequent pregnancies.

transverse scar

If the CS operation was planned in advance, then during the surgical intervention, the doctor makes a transverse incision in the suprapubic region. Then, in the lower part of the uterus, which does not have the ability to contract, the specialist makes the same horizontal incision through which the fetus is removed.

For a young mother, a transverse scar is more preferable. The fact is that with such a cut, the doctor has the opportunity to make a cosmetic seam with special threads. As the suture heals, it becomes less and less noticeable and aesthetically looks beautiful, which is important for women.

Modern specialists prefer to perform exactly a horizontal incision on the body of the reproductive organ, because. it has a large number of pros:

• during the surgical intervention, the woman in labor loses less blood than with a classic cut;
• the body returns to normal faster: the seam heals faster, which accelerates the formation of a scar on the uterus;
• the risk of developing inflammatory processes is reduced;
• the formed scar is stronger and more durable than with a longitudinal incision, therefore less risk that it will disperse during a subsequent pregnancy.

The only disadvantage of this type of incision is less access during the CS. That is why in emergency cases, when the life of a child and mother directly depends on the speed of the doctor’s actions, a transverse incision is not made, but preference is given to classic version so that you can quickly remove the baby and suture the wound.

When not to worry: the norm of the thickness of the scar on the wall of the uterus after cesarean section

Scar after caesarean section reproductive organ women is formed four months after the surgical intervention. However, doctors do not recommend planning next pregnancy earlier than two years after birth. That is how long it takes for the seam to completely heal and heal.

Today, gynecologists insist that the ideal time to conceive is thirty-six months. During this period of time, a strong, not thinned scar should form at the site of the seam. In order not to risk your health and the life of the unborn baby, it is better to maintain the necessary pause between the COP and the next pregnancy.

A young mother should not forget about planned visits to female doctor. The fact is that the excellent and rapid healing of the skin of the abdominal cavity does not guarantee that the tissues of the uterus are also well restored, and the suture does not cause concern. Therefore, upon discharge from maternity hospital obstetrician-gynecologists necessarily conduct a conversation with a woman in which they mention that two, six and twelve months after a cesarean section, she must sign up for an examination at a antenatal clinic.

It is very important that before the couple begins to plan the conception, they should also see a doctor who will assess the condition of the suture and give recommendations: is it a favorable time for pregnancy or is it worth waiting a little longer.

First of all, the gynecologist will assess the thickness of the suture using ultrasound. Normally, it should be 5 mm. Some women are frightened when during pregnancy, as the fetus grows, the seam becomes thinner. This is normal phenomenon: after all, the uterus is stretched, so it is considered a variant of the norm if by the thirty-fifth week the thickness of the seam is 3.5 mm. The gynecologist also determines the structure of the scar. Ideally, the seam should be muscle tissue: it is very elastic, therefore, with an increase in the uterus, it stretches perfectly and this reduces the risk of scar divergence. But the body of each woman is individual, therefore, in some young mothers, connective tissue may predominate in the scar area: it breaks much more often, because. simply can not withstand the load as the fetus grows.

What is an inconsistent scar

Unfortunately, the suture on the uterus is not always scarred as doctors and the youngest mother would like. There are situations when, based on the results of the examination, a woman finds out that the scar on the uterus is insolvent - an incorrectly formed scar tissue in the area of ​​​​the incision on the wall of the woman's reproductive organ. Gynecologists identify factors that signal the insolvency of the scar on the uterus:

• the thickness of the seam is 1 mm;
• seam consists of connective tissue or from mixed, but very little muscle;
• in the area of ​​the scar there are non-united areas, irregularities. This increases the risk of rupture of the uterine wall during stretching of the organ.

Scar failure is a serious pathology that requires timely diagnosis and treatment. Couples should be aware that in this case, planning a pregnancy is strictly prohibited. Gynecologists explain that the causes of this pathology can be different:

• an emergency caesarean section, when a vertical incision was made in the uterus during the operation. In this case, the seam heals worse and slower, the scar may form poorly;
• development of postoperative endometritis - an inflammatory process of the inner layer of the surface of the reproductive organ;
• infection in the suture area or inside the uterus;
• too much early pregnancy. The fact is that the scar has not yet fully formed, therefore, with an increase in the uterus, the seam quickly becomes thinner;
• termination of pregnancy after CS. In case of conception two to four months after the operation, the woman is prescribed an abortion for medical reasons. Also, not all young parents are ready to give birth to children with such a small age difference. During the procedure, the inner layer of the uterus is scraped, which negatively affects the thickness of the scar.

The whole danger of the situation: the consequences of the insolvency of the scar

It should be understood that doctors do not just strongly recommend carefully planning the next pregnancy if the previous birth ended with an operation. The fact is that main danger scar failure - rupture of the uterus during the period of bearing a baby. As the fetus grows, the uterus also grows. It does this by stretching the muscle tissue. But if the seam is thin and consists of connective tissue, it cannot withstand the load and it diverges. The consequences of this are very dangerous:

• severe bleeding in a pregnant woman;
• fetal death;
• death of the expectant mother from extensive blood loss.

