Cervix and uterus after caesarean section. Scar on the uterus after cesarean section: how to avoid trouble

If the first birth of a woman, for various reasons, ended with an operation, then the second and subsequent births require the inclusion of this pregnant woman in the risk group. The divergence of the suture after cesarean is a rather serious problem of modern obstetrics, although many approaches to the management of such patients have recently changed quite a lot. Even 10 - 15 years ago, the verdict of specialists for such women was unequivocal: if there is such a type of delivery in the anamnesis, then all subsequent births should be carried out only by surgery. This was associated with a high risk of uterine rupture along the old scar during the natural process. What are the reasons for this complication?

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The probability of uterine rupture depending on the scar

For a long time, many obstetrician-gynecologists used the classic vertical suture, which was used to suture the muscular wall of the uterus in its upper third. A similar tactic in the operation of caesarean section was considered generally accepted.

Technically, such a delivery was quite simple: the surgeon made a vertical incision, the abdominal cavity was opened between the pubic bone and the navel. However, this technique gave a fairly high percentage of rupture of the uterine wall along the old scar during pregnancy and subsequent delivery through the natural birth canal.

The divergence of the suture on the uterus after cesarean in this case was, according to different authors, from 4 to 12%. This forced the experts to recommend that the woman re-lie down on the operating table.

Currently, all major maternity hospitals and perinatal centers have abandoned this technique. During the operation, an incision is made on the uterus in the lower segment. The scar can be longitudinal or transverse, which practically does not affect the frequency of postoperative complications.

The anatomical structure of the female uterus is such that muscle incisions in this area heal much faster and less often create prerequisites for tissue damage. When carrying out such operations, the probability of divergence of the seam on the uterine wall is sharply reduced and is no more than 1 - 6%. It is these figures that allow modern specialists to allow up to 80% of women who have undergone operative delivery to go into natural vaginal delivery.

Studies have shown that the vast majority of women can give birth on their own after surgery, and rupture of the uterine wall can occur not only as a consequence of surgery.

Who is at risk for uterine rupture during childbirth?

As mentioned above, about 4 - 5% of women in labor are at risk of experiencing a possible divergence of the old scar during vaginal delivery. This probability increases significantly with the age of the pregnant woman. Like the tissues of the whole body, the walls of the uterus lose their former elasticity with age, so an excessive load on the old scar during pregnancy and childbirth can be fatal.

It is also very important to observe the necessary intervals between births. For the formation of a full-fledged dense seam, the female body takes from 12 to 18 months, therefore, a second pregnancy in a woman who has undergone a caesarean section is recommended no earlier than 2 years after the operation.

Pregnant women who do not have a history of operative delivery may be at risk of uterine rupture. Quite often, such complications occur when a woman in labor enters the delivery room for 5, 6 and subsequent births. In such women, the muscular layer of the uterine wall is extremely weakened, such challenges should be taken into account by obstetricians when choosing tactics for conducting childbirth.

However, rupture of the uterine wall during childbirth may also be the result of an unprofessional attitude of the maternity hospital staff to their duties. To speed up childbirth, various stimulant drugs are often prescribed that reduce the wall of the uterus. Their excessive exposure increases the possibility of rupture of the provoked wall during childbirth by several times.

Signs of violation of the integrity of the scar on the uterus

Experts believe that the main difficulty in solving this problem is the difficult prediction of such a complication. Most often this can happen in the last stages of gestation.

Signs of divergence of the seam after pregnancy depend on the stage of development of the process. In modern obstetrics, there are three types of violation of the integrity of the scar:

In addition to monitoring a woman, during vaginal delivery in a pregnant woman with a scar on the uterus, it is necessary to monitor the condition of the fetus. For this, modern medical institutions are equipped with appropriate equipment. This may include the use of dopplerography or a fetoscope.

The medical literature describes situations where there are practically no symptoms of suture divergence after cesarean. The pain syndrome does not exceed the usual threshold for a woman in labor, the strength and frequency of contractions do not change. In such a situation, the experience and alertness of a doctor who delivers a woman with a similar pathology can play a big role.

Uterine rupture is considered the most severe complication, occupying one of the first places among the causes of fetal death and maternal mortality. In this case, only an emergency operation can save the life of the baby, and most importantly, the mother.

What women need to know about the formation of a suture on the uterus

Quite often, young mothers turn to the antenatal clinic with the question of whether the internal seam can open after a cesarean. In such a situation, much depends on the patient herself.

