A scar on the uterus in a woman during subsequent gestations becomes a reason for constant concern and control among obstetricians and gynecologists. The muscle tissue of the uterus in the area of the incision during caesarean section(CS) is replaced by connective tissue, which does not stretch or perform any function in the body. In some cases, a new pregnancy, and indeed the patient's life, after the operation is under threat due to the failure of the scar.
Reasons for the formation of an insolvent scar on the uterus
The diagnosis of an "incompetent scar" means that in some areas the scar has become thinner or modified, and if it is stretched while carrying a baby, a rupture may occur in this place. The most common reasons for the formation of an insolvent scar after a CS are:
- complications in postpartum period associated with sutures (suppuration, dehiscence, fistula formation, inflammation);
- the use of low-quality suture material;
- endometritis of the uterus that occurs after CS as a result of infection inside;
- 2 or more surgical interventions on the uterus (this includes not only CS, but also operations to remove fibroids, polyps, long-term surgical abortions).
Signs and diagnosis of an incompetent uterine scar
A clinically insolvent uterine scar does not manifest itself in any way until the moment of conception. After the attachment of the ovum in the uterus and as it grows, the walls of the organ stretch, which contributes to the development of the clinical picture of a poor-quality scar:
- pain in the lower abdomen, cramping in nature;
- stitching sensations when changing body position and sexual intercourse;
- difficulty urinating;
- nausea and vomiting.
With the divergence of the scar along the old seam, the woman feels sharp pain in a stomach. Clinical picture resembles an attack of acute appendicitis, and if the patient is not provided with assistance in a timely manner, the death of both mother and crumbs may occur.
The main methods for diagnosing abnormalities from the uterine scar are ultrasound and hysteroscopy (performed in the absence of pregnancy). During an ultrasound examination, doctors pay attention to indicators such as:
- scar tissue thickness;
- the presence of grooves or niches in the seam area;
- the presence of visible suture materials;
- the condition of the scar over its entire surface;
- change in the lining of the uterus in the area of the scar.
Why is an insolvent scar dangerous for women's health?
When planning a baby after a COP, a woman needs to go through full examination, including ultrasound, to assess the condition of the scar on the uterus. The failure of a scar when carrying a baby poses a threat to a woman's health, namely:
- the risk of uterine rupture during childbirth;
- constantly increased tone uterus;
- bloody vaginal discharge throughout pregnancy;
- risk of miscarriage;
- constant abdominal pain at the slightest touch to the anterior abdominal wall;
- improper attachment of the placenta or its accretion to the wall of the uterus;
- insufficient nutrition of the fetus with oxygen and other substances necessary for its growth and development.
Inconsistent uterine scar and pregnancy
Pregnancy with an incompetent uterine scar is associated with increased risks:
- delay intrauterine development fetus;
- the threat of early interruption;
- the threat of premature birth;
- rupture of the scar on later dates pregnancy or childbirth.
In order to avoid such risks, pregnancy must be planned and if after the CS the suture was found to be inconsistent, then it should be treated before conception. The measures taken in time allow the child to be delivered normally before the due date.
Treatment of an inconsistent scar on the uterus
If this pathology is detected at the stage of pregnancy planning, the patient undergoes immediate surgical treatment. The intervention consists in excision of the scar tissue and the imposition of new high-quality sutures. After such an operation, a woman is not recommended to become pregnant for 2-3 years, since the body needs time for the seam to completely heal and a wealthy scar to form.
Irina Levchenko, obstetrician-gynecologist, specially for the siteA scar on the uterus is a special formation consisting of myometrial fibers and connective tissue and located where there was a violation and further restoration of the integrity of the uterine wall during surgical intervention... The planning and course of pregnancy with a scar on the uterus is somewhat different from a normal pregnancy.