Video: what an inconsistent scar looks like on ultrasound

Symptoms of the divergence of the seam on the uterus

Before discharge from the maternity hospital, a young mother is given a list of recommendations that she must follow in order to avoid the occurrence of postoperative complications. Of course, with the return home, most of the care of the baby will pass to the mother, but it is worth considering own health and for at least two months after giving birth, provide yourself with help in the person of a husband, grandmother or nanny.

Some young mothers think that the rupture of the seam can only occur during the next pregnancy. However, if the recommendations of the gynecologist are not followed, the suture may break even in the first weeks after delivery with the help of a CS.

If during the period of bearing a baby, the divergence of the scar occurs due to excessive tension of the tissues of the reproductive organ, then during recovery period after surgery, the cause of the rupture of the seam is most often excessive physical activity: lifting weights, for example, a baby stroller, carrying a baby for a long time, etc. A young mother should be alert and urgently call an ambulance with the following symptoms:

• strong pain in the abdomen. If a woman touches the seam, then she experiences a sharp pain;
• the muscles of the uterus are constantly tense. This is especially noticeable during gestation: the reproductive organ is constantly in good shape;
• a young mother feels frequent uterine contractions;
• the appearance of bloody discharge from the vagina, which is not associated with menstruation.

If the scar has already ruptured, the woman's condition will worsen dramatically and will be accompanied by:

• sharp incessant pain in the lower abdomen, which cannot be tolerated;
• severe vomiting;
• downgrade blood pressure. This is due to blood loss;
• loss of consciousness.

In this case, it is necessary to take the woman to the hospital as soon as possible. Delay and loss of time can cost the life of a young mother.

Treatment of the divergence of the scar on the uterus

Before making a decision and making a diagnosis, a woman undergoes an ultrasound scan. During the examination, the doctor can confidently say in what condition the suture is after the CS. If there is a discrepancy between the tissues of the scar on the uterus, urgent surgical intervention is necessary. An abdominal operation will be required so that doctors can assess the extent of the rupture, stop the bleeding, and reseat the suture.

Today, some clinics perform suturing of the scar on the reproductive organ laparoscopic method. However, most often, an open operation is necessary: ​​an incision in the abdominal wall and subsequent suturing of the uterine wall.

If a woman has lost a large amount of blood, she may need a transfusion. After the operation, the young mother is left in the intensive care unit for several days under the constant supervision of doctors. Further treatment includes the use of antibiotics. In some cases, it is also necessary hormone therapy. The treatment regimen in the rehabilitation period is developed by the doctor depending on the patient's condition, the presence or absence of postoperative complications.

After discharge, the woman must come to scheduled checkups to the gynecologist. At each appointment, the doctor will definitely conduct an ultrasound scan to monitor the healing of the scar on the uterus.

Scar discrepancy prevention

To protect yourself from such a complication as a scar rupture after a cesarean section, you must follow all the doctor's recommendations:

• for at least two months after the operation is strictly prohibited physical exercise. Many new mothers strive to get in shape after pregnancy and childbirth. However, it should be remembered that sports exercises can be performed no earlier than six months after CS;
• do not miss scheduled examinations at the gynecologist. The doctor should be visited eight weeks after the operation, then after six and twelve months;
• do not plan a subsequent pregnancy earlier than twenty-four months after birth. Ideally, one should wait three years before becoming pregnant;
• at the slightest symptoms: the appearance of pain, spotting, do not delay a visit to the doctor.

A caesarean section is a full-fledged operation, after which a scar remains on the reproductive organ. As it heals, it forms, heals, but does not disappear. In some cases, there is a risk of scar divergence. Most often this happens during the next pregnancy, when the fetus grows inside the uterus, the walls of the organ are stretched and the seam does not withstand. To protect herself and the unborn baby, a woman should not miss examinations at the gynecologist, pass on time ultrasound procedure and additional examinations if needed.

Pregnancy is an important and responsible period in the life of every woman. Unfortunately, at this time, health problems are by no means uncommon. And in some cases, the doctor recommends the patient a special procedure during which a suture is applied. On the cervix during pregnancy, stitches are needed in order to prevent miscarriage or premature birth.

On the other hand, surgery during childbearing scares women. So in what cases is it assigned similar procedure? What risks does it involve? What is the surgical technique and how does it work? rehabilitation period? The answers to these questions are of interest to many patients.

Cervical suturing during pregnancy: why is it needed?

Uterus - important organ reproductive system. This is where the implantation of the fertilized egg takes place. further development embryo. Normally, the cervix begins to slowly open, starting from the 36th week. But in some patients, the opening occurs in the early stages.

This is fraught with extremely dangerous consequences for the child, because the growing organism may still not be viable. Miscarriage or premature birth are consequences that an expectant mother may face. It is in such situations that doctors prescribe suturing the cervix during pregnancy - such a procedure can save the child's life.