If, after a vaginal birth, after a certain time, the female uterus acquires its original shape, then after a cesarean section, a scar remains on the wall, which can complicate the course of future pregnancies for a young woman. Nature has provided the following method for healing a postoperative scar: in the normal state, the suture site is filled with muscle tissue cells or myocytes, these structures allow the scar to acquire the necessary density and become, as doctors say, wealthy.

If, for various reasons, the suture is overgrown mainly with connective tissue, then the structure of the muscular layer of the uterine wall is disturbed. In subsequent pregnancies with such a scar, various problems may arise.

This pathology usually occurs if a woman after the first operation did not follow the basic recommendations of the doctor, physical activity on the abdominal wall exceeded the permissible norms, there were certain errors and shortcomings in and. Finally, various chronic diseases, a decrease in the body's immune forces can cause a weak scar on the uterus.

A similar problem is usually detected by a specialist during an ultrasound scan of the uterus and the suture on it. It is he who gives the conclusion about possible independent childbirth after a caesarean section.

Uterine scar and second pregnancy

When there are no problems with a scar on the uterus, pregnancy does not affect the woman's condition in any way. Up to 32 - 33 weeks, the pregnant woman generally does not have any clinical manifestations of the existing pathology. Only in the later stages of pregnancy can there be mild pain in the area of ​​the old operation. Most often, such a pain syndrome indicates the presence of an adhesive process in the area of ​​​​surgical intervention, but this may indicate that the scar on the uterus is not elastic enough.

If a woman's pain is localized in one specific place, they are not affected by a change in body position, analgesics and antispasmodics do not bring the desired effect - this is a reason to immediately seek help from a specialist. This should become the rule for a pregnant woman, regardless of the term.

According to modern canons, ultrasound for a woman who had a history of caesarean section is mandatory throughout pregnancy. It is this method of examination that allows obstetrician-gynecologists to decide on the need for a second operation. As early as 28-29 weeks, the location and size of the child, the place of attachment of the placenta in the uterine cavity are determined, which is necessary to avoid the risk of rupture of the muscle wall scar.

From the 31st week, the ultrasound doctor constantly monitors the condition of the scar, and if there is a suspicion of its failure, it immediately raises the question of conducting a new operation. For the same period, there is a period of hospitalization of a similar pregnant woman in the pathology department.

In modern protocols, the time from diagnosing uterine rupture to performing an emergency caesarean section should not exceed 15-20 minutes. Only in this case there are good chances to save the baby and his mother.

When specialists decide to allow a pregnant woman with a uterine scar into natural childbirth, the woman should be informed about a possible emergency operation and about the certain risks of such tactics. In addition, in such a contingent of women in labor, it is impossible to carry out analgesic therapy and artificial stimulation of labor. The doctor simply does not interfere in the course of childbirth, his task is to recognize possible complications and take appropriate measures.

It is up to every pregnant woman who has a scar on the uterus to give birth herself or go for a second operation. There are situations when specialists make a decision for her, but in 70% of cases it is the choice of the woman herself. The task of the doctor in this situation is to give her the full amount of information and support any decision she makes.

Recovery after childbirth is often difficult, even if it happened naturally. After a caesarean section, postoperative problems are added to various postpartum problems, 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 uterine scar is a formation that consists of myometrial fibers (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. The formation of the primary seam is bright red, with clear 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, incapable of contraction, since it consists mostly of connective tissue (muscle tissue is underdeveloped). The scar may have thickenings and depressions (niches), swelling, blood vessels in it are woven into 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. An inconsistent scar has certain thickness parameters - more than 1 cm or less than 3 mm.

In general, the human body is 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. Insufficient observance of aseptic and antiseptic rules in the process of dissection 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. It is not worth delaying too much - more than four years, since the scar on the uterus will lose even more elasticity over the years.

At the planning stage, a woman needs a comprehensive examination in order to fully diagnose the condition of the scar. 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 at an early stage, the threat of termination of pregnancy, 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 can completely or partially enter the woman's abdominal cavity

Uterine rupture is the most severe complication of pregnancy, which can cause 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. Decreased blood pressure in pregnant women.
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. There are 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 drugs against hypoxia in the fetus, which improve 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. Ultrasound procedure. 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 are prescribed - hysterography and MRI.
2. X-ray hysterography makes it possible to examine the relief of the scar. A special agent is introduced into the uterus that 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.

Video: about the need to do an ultrasound before childbirth

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. A surgical operation (plastic) is possible, 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 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, MD, 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 quick rehabilitation.
The laparoscopic method minimizes 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 the 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.