The causes of uterine scarring are not limited to caesarean section. The integrity of the walls of the uterus can be violated during other operations: removal of fibroids, perforation of the uterine wall during curettage, rupture of the uterus during hyperstimulation of labor, various plastic recovery operations(removal of the uterine horn, removal of tubal or cervical pregnancy together with a portion of the uterine cavity).
Scar varieties
Of no small importance is how the incision was made during a caesarean section. The longitudinal incision, which is usually done in an emergency caesarean section, is more prone to failure than the transverse incision in the lower uterus.
Planning a pregnancy with a scar on the uterus
Between the operation, due to which a scar was formed on the uterus, and pregnancy, doctors recommend to maintain an interval of two years - this is how long it takes to form a good scar. At the same time, too long a break is undesirable - more than four years, since even a very good scar can lose elasticity over the years due to atrophy of muscle fibers. The transverse scar is less prone to such negative changes.
Assessment of the condition of the scar
Before planning, you can assess the condition of the scar using ultrasound, X-ray, hysteroscopy or MRI. Each of the methods is valuable in its own way.
Pregnancy with a scar on the uterus
- You need to know that scar on the uterus during pregnancy can cause the placenta to be misplaced: low, marginal or full.
- Possible abnormal placenta accreta varying degrees: to the basal layer, muscular, ingrowth into the muscular layer or complete germination up to the outer layer.
- In the event that the embryo attaches to the area of the scar, doctors make unfavorable forecasts - the likelihood of termination of pregnancy is greatly increased.
- During pregnancy, changes in the scar are most often monitored using ultrasound. At the slightest doubt, doctors recommend hospitalization and observation in a hospital until delivery.
Most dangerous complication there may be a rupture of the uterus at the site of the scar as a result of its thinning and hyperextension. Precede this the most dangerous condition may characteristic symptoms indicating the beginning of scar dehiscence:
- Tension of the uterus.
- Sharp pain from touching the stomach.
- Strong arrhythmic uterine contractions.
- Bloody vaginal discharge.
- Fetal heartbeat disorder.
After the break is completed, the following are added:
- Highly severe pain in a stomach.
- Sharp decline blood pressure.
- Nausea and vomiting.
- Termination of contractions.
A ruptured scar can result in acute oxygen starvation fetus, hemorrhagic shock in the mother due to internal bleeding, fetal death, removal of the uterus.
With a diagnosed rupture of the uterus along the scar, an emergency caesarean section is required to save the life of the mother and child.
Many people care if natural childbirth with a scar on the uterus... If certain requirements are met, such childbirth can be allowed: a single cesarean section in the past with a transverse incision, a presumably well-to-do scar, a normal location of the placenta behind the scar, the absence of any concomitant diseases or obstetric pathology, the head position of the fetus, the absence of a factor that caused the previous caesarean section. It is also important to monitor the condition of the fetus and the presence of all conditions for an emergency caesarean section in the event of a critical situation in the immediate vicinity of the delivery room.
Contraindications to natural childbirth with a scar on the uterus are: a cesarean section with a longitudinal incision in the uterus in history, narrow pelvis, placenta at the site of the scar, placenta previa, several scars on the uterus
During pregnancy and childbirth, the uterus is very huge pressure... When delivery is unable to pass naturally, doctors recommend a caesarean section. They warn that a scar remains on the uterus after such a surgical intervention. Few women know what this is fraught with in the aftermath, and how it can affect the subsequent health of a woman.
Caesarean section as a cause of scar formation
V recent times women are increasingly resorting to artificial childbirth through a cesarean section. Give birth by yourself, suffer for several hours, then recover for a long time after internal breaks- it all sounds intimidating. The operation of the KS does not look so scary - they injected anesthesia, the woman in labor will not feel anything, as her stomach was cut open, the uterus was cut and the baby was taken out. And when he wakes up, the child will already be out of the womb, happy, alive, not crumpled and, most likely, happy. The advantages of a cesarean section over natural childbirth are as follows:
- In some situations, this the only way out to save the life of mother and child;
- No breaks occur internal organs and prolapse of the pelvis;
- Hemorrhoids do not appear from excessive overexertion;
- Caesarean section is faster than the normal labor process;
- A planned operation, for which a woman in labor can calmly prepare and go to childbirth without fading from the pain of contractions.
