Scar on the uterus after. Scar on the uterus after cesarean section. Forecast for the recovery period and possible difficulties

According to testing, a woman can give birth again naturally in 80% of cases if the first was a cesarean section. In most situations, it is safer to give birth vaginally than through surgery after a cesarean section. But when women prepare for standard labor, they are met with indignation from doctors. Obstetricians are convinced that if there is a suture on the organ, then it is unacceptable to give birth on your own in the future. There is a rupture of the uterus along the scar during pregnancy.

A uterine scar is a formation created from connective tissue. It is located in the place where the organ walls were damaged and restored during surgery. Pregnancy with the presence of adhesions is different from an ordinary one. The stitch will remain not only after a caesarean section. The walls of the organ are damaged after other surgical interventions.

There are insolvent and wealthy scars on the uterus. A strong suture stretches, contracts, withstands a certain pressure during gestation and childbirth, and is elastic. Here, muscle tissue predominates, which is similar to the natural tissue of the organ.

Which uterine scar is considered healthy? The optimal thickness is 3 mm, but 2.5 mm is allowed. Spike becomes wealthy after three years.

An incompetent scar is inelastic, incapable of contraction, and ruptures, since the muscle tissue and blood vessels are underdeveloped. The organ grows while expecting a child, and the commissure becomes thin. The thinness of the suture cannot be controlled or treated. If the failure of the scar is clearly visible and the thickness is less than 1 mm, then there are prohibitions on planning children. You can understand what a uterine scar is using ultrasound, MRI, X-ray, and hysteroscopy.

Diagnostics:

1. Ultrasound shows the size, unfused areas, and shape of the organ;
2. the internal appearance is assessed by x-ray;
3. hysteroscopy allows you to determine the shape and color;
4. MRI determines the relationship between tissues.

These methods help diagnose the problem, but not a single method allows one to draw correct conclusions about the seam. This is checked during the process of awaiting childbirth.

Causes

Suture failure poses a serious threat to both the woman and the fetus. Adhesions on the organ cause the placenta to be incorrectly positioned. In case of abnormal placenta accreta, when the embryo is attached to the uterine scar, the pregnancy is terminated at any time.

Quite often it is not possible to carry the child to term. When expecting a baby, changes in the suture are monitored using ultrasound. If there is the slightest doubt, the doctor advises the woman hospital treatment before delivery.

What causes the scar on the uterus to become thinner:

1. complications after cesarean section: suture rotting, inflammation;
2. use of low-quality materials during the operation;
3. development of infectious diseases;
4. performing several operations on the organ.

Where to check a uterine scar? To monitor the symptoms of thinning of the uterine scar during pregnancy, you should be systematically examined after pregnancy and surgery. Monthly examinations with a gynecologist and ultrasound are important. Thanks to this, timely treatment is carried out.

Signs of a failed scar:

• pain in the area of ​​the uterine scar;
• stabbing pain during sexual intercourse;
• difficulty urinating;
• nausea and vomiting.

If you suddenly discover signs of incompetent scar on the uterus, you need to urgently consult a doctor. Often the postoperative suture comes apart during menstruation. The organ becomes filled with blood clots, and when there is an inflammatory process, thin areas diverge.

Signs

If the suture rips apart during a second delivery, this is a dangerous phenomenon for mother and child. This requires urgent surgical intervention. With horizontal dissection, the suture rarely diverges. Many operations are performed at the bottom of the uterus; the scar is least susceptible to rupture in subsequent births.

Ruptures occur from a previously performed cesarean section, as there is an incompetent scar on the uterus during pregnancy. The possibility of suture rupture is influenced by the type of incision during surgery. If it's standard vertical section- between the pubis and the navel, then it will disperse faster.

The vertical incision is rarely used, except in emergency situations. It is used when there is a threat to the baby’s life, if the child is lying across, or it is necessary to react quickly to save the mother and fetus. Such a seam breaks in 5-8% of cases. If you have multiple children, the risk of ruptures is increased. It is dangerous when the scar becomes thinner and overstretched.

Signs of the onset of a rupture:

1. the uterus is tense;
2. sharp pain when touching the abdomen;
3. irregular contractions;
4. abundant bleeding;
5. The child's heartbeat is abnormal.

When a rupture occurs, more symptoms are added:

• severe abdominal pain;
• blood pressure decreases;
• vomiting, nausea;
• the contractions end.

As a result, the fetus lacks oxygen, the mother goes into hemorrhagic shock, the child dies, and the organ is removed. The consequences of rupture of the posterior commissure during childbirth are the most unpredictable. If tissue ruptures, a cesarean section is performed, as it is urgent to save the life of the woman and the fetus.

Symptoms of discrepancy during pregnancy

Childbirth with a scar on the uterus during the second pregnancy is carried out without complications, but a certain percentage of suture dehiscence is present. An important point during the second pregnancy is the age of the woman giving birth and the short interval between conceptions. Mothers who gave birth with an incompetent uterine scar undergo repeat surgery.