The main indications for the procedure

Of course, there are situations when the seams on the neck are simply necessary. The indications for the procedure are as follows:

• Isthmic-cervical insufficiency is a pathology that is accompanied by expansion or shortening cervical canal cervix. A similar phenomenon develops with anatomical defects of the cervix, which in turn can be associated with mechanical damage, previous inflammatory diseases, cancer, etc.
• Hormonal failures, because it is hormones that control the condition of the walls of the reproductive organ. A change in the amount of certain hormones in the blood can cause relaxation or contraction of the muscles of the uterus, early opening of the cervix.
• If the patient's history contains information about previous miscarriages or premature births, then the doctor will most likely closely monitor the patient's state of health and, if necessary, prescribe surgical intervention.

A suture on the cervix during pregnancy can provide normal development child. However, only an experienced obstetrician-gynecologist is able to decide on the procedure.

What kind of preparation does the suture require?

Suturing the cervix during pregnancy is not a very complicated procedure. However, the doctor may decide to perform surgery only after the delivery of all necessary analyzes and tests.

Starting from the 12th week of pregnancy, women are sent for an ultrasound examination, during which a specialist can determine the early opening of the uterus. To confirm the diagnosis, ultrasound may be repeated. Naturally, as before any other operation, it is necessary to take blood and urine tests, check the level of hormones in the blood of a pregnant woman and conduct other tests. The day before the operation, the vagina is sanitized.

Features of surgery

Naturally, patients are interested in questions about how exactly the surgical intervention takes place. In fact, this is not such a complicated procedure, and it lasts no more than 15-20 minutes. Suturing is done under general anesthesia. To strengthen the uterus, as a rule, strong nylon threads are used.

The doctor may suture the outer or inner edges of the pharynx. Tissues are usually accessed through the vagina, but in some cases a laparoscopic procedure (through small incisions in the abdominal wall) is required. The number of stitches depends on how much the neck has opened.

When are stitches removed?

Already stitched on the cervix during pregnancy helps to keep the fetus inside the womb. As a rule, they are removed at the 37th week. Naturally, before that, a woman undergoes an examination and an ultrasound examination, during which it is possible to find out whether the child is developed enough to be born.

The removal of the suture material is carried out without anesthesia - this procedure may not be very pleasant, but painless and fast. In most cases, birth occurs on the same day. But even if there are no contractions, the woman should be in a hospital.

It is worth saying that in some (rare) cases, a suture on the cervix during pregnancy, alas, cannot prevent an early birth process. Then the stitches are removed on an emergency basis. If the procedure is not carried out on time, then the suture threads can severely damage the pharynx, complicate childbirth and create problems in the future (if the woman wants another child).

Postoperative period: rules and precautions

Stitches on the cervix during pregnancy provide the baby with normal intrauterine development. However, the success of the procedure largely depends on how the rehabilitation period goes. The first 3-7 days after the operation, the woman spends in a hospital, under the constant supervision of doctors. She is given a strict reception antibacterial agents(as a prophylaxis of inflammation) and antispasmodics (prevent contraction of the walls of the uterus). In addition, the sutures are regularly washed with antiseptic solutions.

In the first few days, patients feel mild pain in the lower abdomen. Perhaps the appearance of discharge from the vagina in the form of an ichor, with blood impurities. Similar phenomena are considered normal and go away on their own. Gradually, the woman returns to her usual way of life.

There are some requirements that should be observed until the end of pregnancy. In particular, the expectant mother should not lift weights, engage in physical labor overstress (physically or emotionally). Sex life is also contraindicated. It is important for a woman and a child to rest and healthy sleep. Proper nutrition (it will help prevent constipation) and walks in the fresh air will positively affect your health.

Seam on the cervix during pregnancy: complications

Like any surgery, suturing comes with some risks. The procedure can cause some complications, in particular the inflammatory process. Such a pathology may different reasons- sometimes pathogenic microorganisms penetrate into tissues during the procedure, sometimes already during rehabilitation. In addition, it is possible to develop an allergic inflammatory response in contact with tissue suture material. These complications are usually accompanied by the appearance of uncharacteristic vaginal discharge, pain in the lower abdomen, and fever.

The cervix after suturing during pregnancy can become hyperactive. Due to hypertonicity, women feel pulling, cramping pains in the lower abdomen. As a rule, the patient's condition can be returned to normal with the help of special drugs and bed rest.

Do not forget that premature opening of the uterus is a consequence, and not an independent problem. It is necessary to conduct a thorough diagnosis, find out what exactly caused the pathology, and eliminate primary cause. For example, in case of hormonal disorders, the patient is prescribed special hormonal drugs. chronic inflammation also requires some therapy.

Contraindications for the procedure

It is worth noting that this procedure may not be carried out in every case. A suture on the cervix during pregnancy is contraindicated in the following cases:

• The presence of a sluggish inflammatory process in the organs of the reproductive system.
• Increased excitability of the uterus (meaning cases when it cannot be eliminated with medication).
• Bleeding.
• Violation of blood clotting, as massive blood loss is possible.
• heavy chronic diseases including damage to the kidneys, heart, or liver.
• Frozen pregnancy, death of a child in the womb.
• The presence of certain anomalies in the development of the child (if it is confirmed with the help of diagnostic procedures and analyses).
• Suturing has a time limit - the intervention is not performed after the 25th week of pregnancy.

