Pregnancy and childbirth with scar on the uterus after cesarean, removal of fibroids - Causes, symptoms and treatment. MF.

A scar on the uterus is a dense tissue that is formed as a result of a caesarean section or after other gynecological operations on the uterus, for example, after removal of the uterine fibroids. Also, the scar on the uterus may be formed as a result of perforation( piercing the wall) of the uterus during abortion or after removal of the tube in ectopic pregnancy.

As the number of cesarean sections grows every year, this topic is becoming increasingly important.

Gynecologists recommend that women should not become pregnant after cesarean section before 2-3 years after the operation. What is it for? The fact is that only by this time the uterus with the scar is fully restored for normal gestation of subsequent pregnancy.

An important factor for the normal gestation of pregnancy and childbirth is the factor, such as the consistency of the scar on the uterus. The scar on the uterus is of 2 kinds:

- full or wealthy( ie, when there is a complete recovery of muscle tissue after surgery);

- defective or untenable( when connective tissue prevails instead of muscle tissue).

A full scar on the uterus does not pose a danger to the pregnant and fetus, as the muscle tissue is well stretched and elastic, which can not be said for connective tissue. The incomplete cicatrix on the uterus, on the contrary, is a threat to the life of the mother and child, since it can lead to a rupture of the uterus along the scar in the last weeks of pregnancy or directly during childbirth.

Normally, the scar on the uterus does not have any symptoms and the pregnant one, as a rule, does not bother. As the duration of pregnancy increases, pain in the area of ​​postoperative scar may occur. They can be associated with spikes in the small pelvis, with the threat of miscarriage or with the extension of the scar on the uterus. The latter poses a serious threat, since it indicates the inconsistency of the scar on the uterus.

Pain in stretching the scar on the uterus is local. Do not pass with taking antispasmodics, with a change in body position and in a relaxed state.

In any case, even if the nature of the pain is not entirely clear and to the expected delivery is still very far away, pregnant should immediately call an obstetrician-gynecologist and tell in detail about their complaints.

Examination of pregnant women with a scar on the uterus

When examining a pregnant woman, the doctor conducts a finger examination of the scar on the uterus. The presence of pain can indirectly indicate the inconsistency of the scar.

The most reliable method for evaluating the consistency of the scar is ultrasound, which is performed from 35 weeks of pregnancy. In addition, the estimated weight of the fetus and its presentation, the location of the placenta with respect to the scar, is determined. All these indicators are very important for determining the tactics of delivery. It should be noted that in most cases the tactics of delivery are determined only in the maternity hospital on the eve of the forthcoming birth.

All pregnant women with a scar on the uterus are strongly recommended hospitalization in the maternity hospital two weeks before the expected date of delivery, that is, at 38 weeks of gestation.

Seam after operation of caesarean section

Birth with scar on the uterus

To give birth through the natural birth canal or to perform an operation by caesarean section is the most "burning" issue that worries the pregnant woman. It's no secret that until recently, the birth through the natural birth canal in a woman with a scar on the uterus was a great rarity in obstetric practice. In the XX century, even there was even a rule: "Once a cesarean section - always a caesarean section."However, gradually from this rule go.

In what cases is a woman with a scar on the uterus able to give birth through the natural birth canal itself, and in which cases is the cesarean section mandatory?

First, beyond any doubt, the main condition for natural delivery is the consistency of the scar on the uterus. An inconsistent scar is a direct indication for cesarean section.

Secondly, the number of cesarean sections in the history is important. If a woman already had two or more surgeries, the risk of rupture of the uterus during childbirth increases several times. Accordingly, in this case also caesarean section is preferable. The woman can give birth only in the case when the cesarean section was once.

Thirdly, it is necessary to take into account the type of the previous cesarean section, the so-called "operative access".The lower-median laparotomy( transverse incision above the bosom), which is performed most often, is more favorable for natural childbirth in the future. Corporal Caesarean section( incision from the bosom to the navel), on the contrary, does not leave chances to give birth to itself.

Fourth, the placenta previa is important. If the placenta is directly in the scar, then during natural births, the placental abruption is likely. As a result, the baby can die. Therefore, in this case also caesarean section is mandatory.

And finally, in addition to medical indications do not forget about the psychological mood of the future mother. If a woman has absolutely no desire to give birth herself or there is a pathological fear of an impending childbirth, then at the insistence of a woman a caesarean section is done.

In other cases, when a pregnant woman is psychologically ready for childbirth and there are no medical contraindications for this, the doctor should go to meet. Accordingly, the issue of delivery should be discussed with your obstetrician-gynecologist in advance.

Routine cesarean section with a scar on the uterus

The planned cesarean section is carried out at 38-40 weeks of pregnancy. The date of the operation is determined by the doctor, based on the date of the forthcoming delivery, the condition of the scar, the degree of maturation of the placenta and other factors.

Natural delivery with a scar on the uterus

If the birth is planned to be conducted through the natural birth canal, then you should wait for the spontaneous onset of labor. During childbirth, according to indications, it is possible to use various types of anesthesia, including epidural. But, in contrast to birth without a scar on the uterus, in women in labor with a scar on the uterus, it is strictly forbidden to use drugs that stimulate the birth activity in genera, such as Enzaprost, Oxytocin. This can lead to rupture of the uterus.

It is also not recommended to perform amniotomy( autopsy of the bladder), which can lead to a violation of labor. Therefore, the main principle of labor with a scar on the uterus is a minimum of medical intervention. The main task of the doctor in childbirth with a scar on the uterus is to monitor the overall condition of the mother in order to avoid complications. At any time, the tactics of the doctor can be changed and the birth can end in favor of cesarean section.

After the birth of the child, the birth of the child occurs, after which the doctor performs a manual examination of the uterine cavity to assess the condition of the scar. This examination is carried out under general anesthesia. Manipulation takes no more than five minutes. Of course, natural births more favorably affect the health of the mother and baby, so if there are no contraindications to physiological births, then it is not necessary to insist on a cesarean section. And, as already mentioned, the birth should take place under the obligatory dynamic control of the obstetrician-gynecologist in the maternity hospital in order to exclude the risk of rupture of the uterus and death of the fetus.

For rapid healing of the keloid scar on the abdominal skin after cesarean section it is recommended to use special ointments such as Kontraktubeks, Solcoseryl.

In the postpartum period( and after the operation, too), it is recommended that sexual abstinence be performed for 1.5-2 months before complete elimination of secretions from the genital tract. Sexual intercourse can lead to infection in the vagina, cervix and uterus.

Consultation of obstetrician-gynecologist on the topic of labor with a scar on the uterus:

1. Why can not I become pregnant immediately after cesarean section?
Because of the inconsistency of the scar on the uterus.

2. How long does the discharge after birth and cesarean section last?
In both cases, about 4-6 weeks.

3. How many times can I do caesarean section?
No more than 3 times.

4. I have a scar on the uterus. They offered to be operated at 38 weeks of pregnancy. Why not wait 40 weeks?
Because there is a possibility of a rupture of the scar on the uterus at the beginning of labor.

5. Is it possible, if desired, to give birth to the scar on the uterus and myoma?
It is possible, if the doctor will allow.

6. Is there a need for early hospitalization in the hospital if there is a scar on the uterus?
Yes. Hospitalization is compulsory.

7. How soon can you have sex after cesarean section?
When the discharge from the genital tract ends.

8. How long does the suture on the uterus after cesarean section heal?
4-6 weeks.

Obstetrician-gynecologist, Ph. D.Christina Frambos.