During repeated pregnancy, some women undergo cesarean section, even with a standard incision on the organ. Statistics on uterine ruptures by scar say that the vertical and horizontal lower incisions rupture in 5-7% of cases. The risk of ruptures is influenced by its shape. The sutures on the organ resemble the letters J and T, and can even be shaped like an inverted T. In 5-8% of cases, T-like scars diverge.

When a rupture occurs during pregnancy, a complex condition occurs that contributes to the death of both. The main cause of complications is the failure of the uterine scar after childbirth. The main difficulty is the impossibility of predicting suture dehiscence. After all, the organ ruptures, both during childbirth and during pregnancy, even after childbirth a few days later. The obstetrician immediately detects the discrepancy during contractions.

Can a uterine scar hurt? Yes, there is discomfort when stretching. A failed suture always hurts a lot, and separation is accompanied by nausea and vomiting.

1. beginning;
2. threatening uterine rupture along the scar;
3. accomplished.

Factors influencing the onset or already occurred suture rupture are noted. The woman in labor feels unwell, has severe pain, and is bleeding.

Symptoms:

• Between contractions there is severe pain;
• contractions are weak and not intense;
• the scar on the uterus hurts during pregnancy;
• the baby moves in a different direction;
• the fetal head has gone beyond the boundaries of the rupture.

When a child’s heartbeat is abnormal, the heart rate slows down, and the pulse decreases, these are symptoms of a discrepancy. There are cases that after a rupture, labor continues and contractions also remain intense. The suture has ruptured, and signs of uterine scar rupture during pregnancy are not even observed.

Threat of rupture

Situations of discrepancy are systematically studied. If you monitor this type of birth, diagnose a suture rupture in time and perform urgent surgery, you can avoid serious complications or reduce them to a minimum. When organizing an unplanned cesarean section, the risk of death of the child due to rupture of the adhesions during childbirth is reduced. There is a rupture of the posterior commissure after childbirth, damage to the walls of the vagina, perineal skin and muscles, as well as disorders of the rectum and its wall.

When a woman is observed throughout the entire period of gestation, experienced obstetricians of the maternity hospital with the presence of necessary equipment. Under control, the birth takes place without complications for the mother and the child.

There are women who want to give birth at home. They should be aware that suture dehiscence may occur, so it is not recommended to perform the birth at home. If a woman gives birth naturally in a non-governmental institution, then it is necessary to clarify whether this hospital has equipment for carrying out an emergency operation.

There are signs that increase the risk of scar rupture:

• during childbirth, oxytocin and medications are used that stimulate uterine contractions;
• in the previous operation, a single-layer suture was applied, instead of a reliable double one;
• repeat pregnancy occurred earlier than 24 months after the previous one;
• a woman over 30 years old;
• presence of vertical dissection;
• the woman has experienced two or more caesarean sections.

There are techniques that diagnose suture rupture. An electronic device monitors the child's condition. There are obstetricians who use a fetoscope or Doppler, but these methods have not been proven to be effective. Institutions advise using electronic devices allowing monitoring the condition of the fetus.

Treatment and prevention

Treatment for uterine scars includes repeated surgery, but there are few invasive methods eliminating the anomaly. Under no circumstances should you refuse therapy.

If you refuse treatment, complications arise:

• rupture during pregnancy or childbirth;
• increased organ tone;
• the scar on the uterus is bleeding;
• severe pain, it is impossible to even lie on your stomach;
• the risk of placenta accreta increases;
• lack of oxygen for the fetus.

It is not difficult to diagnose the complication. When an organ ruptures, the abdomen changes shape, the uterus looks like hourglass. Mom is worried, faints, the pulse is almost not palpable, bleeding begins, and the vagina swells. It is impossible to listen to the fetal heartbeat, as hypoxia occurs and, as a consequence, the death of the child.

The woman is admitted to the hospital, examined and undergoes surgery. First, blood loss in the patient is excluded. During the operation, the uterus is removed and blood loss is restored. After the procedure, the occurrence of blood clots and low hemoglobin is prevented. If the newborn survives, he is sent to intensive care and nursed under machines.

How to treat a scar on the uterus:

1. operation;
2. laparoscopy – excision of the existing incompetent suture and suturing of the walls of the organ;
3. metroplasty – destruction of the septum inside an organ in the presence of many niches.

To prevent uterine ruptures, conception should be planned in advance and examined. If a woman has previously had an abortion or surgery, then the body must recover. If conception occurs with a uterine scar, it is recommended to immediately register with a doctor.

When the patient is responsible for the long-awaited labor activity, chooses a suitable doctor, carefully monitors your health during the second pregnancy, then the birth of a child will be truly joyful. There are mothers who have two scars on the uterus and a third pregnancy is a common occurrence for them. Women are ready to take such a responsible step. You can discuss the stitch and how the birth will proceed with your obstetrician in advance.

