Pregnancy and childbirth with a uterine scar after cesarean , remove fibroids - Causes, Symptoms and Treatment .MF .
scar on the uterus - a dense fabric, which is formed by caesarean section or after other gynecological surgery on the uterus, for example, after the removal of uterine fibroids.Also, the scar on the uterus may occur as a result of perforation (puncturing the wall) of the uterus during the abortion or after removal of the tube with an ectopic pregnancy.
As the number of caesarean section is increasing every year, this topic is becoming increasingly important.
Gynecologists recommends women after cesarean section pregnant, not earlier than in 2-3 years after surgery.What is it for?The fact that only at this point with scar uterus fully restored for normal pregnancy subsequent gestation.
important for normal gestation pregnancy and childbirth is a factor, as the viability of the scar on the uterus.The scar on the uterus can be of 2 types:
- or full-off (ie, when there is a complete recovery of muscle tissue after surgery);
- defective or insolvent (when the connective tissue predominates, instead of
Complete scar on the uterus is not a danger to the pregnant woman and the fetus, because muscle tissue is well stretched and flexible, which is not the connective tissue.Defective scar on the uterus, on the other hand, poses a threat to the life of the mother and child, because it can lead to uterine rupture at the scar in the last weeks of pregnancy or during labor itself.
Normally, the scar on the uterus does not have any symptoms and the pregnant woman, as a rule, do not bother.With increasing gestational age may experience pain in the postoperative scar.They may be associated with spikes in the pelvis, with the threat of miscarriage or stretch the scar on the uterus.The latter is a serious threat, as evidenced by the insolvency of the scar on the uterus.
Pain are local tensile uterine scar.Do not pass when taking antispasmodics, when changing the position of the body in a relaxed state.
In any case, even if the nature of the pain is not entirely clear, and prior to delivery is still very far-pregnant should immediately seek an obstetrician-gynecologist and give details of their complaints.
survey of pregnant women with a uterine scar
On examination of the pregnant, the doctor performs a digital study of uterine scar.The presence of pain can indirectly indicate a failure of the scar.
most reliable method to assess the viability of the scar is ultrasound, which is carried out from 35 weeks of pregnancy.In addition, determine the estimated fetal weight and its previa, placental location relative to the scar.All these indicators are very important for determining the tactics of delivery.It should be noted that in most cases delivery is determined only by tactics in the nursing home on the eve of the upcoming birth.
All pregnant women with a uterine scar strongly recommend hospitalization in a maternity hospital two weeks before the expected date of delivery, that is, 38 weeks of pregnancy.
seam after cesarean section
Childbirth with a uterine scar
give birth whether vaginally or make cesarean section - the "burning" issue of concern to pregnant women.It's no secret that until recently, birth vaginally in women with a uterine scar is a rarity in obstetric practice.In XX century, even even the right to exist, "Once a cesarean section - always a cesarean."Gradually, however, depart from this rule.
In some cases, a woman with a uterine scar can give birth to herself vaginally, and in what cases a caesarean section is required?
Firstly, without a doubt, the main condition for the natural childbirth is the consistency of the scar on the uterus.Insolvent scar is a direct indication for cesarean section.
Second, counts the number of cesarean section history.If a woman has had two or more operations, the risk of rupture of the uterus during labor increases several times.Accordingly, in this case preferably caesarean section.A woman can give birth only to itself when it was once a cesarean section.
Third, be sure to take into account the form of the previous cesarean section, the so-called "rapid access".Nizhnesredinnaya laparotomy (a cross-section above the vagina), which is performed more often, more favorable for natural childbirth in the future.Corporeal cesarean section (a cut from the womb to the navel), on the other hand, leaves no chance to give birth to itself.
Fourth, has a value of placenta previa.If the placenta predlezhit neposredsvenno the rumen, during vaginal delivery is likely placental abruption.As a result, the baby can die.Therefore, in this case, a cesarean is necessary.
Finally, in addition to the medical indication should not forget about the psychological mood of the most expectant mother.If a woman has absolutely no desire to give birth itself or have a pathological fear of the upcoming birth, cesarean section is done at the insistence of the woman.
In other cases, when a pregnant psychologically ready to leave, and there are no medical contraindications for this, the doctor should go forward.Accordingly, the question of delivery should be discussed with your obstetrician in advance.
Planned caesarean section with a uterine scar
Elective Caesarean section is carried out in 38-40 weeks of pregnancy.Transaction date determined by the physician based on the date of the upcoming delivery, rumen condition, maturity degree of the placenta and other factors.
estesstvenno labor with uterine scar
If the birth is planned to conduct vaginally, it is necessary to wait for spontaneous onset of labor.During labor, if indicated, it is possible to use different types of anesthesia, including epidural.But, in contrast to the birth without the scar on the uterus, in women with a uterine scar, you should not use drugs during labor, causing stimulation of labor, such as Enzaprost, Oxytocin.This can lead to uterine rupture.
not recommended to perform amniotomy (opening membranes) that may result in a violation of labor.Therefore, the main principle of labor with uterine scar is minimum medical intervention.The main task of the physician in childbirth with a uterine scar is to monitor the overall health of mothers, not to miss events.At any time, a doctor can be changed tactics and childbirth can be completed in favor of a caesarean section.
After giving birth, the birth of the placenta takes place, and then to assess the scar doctor holding a manual examination of the uterus.The survey is carried out under general anesthesia.Manipulation takes less than five minutes.
course, natural childbirth more beneficial to the health of mother and baby, so if contraindications to physiological childbirth not, insist on caesarean section is not necessary.And, as has been said, childbirth should take place under the control of the dynamic binding obstetrician-gynecologist in a maternity hospital to rule out the risk of uterine rupture and fetal death.
For quick healing keloid scar on the skin of the abdomen after cesarean section is recommended to use a special ointment, such as Contractubex, Solkoseril.
In the postpartum period (and after surgery, too), we recommend abstinence during 1.5- 2 months before the complete cessation of discharge from the genital tract.Sexual intercourse can lead to penetration of infection in the vagina, cervix and uterus itself.
obstetrical consultation on labor with uterine scar:
1. Why can not I get pregnant immediately after a cesarean section?
Due to the insolvency of the scar on the uterus.
2. How long are vaginal bleeding after childbirth and caesarean section?
In both cases, about 4-6 weeks.
3. How many times can do a cesarean section?
not 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 until 40 weeks?
Because there is a possibility of divergence of the scar on the uterus during early labor.
5. Is it possible, if desired, with a scar on the uterus and fibroids have the most?
is possible, if the doctor will allow.
6. Is there a need for advance admission to the hospital if there is a scar on the uterus?
Yes.Hospitalization is required.
7. How soon can have sex after a cesarean section?
When run out from the genital tract.
8. How long does it heal seam on the uterus after cesarean section?
Obstetrician-gynecologist, Ph.D.Christina Frambos.