It is worth saying that if for some reason the surgical procedure is impossible (for example, if the problem was diagnosed too late), then a special pessary made of durable plastic is applied to the uterus. It not only keeps the cervix closed, but also partially relieves the load on the uterine walls. In addition, the patient is recommended strict bed rest.

A histologically altered area of ​​the uterine wall, formed after its damage during surgical and diagnostic interventions or injuries. In non-pregnant women, it is not clinically manifested. During gestation and childbirth, it can be complicated by a rupture with the corresponding symptoms. To assess the condition of scar tissue, hysterography, hysteroscopy, ultrasound are used. pelvic organs. With a threatening rupture, methods of dynamic monitoring of the fetus are recommended (CTG, dopplerography of the uteroplacental blood flow, ultrasound of the fetus). Pathology is not subject to treatment, but is one of the key factors influencing the choice of natural or operative delivery.

Complications

Cicatricial change in the uterine wall causes anomalies in the location and attachment of the placenta - its low location, presentation, tight attachment, increment, ingrowth and germination. In such pregnant women, signs of fetoplacental insufficiency and fetal hypoxia are more often observed. With a significant size of the scar and its localization in the isthmic-corporal department, the threat of placental abruption, spontaneous abortion and premature birth increases. The most serious threat to pregnant women with cicatricial changes in the uterine wall is uterine rupture during childbirth. Such pathological condition often accompanied by massive internal hemorrhage, DIC, hypovolemic shock and, in the vast majority of cases, antenatal fetal death.

Diagnostics

The key task of the diagnostic stage in patients with a suspected uterine scar is to assess its consistency. Most informative methods examinations in this case are considered:

• Hysterography. The failure of the scar tissue is evidenced by the changed position of the uterus in the pelvic cavity (usually with its significant forward displacement), filling defects, thinning and serration of the contours inner surface on the site of a possible scar.
• Hysteroscopy. In the area of ​​scarring, retraction may be noted, indicating thinning of the myometrium, thickening and whitish coloring in the presence of a large array of connective tissue.
• Gynecological ultrasound. The connective tissue scar has an uneven or intermittent contour, the myometrium is usually thinned. There are many hyperechoic inclusions in the uterine wall.

The data obtained during the research is taken into account when planning the next pregnancy and developing a plan for its management. From the end of the 2nd trimester, such pregnant women perform an ultrasound of the scar on the uterus every 7-10 days. Recommended ultrasound of the fetus, dopplerography of placental blood flow. If a threatening rupture along the scar during childbirth is suspected, the shape of the uterus and its contractile activity are assessed using an external obstetric study. During the ultrasound, the condition of the scar tissue is determined, areas of thinning of the myometrium or its defects are identified. Doppler ultrasound and cardiotocography are used to monitor the fetus. Differential diagnosis is carried out with threatened abortion, premature birth, renal colic, acute appendicitis. In doubtful cases, an examination by a urologist and a surgeon is recommended.

Treatment of a scar on the uterus

Currently, there are no specific methods for the treatment of cicatricial changes in the uterus. Obstetric tactics and the preferred method of delivery are determined by the state of the scar zone, the characteristics of the course of the gestational period and childbirth. If it was determined by echocardiography that fertilized egg attached to the wall of the uterus in the area postoperative scar, a woman is recommended to terminate the pregnancy with a vacuum aspirator. If the patient refuses to have an abortion, regular monitoring of the condition of the uterus and the developing fetus is ensured.

Forecast and prevention

Choosing the Right obstetric tactics and dynamic monitoring of a pregnant woman minimizes the likelihood of complications during pregnancy and during childbirth. It is important for a woman who has undergone a caesarean section or gynecological surgical interventions to plan pregnancy no earlier than 2 years after surgery, and when it occurs, regularly visit an obstetrician-gynecologist and follow his recommendations. To prevent re-rupture, it is necessary to ensure a competent examination of the patient and constant monitoring of the scar, to choose the best method of delivery, taking into account possible indications and contraindications.

Significant changes after childbirth occur in the entire reproductive system of the mother, and most of all in the uterus. After the baby is born female body for a long time to return to normal. In the first postpartum weeks, the uterus resembles a huge stretched muscular sac. Gradually, all internal mechanisms and organs are restored. But it should be understood that this process can continue for several months and even a year or two. Therefore, proper care, daily hygiene, the control of an obstetrician-gynecologist and an optimistic attitude should become your daily rule.

It is not always possible for a woman to give birth to a child. naturally. Today, the number of women in labor who gave birth to a baby by caesarean section is increasing. This operation is no longer complicated, the surgical intervention can be carried out with the help of both full and partial anesthesia. But after caesarean woman you will have to be patient, because the restoration of her body, especially the uterus, will take more than one week.

Condition of the uterus in the postpartum period

Immediately after childbirth, the uterus of every woman is enlarged in volume, stretched in size and resembles a continuous bleeding wound. Its bottom is approximately 4-5 cm below the navel, and the diameter is 10-12 cm. Gradually uterine contractions contribute to its reduction and healing of the inner surface.