Planning and managing a pregnancy with uterine scars is somewhat different from monitoring an expectant mother without any abnormalities. A scar is a durable seal formed by the connective tissue and fibers of the myometrial layer of the uterus. This formation appears at the site of rupture and regeneration of the uterine wall after surgery. A scar on the uterus during pregnancy - is there a chance to give birth to a baby on your own or to prepare for an artificial birth?

The successful development of the fetus depends, first of all, on the condition of the mother’s body. If the surface of the uterus is marked by a mark from a dissection in the past, this, of course, will immediately affect the development of a new life.

Where do pregnancy scars come from?

A rough strip of tissue on the uterus appears not only after a planned or emergency cesarean section. The need to violate the integrity of the sexual muscular organ may be dictated by the following factors:

• gynecological operations (excision of foci of adenomyosis, fibroid nodes);
• termination of pregnancy located in the tube or cervix;
• negative consequences of artificial termination of pregnancy or intrauterine examination;
• regenerative plastic surgery of uterine anomalies (removal of the uterine horn, intrauterine septum).

What is a scar like during pregnancy?

Scarring is a natural process of regeneration of living tissues whose integrity has been compromised. The cut shell can be restored through complete or incomplete regeneration. In the first case, the wound heals with a predominance of smooth muscle cells of myocytes, in the second case, strong fibrous connective tissue becomes the material for scarring.

Accordingly, the dense mark from the previous surgical incision is classified, depending on the quality of healing, based on the degree of its consistency.

Consistent (full) scar formation

The scar is filled mainly with muscle tissue, the structure of which in many ways resembles the “native” tissue of the uterine wall. A healthy scar has a high degree of elasticity, stretches and contracts well and has sufficient potential to take on the strong pressure that the entire uterus experiences during the enlargement of the fetus and during the birth of the child.

Incompetent (incomplete) scar formation

The tissue of such a scar has nothing to do with muscle. It is deprived of the ability to stretch and, therefore, will not contract during contractions. Moreover, dense fabric can simply crack, because it consists mainly of threads connective tissue, while the muscles and blood vessels around it are underdeveloped. During pregnancy, the uterine scar gradually becomes thinner as it enlarges, and modern medicine has no way to influence this process.

If the inferiority of the scar seal is severe (thickness does not exceed 1 mm, there are many inelastic fibers, there are niches and seals in the scar), this can become a significant obstacle to planning motherhood. Normally, the scar on the uterus during pregnancy is no less than 3.6 - 3.7 mm in thickness after 32 weeks of the “interesting” position, and no less than 2 mm at 37 weeks.

Specifics of postoperative incision regeneration

The quality of fusion of dissected uterine membranes is largely influenced by the following circumstances:

Type of operation

Thus, the condition of the scar is influenced by the method of incision of the uterus during cesarean section. At elective surgery and full-term pregnancy bottom part The uterus is cut transversely. The advantages of a transverse scar over a longitudinal one are obvious: the fibers of the cut muscle tissue have a transverse location on the uterus, so they are restored quickly and efficiently. With a longitudinal incision, fibers cut across the muscle tract heal much more slowly. Indications for longitudinal section are emergency delivery in case of severe bleeding and severe fetal hypoxia, as well as delivery at less than 28 weeks.

When cutting benign neoplasm uterus by conservative myomectomy, during which tumor nodes are removed, the localization of the excised nodes, surgical access, as well as the very fact of dissection of the entire membrane are of great importance for the successful regeneration of damaged tissue. Small fibroids that have formed outside the uterus are removed without surgically opening the uterine cavity. After such an operation, a completely wealthy scar is formed, which is many times stronger in strength than the scars that remain after intracavitary surgery when intermuscular fibroids are removed.

The scar that occurs due to accidental damage to the uterus after an artificial termination of pregnancy has a more elastic structure if during the operation the perforation hole was only sutured, without additionally cutting the wall of the uterus.

Terms of conception after surgery

The length of time after surgery is of paramount importance to the extent of scar regeneration. The full structure of muscle tissue is restored 1 to 2 years after the dissection. This is why doctors recommend that women plan a second pregnancy with a uterine scar on average 1.5 to 2 years after surgery. However, a long period of time between the first and second pregnancies (more than 4 years) is also undesirable, since the scar loses its elasticity due to an increase in the percentage of connective tissue in its structure.

Forecast for the recovery period and possible difficulties

The fewer complications after surgery, the better the scar will be. Its normal formation can be hampered by such deviations from the norm after cesarean section as:

• endometritis – inflammation of the inner walls of the uterus;
• partial contraction of the uterus;
• partial rejection of the placenta from the uterus, which entails the need for curettage of the uterine cavity.

Diagnostic study of a scar on the uterus

When planning a second pregnancy with a scar after cesarean section, it is important to undergo full examination to make sure that scar formation on the uterus is complete. To do this, experts use several methods.