Ultrasound examination plays an extremely important role after childbirth, especially if surgery has been introduced into this process, such as, for example, with a caesarean section. It helps to prevent the occurrence or frequent occurrence in time.

It is necessary to control the condition of the uterus with the help of ultrasound diagnostics after surgical delivery. This will help distinguish just minor pain in the lower abdomen from pain preceding postpartum endometritis.

On ultrasound, you can see how much the uterus after a caesarean section differs from the uterus after an independent birth. If the birth of the baby occurred naturally, without surgical intervention, then the uterus contracts in length much faster than it happens after surgery.

Also, after a caesarean section, sometimes there is a thickening of the anterior wall of the uterus, which stands out significantly in the region of the suture in the lower uterine segment. It is possible to recognize exactly where the sutures were made on the uterus after the operation if, in the projection of the suture, a zone with an inhomogeneous density with a width of about one and a half to two centimeters is outlined, in the structure of which it will be possible to distinguish point and linear signals.

With the development of endometritis due to operative childbirth, a characteristic phenomenon will be swelling of the sutures in the uterus, and occasionally eruption of the sutures is also observed. If the course of endometritis after cesarean section is especially difficult, then partial failure or divergence of the sutures may occur, as well as pronounced swelling and increased formation of gases in the suture area.

One of the first signs of postpartum endometritis that occurs after surgical delivery is the subinvolution of the uterus. It is especially pronounced on the 3rd - 5th day after the birth of the child. As a rule, subinvolution of the uterus is more pronounced after delivery by caesarean section than with.

In addition, ultrasound plays an important role in determining the exact cause of a young mother's fever. Timely diagnosis will allow you to find foci of hemorrhage or sudden inflammation in the area of ​​the scar.

Ultrasound examination is recommended to be repeated, a week after discharge from the hospital, for all women in labor who have risk factors. This risk group includes those women who have a high probability of complications in the postpartum period, as well as those in whom both the birth and postnatal process proceeded with some difficulties. Such a diagnosis makes it possible to prevent possible complications or prevent a recurrence of the disease.

After the birth of a child, serious changes occur in the body of a young mother, which are mostly localized in the uterus. For a long time after childbirth, the female reproductive system returns to normal. Recovery of the uterus takes at least several months. At this time, it is necessary to follow the rules of daily hygiene and visit the gynecologist on time to avoid possible complications.

Not every woman can give birth naturally. Nowadays, the number of young mothers who gave birth to their child by caesarean section is steadily increasing. Such childbirth is no longer considered difficult, doctors perform the operation with partial or complete anesthesia. But after the birth of a baby in this way, a young mother will need more patience, because the uterus recovers longer after a cesarean section than after a physiological birth.

After childbirth, the uterus becomes larger in size, and its inner layer looks like a whole bleeding wound surface. The bottom of the uterus has a diameter of 10 cm, immediately after delivery it is located 5 cm below the navel. Constant contractions of the muscle layer of the organ gradually lead to a decrease in its volume and restoration of the mucous layer.

The contractions of the uterus immediately after childbirth cannot be called strong, on the contrary, the muscle fibers contract too weakly. And the type of childbirth does not play any role. Gradually, the contractility of the reproductive organ increases, but uterine contractions after cesarean section will still be weaker. Therefore, it takes longer to recover. The total duration of the postpartum period after caesarean section is two months. At this time, lochia comes out of the female genital tract - bloody discharge from the uterus.

During a surgical intervention associated with an incision in the muscular layer of the uterus, the vessels, nerve endings and muscle fibers lose their integrity, so the organ cannot contract as quickly as after natural childbirth. If the involution of the uterus after caesarean section is extremely slow, the doctor may prescribe specific drug therapy to the woman in labor.

Types of sutures on the uterus after caesarean section

During surgery on the abdominal wall and uterus, the doctor makes a transverse or longitudinal incision. Subsequently, the tissues in this place are scarred, a scar is formed, which does not always have an aesthetic appearance. In addition, cicatricial changes after surgery, if the rules of care are violated, can become a source of serious complications, for example, provoking infections of the reproductive organs.

For sutures in medicine, materials of synthetic and natural origin are used. There are self-absorbable materials that do not require removal. In other cases, it is customary to remove the sutures on the 6th day after the operation. The quality of the suture material, as well as its quantity and the technique of surgical intervention, directly affect the rate of organ recovery and how the suture will look in the future.

Internal seams are superimposed directly on the wall of the reproductive organ. on the uterus after caesarean section requires special strength and compliance with all conditions for its subsequent healing. Usually, the doctor uses absorbable materials for the internal suture.