Both after and after caesarean section, contractions of the cervix are very weak and intensify until the end postpartum period. However, in a woman who has undergone surgery, the uterus recovers more slowly, its weight decreases gradually. For some time, slight postpartum spotting is observed from the uterus, which are scientifically called lochia.

The postpartum period after caesarean section lasts up to 60 days. Why is the uterus not in a hurry to contract? After the operation, the integrity is broken muscle fibers uterus, its vessels and nerve endings. That is why the rate of contraction, or involution (this is what doctors call this process), slows down. If necessary, the woman is assigned a special drug therapy. Medicines should stimulate the contractile activity of the muscles of the uterus, as well as reduce bleeding from vessels damaged during incision.

The uterus contracts slowly, so the woman does not recover very quickly. This may cause the mother and child to be discharged from the hospital a little later after a caesarean section. At home, another discomfort arises: it is difficult for a woman to roll over on her side, it hurts to cough and sneeze, stand up, walk. Intestinal gases torment, stomach swells, sometimes appears sharp pain. This discomfort leads to difficulty in breastfeeding because finding a comfortable position is extremely difficult.

Possible complications after caesarean section

If during natural childbirth a woman loses up to 300 ml of blood, then during a cesarean section, the volume of blood loss increases to an average of 500-1000 ml. In the first case, the mother's body independently restores the lost volume of blood, while in the second case, it cannot cope with the problem on its own. That is why during and after the operation, a woman is injected with blood-substituting solutions.

It should be understood that a caesarean section is the same operation as the others, and some complications are possible after it:

• the integrity of the intestinal peritoneum is violated;
• spikes occur- adhesions between intestinal loops and other internal organs. This causes pain in the abdomen, discomfort when sitting, walking, and any other movements;
• endomyometritis- inflammation of the uterus. During the operation, there is a direct contact of the uterine cavity with air, which is difficult to achieve complete sterility. To prevent endomyometritis after surgery, the mother is prescribed antibiotics;
• subinvolution- Violation of uterine contraction. In this case, the doctor prescribes a 2-5-day therapy aimed at improving the contractility of the uterus.

Recovery of the uterus after caesarean section

Whatever the birth, in any case, they can be compared with hard work, after which the female body needs a good rest.

After the operation, the mother stays in a special postpartum ward for the first day. Doctors are constantly monitoring the woman in labor. Nurse handles daily postoperative suture antiseptic solution, change bandages. An ice pack is placed on the mother's stomach: this stimulates the uterus to contract and helps stop bleeding. Also, a woman is prescribed painkillers that promote uterine contraction, and drugs to restore the function of the gastrointestinal tract. Mom must remember that her body must fully recover, and a strong scar must form on the uterus. Therefore, resume sexual life after a caesarean section, doctors recommend two to three months after surgery. It is better to plan the next pregnancy in a year or two, but not earlier. It is believed that the scar is finally formed by the end of the first year after caesarean section and does not change further.

Visit your gynecologist, get an ultrasound to make sure that the body's recovery process is proceeding normally, ask about acceptable methods of contraception. If you are planning another pregnancy, then the doctor will advise you to do a hysterogram - x-rays in frontal and lateral projections obtained after insertion into the uterus contrast agent. You can also undergo hysteroscopy - this is a visual examination and study of the scar on the uterus, which is performed using an endoscope inserted into the uterine cavity 8-12 months after the operation.

Recovery of the uterus after surgery largely depends on how the pregnancy proceeded, on the age of the woman, physique, and even the conditions under which the operation took place. Unfortunately, every mother who gave birth by cesarean should be psychologically prepared for the fact that she will have to endure pain for some time. Unpleasant sensations may occur due to internal wounds and uterine contractions.

Suture on the uterus after caesarean section

During childbirth by caesarean section, doctors use several. There are currently three types:

• transverse section of the uterus. Most often practiced and produced in lengths of 10-12 cm in the lower segment. It is less traumatic, with less blood loss, and also facilitates wound healing, reduces the risk of postpartum infection. The scar almost does not affect subsequent pregnancies, and childbirth can occur naturally;
• classic cut. It is carried out vertically in the upper part of the uterus, where it is located great amount blood vessels, and therefore is accompanied heavy bleeding. For this reason, doctors rarely do it;
• vertical cut. It is performed only in extreme cases, with some abnormal development of the uterus and premature birth.

No less important is the operation to suture the uterus after the incision

The incision on the uterus is usually sutured with a single-row or double-row suture without interruption. At the same time, doctors use special materials that completely resolve on their own over the course of several weeks to 3-4 months. It can be Dexon, Monocryl, Vicryl, Caproag and other sutures. After childbirth, doctors control the wound healing process and make sure that the suture after a cesarean section does not become inflamed.

The postoperative scar will heal longer: up to six months, and for some women - up to a year. Again, this is a lengthy process, and it is due to the fact that during the surgical incision, the integrity of the nerve endings was violated.

After the operation, you should take painkillers for several days, as the suture delivers pain. A skin scar is formed in about 6-7 days, so a woman can take a shower on her own only after a week. To alleviate discomfort, women are advised to bandage the stomach with a diaper or wear a special postpartum bandage.