1. Ultrasonography. During the procedure, the doctor can assess the condition of the muscle tissue and guess what the thickness of the scar on the uterus will be during pregnancy, study the degree of healing at the site of the previous dissection by the presence of niches (areas in the structure of the scar that have not grown together).
2. X-ray of the uterus. Using this procedure you can study internal structure scar.
3. Hysteroscopy. Using special equipment, the doctor assesses the condition blood vessels located in the scar tissue, its color and shape.
4. MRI. This is the only method by which the volume of connective tissue and muscle fibers in the structure of the scar.

Unfortunately, even such a large set diagnostic methods will not give the doctor a detailed idea of ​​the consistency or failure of scar formation. This can only be verified by practical means, that is, pregnancy and childbirth.

Features of pregnancy with a uterine scar

Pregnancy with a uterine scar is in many ways more difficult than a normal one. The scar often becomes the cause of pathological formation of the placenta - low, marginal or complete presentation. In addition, in some cases there are varying degrees of its improper ingrowth into the basal, muscle layer or complete germination to the outer layer. Pregnancy is unlikely to be maintained if the embryo attaches to the scar area - the prognosis in this case is unpromising.

After pregnancy, the condition of the scar formation is carefully monitored using ultrasound. As soon as there is the slightest concern for the safety of the fetus, the expectant mother will be hospitalized and, most likely, will remain under observation in the hospital until the very birth.

What you should be most concerned about is uterine rupture along the scar during pregnancy. This happens if the scar has become too thin over time and has stretched excessively during pregnancy. You can predict a dangerous condition in the form of scar divergence based on the following specific signs:

1. Feeling strong voltage in the area of ​​the uterus.
2. Intense pain on palpation of the abdomen.
3. Strong irregular contractions of the uterus.
4. Discharge of blood from the vagina.
5. Abnormal or absent heartbeat in the fetus.

When the uterus ruptures along the scar, the clinical picture is supplemented with the following alarming symptoms:

1. Excruciating pain in the lower abdomen.
2. Rapid development of hypotension.
3. Nausea, vomiting.
4. Fading of contractions until complete cessation.

As a result of the incident, the fetus in the womb is deprived of vital oxygen, and the woman in most cases experiences hemorrhagic shock due to massive internal bleeding. Unfortunately, this situation can resolve very badly: the child dies and the uterus has to be removed. There is a chance to save the situation by emergency surgery caesarean section, but this requires timely diagnosis of the pathology.

Medical monitoring of expectant mothers in the presence of complications

In the first months of pregnancy, a woman undergoes a general examination and, if necessary, consults with doctors of related specialties. A pregnant woman will certainly be prescribed ultrasonography. The procedure will help to reliably determine where the embryo has attached to the uterus. If this occurs near the isthmus at the front of the uterine cavity (that is, next to the scar), the pregnancy will most likely be terminated by vacuum aspiration. The need for artificial removal of the fertilized egg is due to the fact that the development of the chorion in the immediate vicinity of the previous site of rupture can provoke thinning of a wealthy scar formation and, as a consequence, rupture of the uterus itself. If you do not intervene in the situation, the child can be born exclusively through cesarean section. However strict prohibitions there is no risk of pregnancy even in this case, so the question of saving the baby is decided by the pregnant woman herself.

The next scheduled screening in combination with ultrasound and analysis of the hormonal status of the FPC is carried out at 20–22 weeks of pregnancy. At this time, it is possible to diagnose abnormalities in the development of the child, determine whether its size corresponds to the gestational age, and detect placental insufficiency, if any. Placental insufficiency is an indication for immediate hospitalization expectant mother and monitoring her in stationary conditions.

If the pregnancy is proceeding satisfactorily, and the woman’s uterine scar is strong, the next scheduled examination awaits the pregnant woman at 37–38 weeks of pregnancy. As a rule, all procedures are carried out where the woman plans to give birth. They also plan the “scenario” of delivery in advance, thinking through the combination medicines, which will be used during childbirth. In such cases, as a rule, antispasmodics, sedatives and antihypoxic agents are used to stimulate blood flow in the uterus and placenta.

Uterine scar and natural childbirth

A woman who has undergone uterine surgery can give birth to a child on her own, doctors say. Delivery is likely to take place without complications if the condition of the expectant mother meets the following requirements:

• only one caesarean section in the past;
• the caesarean section was performed by a transverse incision;
• high probability of scar consistency;
• attachment of the placenta away from the scar;
• absence of serious chronic diseases in the mother;
• absence of obstetric disorders;
• position of the baby head down in the uterus;
• absence of a reason why a caesarean section was performed during the first birth.

Doctors also pay great attention intrauterine development of the baby, and try to foresee in advance the availability of suitable conditions to carry out an emergency caesarean section if a force majeure situation arises.

It is not always possible to realize in practice a pregnant woman’s desire to give birth on her own. An understandable stumbling block for natural childbirth with a uterine scar is:

• longitudinal dissection of the uterus during the first cesarean section;
• narrow pelvis of a woman in labor;
• location of the placenta close to the scar formation;
• low placentation;
• several scars on the uterus.