But obstetricians-gynecologists strongly advise women to give birth naturally. Only in last resort resort to surgical method... Natural childbirth is foreseen by nature. During the entire existence of the world, women have given birth in this way. The disadvantages of a cesarean section are the following:
- Psychological state, with KS, the woman in labor does not feel the connection with the child;
- Recovery after surgery, including limitation in physical activity, so at first you cannot take the child in your arms;
- Recovery from anesthesia;
- A large scar remains on the abdomen;
- A scar remains on the uterus after a cesarean section.
During the operation, it is opened abdomen a longitudinal incision, then the uterus is opened. Her surgeons strip in two ways - transverse or longitudinal. The choice of doctors depends on the location of the fetus and the condition of the mother. A longitudinal scar is more prone to failure than a transverse one. In some cases, when emergency operation, surgeons make a transverse incision of the abdominal cavity.
Scar on the uterus
The remaining scar on the uterus after a cesarean section will make itself felt in the event of another pregnancy planning. A scar is a mark from an incision. In other words, it is a scar that is in the process of healing. It consists of the myometrium of the uterus and connective tissue cells. At the site of this scar, the wall of the uterus is thinner, to varying degrees less elastic and resilient.
Such education can be not only after the COP, but also after other gynecological operations... For example, after myomectomy or surgical termination of pregnancy. The presence of a scar on the uterus can be a serious contraindication for bearing a fetus and childbirth. If education was diagnosed during pregnancy, then it will be provided increased attention to mother and fetus. The gynecologist will plan methods to prevent scar rupture, including repeated CS instead of a regular delivery.
Scar varieties
Many women give birth naturally with a scar on the uterus. It depends on the nature of the education. Doctors gynecologists distinguish two types of scars on the uterus, depending on its properties and thickness:
- Insolvent;
- Wealthy.
An inconsistent scar is distinguished by the fact that it is at that stage of regeneration when it consists only of connective cells. The scar is just starting to heal. In thickness, it is no more than 1 mm. Its inconsistency is also characterized in some cases by a ribbed surface. This formation lacks such a property as elasticity. Therefore, with an increase in the uterus and contractions, it bursts. With such a scar, pregnancy planning is advised to be postponed for a certain period of time so that it passes into the stage of a wealthy education.
A solid scar already contains not only connective cells, but also muscle fibers. Thanks to this composition, it can stretch and contract along with the rest of the tissue of the uterine wall. In terms of thickness, it is approximately 3.4 - 3.7 mm. This indicates that during the enlargement of the uterus or during childbirth, it can withstand the load. With this kind of scar, women in labor even go to natural childbirth, avoiding another scar after the CS.
After a certain time after childbirth, the scar on the uterus should go into the stage of solvency. But in some cases, this does not happen. Doctors identify several reasons why a scar remains in an untenable stage. These include:
- The occurrence of postpartum complications, for example, suppuration at the sutures, inflammation, partial dehiscence, or the formation of fistulas on the surface of the scar;
- Endometritis after CS;
- Not the first gynecological surgery or the presence of scars on the walls of the uterus;
- Slow recovery due to the individual characteristics of the body.
In these situations, doctors prescribe certain types treatments to speed up the regeneration process. Throughout the treatment, the condition of the scar is periodically diagnosed. An insolvent scar has practically no effect on a woman's condition. It does not interfere with life and does not cause pain... However, during pregnancy, it makes itself felt.
At the planning stage of pregnancy, women undergo a complete examination. During the ultrasound, the doctor will see that the uterus after the CS, along the scar. In the process of ultrasound diagnostics, its shape and size will be revealed. However, the consistency of the scar at this stage is very difficult to identify. Therefore, doctors recommend to undergo further diagnostics to clarify the diagnosis.