Physical activity can be started no earlier than 2-3 months after childbirth. Exercises should not be heavy and painless. And remember that after a caesarean section, you can not lift any weights! If you overexert your muscles abdominals, this can affect the healing process of the postoperative scar, up to the formation of hernias. Take care of yourself and your baby!

Specially for Nadezhda Zaitseva

A number of studies confirm that from 70 to 80% of women whose first birth ended with a caesarean section can give birth to a second child naturally. In most cases, vaginal delivery after a caesarean is safer for both mother and baby than a second operation. However, many women who are determined to have a natural childbirth after CS have faced harsh criticism of such childbirth from obstetricians and doctors. Indeed, even now, many doctors continue to believe that vaginal delivery with a scar on the uterus is unacceptable, as it seriously increases the risk of scar divergence. Let's see if this is true, shall we?

Repeated births with a scar on the uterus mostly pass without any special complications. However, in 1-2% of a hundred such births may end in partial or complete rupture of the suture. Other studies have estimated the chance of uterine rupture at 0.5%, provided that labor was not initiated medically. Also, one of the factors that increase the risk of rupture, according to some reports, is the age of the mother and too short an interval between pregnancies.

Divergence of the suture on the uterus repeated births– potentially dangerous state, for both mother and child, and requires immediate surgical intervention. Fortunately, uterine rupture, if the operation was performed with a horizontal incision in the lower segment of the uterus, is quite rare, occurring in less than 1% of women who give birth vaginally after caesarean. Most operations are performed in the lower uterine segment, the scar from this type of operation is less at risk of rupture during subsequent pregnancy, labor and childbirth.

It is important to know that uterine rupture also occurs in women who have never been operated on. In this case, uterine rupture may be associated with weakening of the uterine muscles after several pregnancies, excessive use of stimulant drugs in childbirth preceding surgical operations on the uterus or using forceps.

Uterine rupture during childbirth can be spontaneous and violent (doctor's mistake), and the rupture can be complete or partial. Some divide tears into three categories: spontaneous, trauma-related, and scar-related. Most often, the rupture still occurs due to the failure of the scar on the uterus, left over from a previous caesarean section.

The likelihood of scar dehiscence also largely depends on the type of incision that was made during the operation. With a classic incision, which is made vertically between the navel and the pubic bone, the risk of scar divergence is higher than with a horizontal one.

The classic vertical incision in the upper part of the uterus is now used quite rarely and only in emergency cases. This type of suture is used in case of a threat to the life of the fetus, the transverse position of the child, or in other emergency cases, when the rescue of the mother and child depends on the speed of response. The risk of rupture of such a seam is from 4 to 9%. Mothers with a classic uterine suture who have multiple children have a higher risk of scar dehiscence.

The American College of Obstetricians and Gynecologists (ACOG), the Society of Obstetricians and Gynecologists of Canada (SOGC), and the British Royal College of Obstetricians and Gynecologists (RCOG) recommend that women with a classic uterine incision should have a caesarean section in their second pregnancies.

The risk of uterine rupture with vertical lower and horizontal lower incisions is approximately the same, that is, it is somewhere from 1 to 7%. The shape of the scar on the uterus can vary and increase the risk of its divergence. Sometimes women make an incision in the uterus that looks like a Latin letter T or J, or even an inverted T (this type of incision is very rare). It is estimated that 4 to 9% of T-like scars may radiate.

What are the symptoms of uterine rupture?

Rupture of the uterus during pregnancy or childbirth is a serious complication that can lead to the death of the mother and fetus. Today, the main cause of uterine rupture is the failure of the scar left from previous births or other medical operations on the uterus. The main difficulty in diagnosing uterine rupture is that it is very difficult to predict the rupture in advance. A rupture can occur during pregnancy, childbirth, or even a few days after them. The risk of uterine rupture increases after the use of oxytocin, and also due to the large number of births in the mother. An experienced doctor can, by indirect signs, determine the divergence of the scar during contractions or attempts.

To prevent uterine rupture, some studies suggest measuring the thickness of the scar with ultrasound or monitoring the intensity of contractions during labor. However, this method of conducting labor with a scar on the uterus does not have a serious evidence base, which would allow this method to be applied everywhere.

Distinguish threatening, begun and completed uterine rupture. There are a number of signs, with the appearance of which we can talk about the onset or occurred uterine rupture. At clinical picture uterine rupture, a deterioration in the condition of the woman in labor is observed, severe pain appears, development of vaginal bleeding. Also, uterine rupture may indicate:

∙ sharp and strong pain between contractions;
∙ weakening contractions or reducing their intensity;
∙ pain in the peritoneum;
∙ regression in the advancement of the head (the baby's head begins to move back to birth canal);
∙ protrusion under the pubic bone (the head of the child crawled out of the seam);
∙ sharp attack pain in the area of ​​the previous scar.