Natural delivery with a uterine scar. Video

A scar on the uterus is a serious problem in modern obstetrics, especially considering that the frequency of delivery by cesarean section is constantly increasing.

A uterine scar is spoken of when surgery was performed on the uterus. A scar can never have a muscular structure like the myometrium. It is always associated with the formation of connective tissue. If there is a lot of it, then it has a significant impact on contractile activity uterus, sharply disrupting it. This is due to the fact that connective tissue is not capable of contraction.

A scar on the uterus during pregnancy in a woman can be a consequence of such surgical interventions in the past as:

— conservative myomectomy (removal of the myomatous node followed by suturing of the uterine wall);

- suturing the uterine wall after perforation performed during a medical abortion.

The course of reparative processes in a postoperative wound is influenced by whole line factors, which include the type of suture material, the characteristics of the body in relation to the formation certain type collagen, which makes up connective tissue, the presence or absence of infection in the postoperative wound, surgical technique (the better it is, the better the wound healing occurs).

What is an incompetent uterine scar?

To predict the course of pregnancy, it is very important to evaluate the scar on the uterus after cesarean section. One of the reliable ways to assess its quality is ultrasound in the first weeks of pregnancy. Using this method, the thickness of the postoperative scar on the uterus is measured, as well as the identification of possible niches, that is, defects along the scar.

Normally, the scar should have a thickness of 5 centimeters or more by the end of full-term pregnancy. As a rule, to obtain reliable results, either a vaginal sensor is used, or, if an abdominal sensor is used, the bladder must be well filled. The consistency of the uterine scar can be assessed both during pregnancy and at the planning stage. In the latter case, this will make it possible to identify an incompetent scar (complete failure), when pregnancy is contraindicated without certain therapeutic measures.

It is also possible to indirectly assess the consistency of the scar by identifying the characteristics of the course of the postoperative period. Certain circumstances may indicate an increased risk of having an incompetent scar.

Thus, thinning of the scar on the uterus indicates its failure.

How does pregnancy proceed if there is a scar on the uterus?

A scar on the uterus leaves a serious imprint on the course of pregnancy. Every obstetrician-gynecologist knows these features, and therefore takes them into account at the stage of pregnancy management. These should include the following:

- increased frequency of threatened miscarriage;

- development of placental insufficiency in a higher percentage of cases than in the general population of pregnant women;

- abnormalities of placenta attachment (tight attachment, true rotation, placenta previa).

Abnormalities of placental attachment are the most serious problem. They may cause spotting during pregnancy with placenta previa or may cause abnormal separation of the placenta. These, in turn, lead to an increased incidence of manual separations, as well as cases of hysterectomy due to true rotation.

Which scar is insolvent and the reasons for its formation

A scar is considered defective in two cases:

- if its thickness is less than 5 millimeters;

— there are defects (so-called niches).

Usually, a scar becomes insolvent if it develops inflammatory process or poor surgical technique (tissues are not restored layer by layer). Certain signs allow one to suspect an incompetent scar on the mammary tract during pregnancy.

— there was an increase in body temperature in the postoperative period;

- presence of pathological discharge from the wound, etc.

The suture material also has a direct impact on the consistency of the scar. Thus, catgut most often leads to the development of an incompetent scar. Vicryl is the best in this regard suture material, since the tissues heal well.

Grigory Rubtsov - Last Year's Eyes

How to give birth with a uterine scar?

If there is a scar, childbirth with a scar on the uterus can be twofold:

- through natural birth canal(under constant ultrasound monitoring);

- by caesarean section.

It should be understood that vaginal birth is possible only if following conditions:

- absence of indications for cesarean section, which were in the first birth;

— possibility of continuous ultrasound monitoring;

Failure of the scar during childbirth can lead to death for both mother and child. Therefore, for any deviation from normal course such births must be completed by caesarean section as a matter of urgency.

The effect of caesarean section on the condition of the uterus

Every surgical intervention on the uterus does not pass without leaving a trace. Therefore, at present, in gynecology, such a concept as disease of the operated uterus has been formed. It lies in the fact that the operation leads to various neurohumoral abnormalities. As a result, this is accompanied by menstrual irregularities, pain syndrome and other unpleasant symptoms.

Thus, the number of surgical interventions on the uterus in women in reproductive age should be reduced as much as possible. This will avoid certain problems in the future. Obstetrician-gynecologist Marina Slavina

Attention! The Site Administration does not provide any medical services. All materials are for informational purposes only. The same applies to the advisory section. None online consultation will never replace face-to-face medical care, which appears only in specialized medical institutions. Self-medication can cause irreparable harm! For any diseases or ailments, please contact your doctor!

Read along with this article:

• Dilatation of the cervixDilatation of the cervix should only occur in ...

Add a review

Uterine scar and its effect on pregnancy

If there is a scar on the cervix during pregnancy, many women are concerned about its effect on repeated childbirth and the possibility of it occurring naturally.