Depending on the method of incision, the seams are of the following types:

• vertical - superimposed down from the navel to the pubic region with an appropriate vertical incision;
• transverse - superimposed along the bikini line, called the Joe-Kohen laparotomy;
• arcuate - the incision is made in the area of ​​\u200b\u200bthe skin above the pubic bone, is called the Pfannenstiel laparotomy.

As a rule, during a planned operation, doctors practice Pfannenstiel laparotomy. The seam placed on the incision will have cosmetic properties, that is, after healing, it will soon become difficult to see on the skin. In addition, such a suture on the uterus after cesarean section heals faster and more successfully, and blood loss after childbirth will be minimal.

During an emergency operation, when it comes to saving a mother or a child, there is no time to think about aesthetics. The doctor performs a longitudinal dissection of the reproductive organ and then puts strong interrupted sutures on it. This seam cannot be called aesthetic, but it has its advantages - it is produced quickly.

Recovery of the uterus after caesarean section

Whatever the birth, every woman in labor needs peace and rest. In the first hours after the woman stays in the ward under the constant supervision of the medical staff. The suture after the operation is systematically treated with antiseptics and the dressings are changed, and the appearance of signs of divergence of the suture on the uterus after cesarean section is monitored.

An ice bubble is applied to the lower abdomen of the woman in labor, since the cold is a stimulator of muscle contractions of the uterus and reduces the likelihood of postpartum hemorrhage. Also, the patient is prescribed drug therapy, the tasks of which are pain relief and restoration of the digestive organs.

After operative childbirth, it is recommended to resume sexual activity no earlier than after a full two months. Planning for the next pregnancy can be done one and a half years after the operation. The scar on the uterus will be formed completely one year after cesarean.

After discharge from the maternity hospital, a woman is recommended to visit a gynecologist for an ultrasound examination and subsequent monitoring of the restoration of the reproductive system. In this case, the doctor must select a suitable contraceptive for the patient, since conception and pregnancy during the healing of the suture on the uterus after cesarean section is unacceptable.

In the future, when planning a new pregnancy, a woman should undergo hysterography - an x-ray examination of the uterus in several projections, and hysteroscopy - a visual examination of the genital organ using an endoscope from the inside.

These procedures allow you to assess the condition of the uterine scar and its possible behavior in future pregnancies. They are also necessary when it comes to the development of uterine fibroids after cesarean section. These manipulations can be carried out 8 months after the birth of the child.

Any physical activity is prohibited within 2 months after childbirth. Weight lifting, physical education and sports - everything is banned. With overstrain of the muscle fibers of the abdominal press, a divergence of the suture on the uterus after a cesarean section is possible, which prevents the normal healing of the postoperative scar.

The success of postpartum recovery of the uterus after caesarean section is directly related to the characteristics of the course of pregnancy, the age of the woman, her state of health and the technique of performing surgical intervention.

Possible complications after caesarean section

Operative childbirth is a surgical operation, so complications can be different.

1. Surgical complications:

• trauma of the bladder, intestines;
• damage to parametrium, vascular bundles;
• injury to the presenting part of the child;
• hematoma after caesarean section on the uterus;
• sewing to the uterus of the bladder;
• internal or external bleeding.

1. Anesthetic complications:

• Mendelssohn's syndrome - aspiration of the respiratory tract;
• portocaval syndrome;
• failure of tracheal intubation.

1. Postoperative complications:

• subinvolution of the uterus after caesarean section (violation of its contractility);
• purulent-septic conditions: endometritis, peritonitis, sepsis;
• vein thrombosis, thrombophlebitis;
• adhesive process, characterized by adhesions between various organs of the abdominal cavity.

Most often, childbirth performed by surgery is complicated by massive blood loss. Of course, bleeding cannot be avoided with any type of childbirth. But if during natural delivery a woman can lose no more than 400 ml of blood (of course, provided that no complications arise), then during operative delivery this figure reaches 1000 ml.

Such blood loss is due to extensive damage to the vascular wall of the uterus, which occurs during the incision during the operation. If a woman loses more than 1 liter of blood, then most likely she will need an urgent transfusion. In 8 situations out of 1000, massive blood loss results in resection or removal of the uterus. In 10 out of 1000 cases, women need the help of an intensive care team.