Unusual fetal heartbeat, various slowdowns in heart rate or bradycardia ( low heart rate) may be signs of scar rupture. It happens that even after the divergence of the scar, labor activity does not stop, there is also no decrease in the intensity of contractions. Sometimes it happens that a break has occurred, and clinical symptoms missing in whole or in part.

There are methods for diagnosing scar rupture using an electronic device for monitoring the condition of the fetus. Some obstetricians observe labor with a uterine scar using a fetoscope or Doppler, but these methods have not been proven to be effective. Various medical institutions still recommend that such childbirth be carried out using the device. electronic monitoring fetal condition.

How often does a uterine scar rupture?

In women who have already been operated on, uterine rupture occurs in the area of ​​the scar. Numerous studies prove that for women in labor who have had a history of one caesarean section in the lower segment of the uterus, the risk of rupture is from 0.5% to 1%. Women with multiple caesarean sections are at slightly higher risk.

Here are the numbers that show the number of scheduled and performed natural births after caesarean section in one of the American hospitals over a ten-year period.

Number of previous CS Successful vaginal delivery after CS Percentage of scar dehiscence Perinatal mortality
10,880 planned natures. delivery after one CS 83% 0.6% 0.018%
1,586 planned natures. delivery after two CS 76% 1.8% 0.063%

241 planned natures. delivery after three CS 79% 1.2% 0

Source: Miller, D.A., F.G. Diaz, and R.H. Paul. 1994. Obster Gynecol 84 (2): 255-258 The study population included women in breech presentation, pregnant women with twins, and those who delivered with the use of oxytocin.

At independent start deliveries in women with a scar on the uterus, the risk of uterine rupture is less than one percent. This is about the same or even less than the number of other complications that can occur in childbirth.

Doctors confirm that the risk of scar divergence after one cesarean section is no higher than the likelihood of any other unforeseen complications in childbirth (the latter include fetal distress, maternal bleeding due to premature placental abruption, or umbilical cord prolapse).

In 2000, out of 4 million registered births that ended in the birth of a child, the American National Center for Health Statistics recorded a certain number of complications in childbirth. In the table below, comparative analysis the risk of scar dehiscence when attempting natural childbirth after a single caesarean section in the lower segment with the risk of developing other unpredictable complications in childbirth.

Reported birth complications in the United States Number per 1,000 births
Umbilical cord prolapse 1.9
Intrauterine suffering of the fetus 39.2
Placental abruption 5.5

Source: CDC: NCHS: Births: Final Data for 2000

Uterine rupture during vaginal delivery after caesarean section Number per 1000 births
Of the 100 women who give birth vaginally after cesarean, uterine rupture occurred on average in 0.09% - 0.8% of cases (data based on a worldwide systematic review similar births) 0.9 – 8

Source: Enkin et all 2000. A Guide to Effective Care in Pregnancy and Childbirth

According to research by the Vermont/Hampshire Project for Vaginal Birth after C-section, rupture of the suture is possible in about 5 out of 1000 women. In the second planned caesarean section, this outcome occurs in 2 out of 1000 women in labor. Doctors at the Royal College of Obstetricians and Gynecologists in Britain confirm that the gap uterus is a very rare complication, but the risk is higher in women who plan to give birth vaginally after cesarean (35 per 10,000 for vaginal delivery with a uterine scar) compared to 12 per 10,000 births for a planned repeat caesarean section.

When the suture on the uterus diverges ...

The divergence of the scar on the uterus when trying to give birth naturally happens quite rarely, but if it does happen, the only salvation is an urgent caesarean section.

The longer it takes a doctor to make a diagnosis, the more likely the baby and/or placenta will pass through the uterine wall into the abdomen. This seriously increases the likelihood of major bleeding, and in a child can cause neurological disorders and very rarely death.

Therefore, when the uterine rupture along the scar has begun or has taken place during pregnancy or childbirth, the woman undergoes a caesarean section, during which the child is taken out and the gap is sutured. Rupture along the scar is not always accompanied by the appearance of symptoms of a classic uterine rupture, as it begins gradually.

The authors of The Guide to Pregnancy and Childbirth, a respected international publication, state that any medical institution that deliveries and has emergency medical equipment can deliver women with a scarred uterus.

The American College of Obstetricians and Gynecologists recommends that women who give birth spontaneously after a caesarean have a doctor who can perform emergency surgery, an anesthetist, and other staff that may be needed in case of emergency surgery. The Obstetricians and Gynecologists Society of Canada (SOGC) recommends continuous monitoring of vaginal deliveries with a scar and immediate laparotomy (surgical incision in the abdomen) if scar dehiscence is suspected. "Immediate access to the operating room and on-site blood transfusion" are also recommended.

Despite this, many clinics in the US state that they do not have the ability to "immediately" adequately respond in the event of a scar dehiscence, so they freely refuse women seeking vaginal delivery after a caesarean.

Supporters of natural childbirth with a scar on the uterus insist on improving the approach to the quality of medical care provided to women after caesarean. They believe that it is more appropriate to support women who want to give birth themselves after a first caesarean section than to dissuade them by printing stories about unsuccessful attempts at vaginal birth with a scar.