Reasons for appearance

• C-section

A type of operation that resulted in a scar on the uterus. If the injury is a consequence of a cesarean section, the woman should have an idea of ​​what kind of incision was made. If there is a planned caesarean section, a transverse incision is made in the lower part of the uterus. In this case, there is a high probability of the formation of a full-fledged scar that will withstand repeat pregnancy and childbirth. Placenta accreta, emergency delivery, or a short pregnancy requiring a cesarean section lead to a longitudinal incision being made in the uterus. This condition is unfavorable for the fusion of muscle fibers.

• Other reasons

The cause of the scar may be a previous conservative myomectomy, suturing of a perforation on the cervix, or removal of the fallopian tube. The damage formed during myomectomy is characterized based on the presence of an opening of the uterine cavity. If the fibroid is small, it is often located outside the uterus and opening its cavity is not required. In this case, a wealthy scar is formed and its thickness is sufficient for bearing a child in the future. Perforation of the uterus during an abortion leads to positive results if it was carried out only by suturing the hole itself, without cutting the uterine walls.

Scar condition

In order to predict pregnancy and further childbirth in the presence of a scar on the uterus, it is necessary to know the degree of its healing, based on which it can be solvent (full) or insolvent. A uterine scar is healthy if the muscle fibers have fully recovered after surgery and its normal size is 2.5 mm or more in the narrowest area. This damage has an elastic structure, capable of both contraction and stretching, so pregnancy with such a scar passes without complications. If the scar consists mainly of connective tissue, it is classified as inferior, since it is not able to stretch or contract. Several factors influence how the uterine scar will recover:

Postoperative pregnancy

The time interval between the operation and the onset of pregnancy plays an important role in scar healing. For optimal formation, at least 12 months are required. However, if you are planning a pregnancy, you should not wait more than 4 years after a cesarean section, as the scar will become covered with connective tissue and become less elastic.

Postoperative period

The period following the operation, as well as possible complications affect the condition of the rumen. Complications include intrauterine inflammation, weak contraction after childbirth, delayed placenta followed by cleansing.

Diagnosis of the condition

If you have a scar on the uterus, you need to undergo an examination to determine its consistency even before pregnancy occurs. This is necessary for a more accurate prognosis of the course of pregnancy with a scar and subsequent births. If there is a risk of scar failure, this should be identified outside of pregnancy. Several methods are used to examine damage:

• Hysterosalpingography

A reagent is injected into the uterine cavity, after which the uterus and fallopian tubes are examined using X-ray equipment. The pictures will show the condition of the scar from the inside, its location, as well as the internal shape of the uterus, its cervix and the degree of deviation from the middle. Unfortunately, this study gives an incomplete picture, therefore it is used as additional method obtaining information after cesarean section.

• Hysteroscopy

The most informative diagnostic method is to examine the inside of the uterus using a very thin optical instrument inserted through the vagina. The study can be carried out only 8 months after cesarean section on the 4th day of the menstrual cycle. A full-fledged scar should have a uniform pink color without white inclusions.

This method is used after pregnancy has occurred, since other methods are unacceptable.

Indications for independent childbirth

In most cases, doctors try to play it safe, and a pregnancy with a scar ends in a cesarean section. However, today the patient can be given the opportunity to give birth to a baby in a natural way. The following conditions must be met:

• Pregnancy occurred no earlier than 24 months later. after surgical intervention. In this case, we can talk about the consistency of the scar and the ability of the surrounding tissues to withstand the load during contractions;
• The ultrasound examination shows the consistency of the scar;
• The weight of the unborn child should be small. The norm does not exceed 3.5 kg. Otherwise, the scar on the uterus will not withstand the load, thinning of the tissues and placental abruption will occur;
• Natural birth is allowed only if the baby is in cephalic presentation;
• The placenta must be located along the posterior uterine wall. Otherwise, uterine rupture may occur, which will lead to fetal asphyxia and death;
• Correspondence between the size of the pelvis and the head of the unborn baby. Otherwise, high pressure will be exerted on the lower part of the uterus, which will lead to its overstretching;
• Pregnancy occurs when there is no more than one scar on the uterus;
• The fetus develops without pathological changes and without placenta previa;
• The first caesarean section occurred unplanned or the pregnancy is accompanied by complications.

We will select a good doctor and cosmetologist for free

Indications for caesarean section

In addition to the above indications during pregnancy with a scar, there may be factors that indicate a mandatory cesarean section.

• Failed scar

This factor is detected both by ultrasound and in the presence of certain symptoms: scar pain, pain in the lower uterine segment and discomfort indicate that additional research is necessary.

• Pregnancy time

If pregnancy occurs earlier than 18 months. after cesarean. The chance of an incompetent scar is quite high, so complications may arise during natural childbirth.

• Fetal weight

If the norm maximum weight the child is exceeded and the weight is more than 3.5 kg, the anterior uterine wall experiences excessive stress and stretching, therefore natural childbirth can be dangerous because the scar on the uterus can break apart.