As for lochia, which are normally removed from the uterus within a few weeks, the following symptoms should alert a woman:

1. If there was discharge after the operation, but suddenly disappeared after a few days, you need to urgently inform the doctor about this. This complication may occur because the cervix is ​​closed after a caesarean section due to spasm, or its cavity is filled with blood clots, preventing the normal cleansing of the organ. Stagnation in the reproductive organ can cause the reproduction of pathogenic microflora and cause endometritis and sepsis - the most severe consequences of childbirth.
2. If lochia go longer than 2 months and become more abundant, you need to call emergency help. Most likely, the uterus after childbirth could not contract in the required volume, and there was a possibility of hypotonic bleeding.

Do not be afraid of operative childbirth, if the doctor insists on their conduct - by his actions he tries to prevent negative consequences, and sometimes save the life and health of a woman and her child. It is better to plan the next pregnancy no earlier than 2 years after the surgical delivery, providing the body with enough strength and opportunities for rehabilitation.

Useful video about re-birth after caesarean section

After childbirth by caesarean section, the process of healing of the postoperative wound begins. First, its edges stick together. Then cells gradually multiply, blood and lymphatic vessels grow. By 5-7 days, the scar area is penetrated by elastic fibers, and fibroblasts begin to synthesize collagen. By day 20, muscle cells grow into the area of ​​the scar and restore the skeleton of the uterus.

All these processes take a lot of time. The consistency of the scar can be considered satisfactory not earlier than 2 years after the operation. For women who have undergone a caesarean section, planning a new pregnancy should begin with an assessment of the condition of the suture. In non-pregnant women, various methods are used:

• Ultrasound of the small pelvis;
• ultrasound hysteroscopy;
• Hysterosalpingography.

How many mm should be a suture after cesarean has been found out through various studies and observations. The state of not the suture itself is assessed, but the lower segment of the uterus, located under the scar, and the scar itself.

The following metrics are considered valid:

• Segment thickness 4-5 mm;
• A clear layer of myometrium is revealed along the entire length of the scar;
• There are no areas of local thinning.

The lower segment of the uterus is considered insolvent with the following characteristics:

• Suture 3 mm or less after cesarean;
• Cicatricial changes in tissues in different areas.

At what thickness of the seam can pregnancy be planned?

If a woman underwent an ultrasound scan, which determined the thickness of the suture of 4 mm after cesarean, then it is necessary to additionally perform hysteroscopy. During the study, using special video equipment, you can assess the condition of the scar.

If the tissue in the incision area has a pink tint, then there are enough myocytes and sprouted vessels in it. The white color of the suture indicates its failure and the predominance of fibrous tissue. Myocytes are highly extensible, so the uterus can grow to the size of a pregnant woman.

But the scar can change during pregnancy. The growing uterus is stretched. The tissues in the suture are not able to stretch in the same way as the entire organ, the lower segment becomes thinner. But everything has a limit. A 2 mm suture after cesarean in the last weeks of pregnancy is considered the norm.

Some researchers propose to evaluate not the full thickness of the suture, but only the thickness of the residual myometrium (RMT). To do this, you need to know the size of the niche under the scar. If its size is more than 50% than TOM, pregnancy is not recommended.

The assessment of the state of the seam in a pregnant woman is carried out regularly from 33 weeks. But by ultrasound at 28-30 weeks, the position and presentation of the fetus, the localization of the placenta are determined. This is necessary for the choice of further tactics and method and term of delivery.

The thickness of the seam after cesarean during the second pregnancy

The second pregnancy after cesarean most often also ends with an operation. In the course of suturing a wound on the uterus, doctors prefer to remove the scar tissue. It fuses worse, a divergence of the seam may occur. A fresh wound on the muscles goes through the same stages as in the second pregnancy.

In a non-pregnant woman, a 5-7 mm suture after cesarean is considered very pronounced. The normal thickness of the suture on the uterus after cesarean during the second pregnancy can be just over 3 mm.

If a failed suture was identified before pregnancy, then an operation is performed to excise the scar tissue, and the wound is sutured again.

During pregnancy, the uterus is stretched, it can be thinned even up to 1.5-2 mm. For a period of 38 weeks, this is allowed. This condition does not threaten normal gestation, but is a contraindication for independent childbirth.

Women with a scar on the uterus, regardless of its condition, are hospitalized at 37-38 weeks to resolve the issue of due date. Staying at home in anticipation of contractions in this position is very dangerous.

A formidable complication of scar failure is. In modern conditions, this condition develops extremely rarely, doctors have time to foresee or diagnose pathology and give birth to a young mother in a timely manner.

The first caesarean section is not an absolute indication for repeated births in the same way. But in most cases, doctors prefer not to take risks and perform the operation in order to save the life of the newborn and his mother.