Dr. Bruce L. Flamm, a well-known researcher in the field of vaginal birth with a uterine scar, warns American doctors against jumping to conclusions and advises supporting natural childbirth in women with a previous history of CS. In his opinion, the unwillingness of doctors to support a woman's desire to give birth herself and the policy of "second caesarean after the first" will contribute to "an additional 100,000 operations per year. “It is unlikely that such a large number of operations will be carried out without any serious complications, including without maternal deaths,” Flamm said.

The divergence of the scar, what threatens the mother and child?

Most researchers studying cases of suture divergence during repeated natural childbirth agree that constant monitoring of such childbirth, timely diagnosis of scar divergence and timely emergency operation minimize severe complications. One study in a large California clinic proves that the consequences for children are much more encouraging if adequate measures are taken in the first 18 minutes or less after the onset of uterine rupture.

The ability to perform an emergency cesarean seriously reduces the risk of fetal death due to suture divergence. During the study of data on infant mortality in the divergence of the scar, the following was established:

Number of women who gave birth with a scar on the uterus Number of children who died due to uterine rupture Physicians
17 613 5 Other Raget, 2000
10000 3 Other Rosen, 1991
5022 0 Other Flamm, 1994

Representatives of the Vermont/New Hampshire Center for the Support of Natural Birth with a Uterine Scar concluded that the marginal risk of infant mortality when trying to give birth naturally is somewhere around 6 children per 10,000, while 3 women can lose a child during a planned caesarean section. per 10,000.

Women who are closely monitored during pregnancy and are delivered by experienced doctors in a maternity hospital equipped for emergency care usually give birth without serious consequences for yourself and the child.

Those women who want to give birth at home after a cesarean should remember that the risk of scar dehiscence is not a myth. Home birth with a scar on the uterus is not recommended in countries such as the US, Canada, UK.

Women considering vaginal delivery after caesarean in private hospitals should ask if the clinic has emergency resuscitation resources and the ability to perform immediate surgery in case of unforeseen complications.

Can the risk of seam splitting be minimized?

Although it is almost impossible to predict exactly which of the women who give birth after caesarean will have a dehiscence of the seam, nevertheless, it is possible to identify those factors that can increase the risk of uterine rupture. The latter include:

∙ During childbirth, oxytocin or other drugs that stimulate the production of prostaglandins are used.
∙ The previous caesarean section ended with a single-layer suture (this type of suture was applied earlier to reduce the time of the operation), while the method of double suturing the uterine wall is more reliable.
∙ A woman becomes pregnant and delivers with a uterine scar less than two years after her first caesarean.
∙ The age of the woman in labor is over 30 years.
∙ A classic vertical incision was made in the previous CS.
∙ The woman has a history of two or more CSs.

According to the American College of Obstetricians and Gynecologists, for arousal labor activity in women after CS, the use of prostaglandins is not recommended. The Panel states that the use of misoprostol in labor seriously increases the risk of uterine rupture and should not be used in labor with a scar.

Informed Choice - Informed Refusal

Under existing US law, a woman who has given birth to her first child through CS surgery has the right to try to give birth on her own or choose a repeat caesarean section.

In Russia, according to the law on "Health Protection of Citizens" (Section VI. Rights of Citizens in the Provision of Medical and Social Assistance, Art. 30), each person, when applying for any medical assistance, has the right to:

1) respectful and humane attitude on the part of medical and service personnel;
2) the choice of a doctor, including a family doctor and an attending physician, subject to his consent, as well as the choice of medical treatment - preventive institution in accordance with contracts of compulsory and voluntary medical insurance;
3) examination, treatment and maintenance in conditions that meet sanitary and hygienic requirements;
4) holding, at his request, a consultation and consultations of other specialists;
5) relief of pain associated with the disease and (or) medical intervention, accessible ways and means;
6) keeping secret information about the fact of applying for medical care, about the state of health, diagnosis and other information obtained during his examination and treatment
7) informed voluntary consent for medical intervention in accordance with Article 32 of these Fundamentals; 8) refusal of medical intervention in accordance with Article 33 of these Fundamentals;
9) obtaining information about their rights and obligations and the state of their health in accordance with Article 31 of these Fundamentals, as well as the choice of persons to whom, in the interests of the patient, information about the state of his health can be transferred;
10) receiving medical and other services within the framework of voluntary medical insurance programs;
11) compensation for damage in accordance with Article 68 of these Fundamentals in the event of harm to his health during the provision of medical care;
12) admission to him of a lawyer or other legal representative to protect his rights;
13) admission to him of a clergyman, and in a hospital institution for the provision of conditions for the performance of religious rites, including the provision of a separate room, if this does not violate the internal regulations of the hospital institution.

In case of violation of the rights of the patient, he may file a complaint directly with the supervisor or other official medical and prophylactic institution in which he receives health care, to the relevant professional medical associations and licensing commissions, or to the court.

Remember that regardless of your financial situation and social status, every woman has the right to ask questions, receive full information about possible consequences, discuss your upcoming birth with your doctor, and based on this, make an informed choice - to give birth naturally after a CS or to choose a second operation.

stole from the site 123ks.ru