• Fetal presentation

Childbirth with a breech or leg presentation is accompanied by a high risk, both for the child himself and for the mother in labor. If the child lies obliquely and transversely, this is an undeniable factor for cesarean section, regardless of the fact that the pregnancy occurs with a scar.

• Location of the placenta

With placenta previa, there is a high risk of placenta abruption, which will result in severe bleeding. If the placenta is located low on the anterior uterine wall, there is Great chance its attachment to scar tissue, and this threatens chronic fetal hypoxia. Moreover, pregnancy with a scar can be dangerous because placenta accreta occurs, and this also threatens fetal hypoxia.

• Pelvic width

If a woman in labor has a very narrow pelvis, this can lead to rupture of the uterus along the scar due to excessive tension of the tissue in its area.

• Number of scars

If there is more than one scar on the uterus that appeared during a cesarean section or other surgical procedures, then natural labor is impossible.

• Fetal pathology

If the fetus develops with pathological abnormalities, childbirth without surgical intervention can be dangerous both for him and for the woman in labor.

• Indications for the first cesarean section

If the first cesarean section was performed according to absolute indications, based on the state of health and clinical features, then the second birth cannot be natural.

Management of natural childbirth

Most doctors try to give preference to natural labor, but a scar on the uterus puts such women in labor at risk, since placenta accreta and scar divergence can occur. In this case, the natural birth process can only take place if certain equipment and conditions are available in the maternity hospital. Required conditions include:

• Ultrasound and fetal monitoring

As soon as a patient with a scar enters the hospital with contractions, an ultrasound examination should be immediately performed. Based on the results, the doctor will evaluate the position of the baby, the placenta, the condition of the scar, as well as a number of other points that affect natural labor. If the norm for all indicators is not exceeded, then there is no reason for concern. In order to have constant control over the condition of the fetus and listen to its heartbeat, the woman is connected to a CHT machine.

• Anesthesia and resuscitation

To smoothly dilate the cervix and relax the muscles, the woman in labor needs to receive epidural anesthesia. In addition, there must be a prepared operating room and intensive care unit for the woman and the unborn baby.

Contraindications for natural childbirth

When having a natural birth with a scar on the uterus, it is strictly prohibited:

• Stimulate labor with oxytocin, since rapid labor with a scar can lead to the uterus breaking down and rupturing;
• Use forceps or turn the fetus for malpresentation;
• Wait more than 15 hours if labor is weak, water breaks and the cervix is ​​not dilated;
• The slightest manifestation alarming symptoms requires immediate medical intervention.

Caesarean section during labor

If during natural labor there are difficulties on the part of the woman in labor or the fetus, an emergency cesarean section is performed. Complications include acute fetal hypoxia, premature rupture of amniotic fluid and lack of opening of the cervix, placental abruption, rupture of the uterine muscles, bleeding, threatened uterine rupture, placenta accreta, etc.

Even if there is a scar in the uterine area, there is a possibility of natural childbirth. If all conditions are met, the probability of a scar rupture is 1 in 100 cases. The main thing is to consult a doctor in time. Successful birth, health to you and your unborn baby!

• Is natural childbirth possible?

Where it's thin, that's where it breaks! Do you know this expression? What is the consistency of a uterine scar? What is a scar? In what cases does it occur? How long does it take for it to fully form? Scar thickness and consistency - are these concepts the same? Is it possible for a scar to diverge during pregnancy? What are the conditions for a natural birth for a woman with a uterine scar? Is it worth connecting the emotional component? Or is it simply necessary to soberly and competently assess the situation? Let's look at these questions in order.

Surgical interventions on a woman’s body and possible consequences

A wonderful idea of ​​nature - the creation female body in order to fulfill the holy and noble mission, to bear and give birth to full-fledged offspring! The norm of a full-fledged family is the creation of conditions for fertilization, gestation and birth of healthy offspring. However, not every representative of the fair half of humanity can boast of complete women's health during pregnancy. On the path to healthy motherhood, various obstacles may arise, which, with a competent, correct, timely, qualified approach, can be overcome and resolved. We are talking about forced surgical interventions in a woman’s body, necessary to correct her health.

For example, an operation such as a conservative myomectomy can restore a patient's ability to conceive. The fibroid is removed, but the organ is preserved. However, after surgery, as a rule, a scar always forms. A scar can also occur during various necessary plastic reconstructive surgeries (when the uterine horn is removed, a tubal or cervical pregnancy is operated on simultaneously with the uterine angle). The wall of the uterus is perforated during surgery to forcefully remove the fertilized egg; if labor is overstimulated, rupture may occur. For some women during pregnancy, doctors prescribe a planned caesarean section if they are unable to deliver on their own. As a result, the integrity of the uterus is compromised. After suturing the incisions, punctures or ruptures made, a scar is formed on the uterus. All of this can have consequences during pregnancy.

Restoration of sutures after surgery

A uterine scar is a special type of formation that consists of myofibrils and connective tissue. It is located in the place where surgical intervention was performed and a violation occurred, and then the integrity of the uterine wall was restored. Analysis of scar formation and recognition of its consistency is very important for the further prognosis of a woman’s condition, the possibility of bearing a child and spontaneous childbirth. For this, there are a number of criteria by which the norm of a formed, wealthy scar on the uterus is determined.

What signs characterize a wealthy (full) scar? It is elastic and stretches well during pregnancy. It contains full-fledged muscle fibers. When forming a scar, it is especially important how the dissection was performed. If the cut was made across the muscle fibers, then the chances that they will heal well and recover are greater than if they were cut lengthwise. The timing of scar formation plays a role. Doctors believe that the most best time, which should take place after the operation, approximately 1-2 years. But no more than 4 years, because the scar becomes overgrown with connective tissue, and this, in turn, reduces its elasticity.

Signs that indicate inferiority (failure) of the scar are its unevenness, the outer contour is intermittent, it is thinned by less than 3-3.5 mm. If more than 3-4 years have passed after the operation, then a lot of connective tissue forms in it, it becomes inelastic and can separate during pregnancy.

Types of diagnostics

If the family has decided to conceive a child and the woman’s uterus has already been subjected to surgical intervention at this point, it is necessary to diagnose the formed scar to predict the course of the planned pregnancy. If the operation took place not long ago, diagnostics will help determine the rate of healing, answer the question of how the scar is formed, and evaluate it (the thickness of the scar and its viability are different concepts!).

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

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

Varieties of tripe

The scar can be solvent or insolvent.

A wealthy scar is characterized by a predominance of muscle tissue, similar to the natural tissue of the uterine wall. A healthy scar is elastic, can stretch, contract and withstand significant pressure during pregnancy and childbirth.

An incompetent scar is described as inelastic, unable to contract and prone to rupture due to the fact that for some reason a large area of ​​it consists of connective tissue with simultaneous underdevelopment of muscle tissue and the network of blood vessels. The gradual growth of the uterus during pregnancy leads to a thinning of this scar. Thinning of the scar on the uterus, in turn, is an uncontrollable process that is not subject to any treatment.

Severe inconsistency of the uterine scar (thickness less than 1 mm, niches, thickening or depressions in the scar, overwhelming predominance of connective tissue) may even be a contraindication to planning pregnancy.

The way the incision was made during a caesarean section is of considerable importance. A longitudinal incision, which is usually made in an emergency caesarean section, is more prone to failure than a transverse one in lower section uterus.

Planning a pregnancy with a uterine scar

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

Scar assessment

The condition of the scar can be assessed before planning using ultrasound, x-ray, hysteroscopy or MRI. Each method is valuable in its own way.

Ultrasound helps to find out the size of the scar (the thickness of the uterine wall in this area), to see the existing niches (the presence of unfused areas in the thickness of the scar), and its shape.

X-ray of the uterus (hysterography) allows you to evaluate the internal relief of the scar.

As a result of hysteroscopy, it is possible to determine the color and shape of the scar, the vascular network of the scar tissue.

MRI is considered the only method by which it is possible to determine the ratio of connective and muscle tissue in the composition of the scar.

Despite so many methods used to assess the condition of the scar, none of them will allow us to make an absolutely accurate conclusion about the consistency or failure of the scar. This can only be verified in practice, that is, during pregnancy and childbirth itself.

Pregnancy with a scar on the uterus

You need to know that a scar on the uterus during pregnancy can cause an incorrect location of the placenta: low, marginal or complete presentation.

Pathological accretion of the placenta of varying degrees is possible: to the basal layer, muscle, growth into the muscle layer or complete germination up to the outer layer.

If the embryo attaches to the scar area, doctors make unfavorable prognoses - the likelihood of termination of pregnancy is greatly increased.

During pregnancy, changes in the scar are most often monitored using ultrasound. If there is the slightest doubt, doctors recommend hospitalization and observation in a hospital until delivery.

Most dangerous complication The uterus may rupture at the site of the scar as a result of its thinning and overstretching. Precede this most dangerous condition There may be characteristic symptoms indicating the beginning of scar divergence:

Uterine tension.

Sharp pain from touching the stomach.

Strong arrhythmic uterine contractions.

Bloody vaginal discharge.

Fetal heartbeat disturbance.

After the break is completed, the following are added:

Very severe abdominal pain.

A sharp decrease in blood pressure.

Nausea and vomiting.

Stopping contractions.

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

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

Many people are concerned about whether natural childbirth with a uterine scar is real. If certain requirements are met, such births may be permitted: a single previous cesarean section with a transverse incision, a presumably healthy scar, normal location placenta behind the scar area, absence of any concomitant diseases or obstetric pathology, cephalic position of the fetus, absence of the factor that caused the previous cesarean section. Monitoring the condition of the fetus and the availability of all conditions for an emergency caesarean section in the event of a critical situation in the immediate vicinity of the delivery room are also important.

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