- X-ray
- Hysteroscopy
On X-ray examination there is a chance to view the uterus with inside and reveal the relief of the scar. The presence of irregularities and depressions on the scar indicates its failure. Hysteroscopy helps to identify the presence of blood networks in the scar, which also indicates the consistency of the formation, its color and shape. On magnetic resonance imaging, doctors determine the ratio of connective cells to muscle fibers... Photo and video recording from research helps to make a diagnosis most accurately.
However, none of them provide a 100% guarantee. accurate diagnosis... The doctor decides on the viability of the scar himself, takes responsibility for the life of the fetus and mother. He also analyzes the anamnesis of the woman in labor, studies the causes of the scar, why the cesarean section was performed for the first time, studies the test results, reveals the body's ability to regenerate. Therefore, such increased attention is paid to a woman in labor with a scar on the uterus.
In late pregnancy, a woman should be especially attentive to herself and listen to every movement, every reaction of the body. The scar can break apart at any time, even if it seemed to be strong enough before. Superfluous exercise stress or a false contraction puts the uterus under such tension that the scar may not be able to withstand it. If appeared following symptoms, then you should immediately consult a doctor, as there is a threat of uterine rupture:
- Sharp pain in the lower abdomen
- Increased body temperature
- Small spotting
- Tension in the uterus
- Knocked down heartbeat fetus
In this case, urgent hospitalization is needed. Based on the results of the examination and examination, the doctor can issue a verdict on an emergency caesarean section. If a woman does not consult a doctor in time for medical care, uterine rupture may occur. Internal bleeding will cut off oxygen to the child, and it will not be possible to save him. Due to severe blood loss, the mother may experience hemorrhagic shock, which also leads to irreversible consequences or death.
Planned COP
In some cases, obstetricians-gynecologists recommend that women give birth through a planned caesarean section. Before making a decision, the doctor carefully examines the history of the woman in labor, analyzes many factors and issues a verdict. These factors in favor of a cesarean section include:
- A narrow pelvis of a woman. The fetus can cause damage and rupture of internal organs if it goes into the light in a natural way, including tearing the uterus along the scar.
- The woman has already given birth more than twice. This indicates a thinning of the walls of the uterus, not only in the area of the scar, but in general.
- There is more than one scar on the uterus. The more scars, the weaker the tissues become.
- Incorrect fetal position. If the fetus naturally comes out with the pelvis forward, then this will create an additional load on the walls of the uterus.
- The reasons why the QS was done for the first time. It is possible that this is due to the characteristics of the organism.
In these situations, the doctor has no doubts about artificial childbirth in a planned manner.
Video: Planned and emergency caesarean section. Indications and consequences of caesarean section.
Ultrasound of the scar after cesarean
After giving birth with CS, doctors monitor the condition of the woman in labor for a long time. The recovery of a woman is slower and more difficult than with natural childbirth... In some cases ultrasound diagnostics pelvic organs are performed immediately after the operation to reveal the integrity of the suture.
The next time an ultrasound scan is performed three days after the CS. At this stage, doctors monitor whether the healing process has begun, whether the uterus has accepted natural shape if there are any other complications. If at this stage deviations are noticeable, for example, swelling of the scar, then this is the first sign of the onset of the disease. It can be endometritis or another postpartum complication that doctors diagnose based on research. Based on the results, the necessary treatment is prescribed.
Early diagnosis of complications helps to avoid serious complications which can lead to further infertility or removal of the uterus. Throughout the entire recovery period, the doctor prescribes periodic diagnostics. Thus, it monitors the process of scar regeneration and prevents the appearance of pathologies in the early stages.
Within 2 years after the artificial birth, the mother is recommended to periodically undergo diagnostics of the suture on the uterus. It is not recommended to become pregnant during this period. This is due to the failure of the seam. Depending on individual indicators, the doctor may allow a woman to plan a pregnancy earlier than the end of this period, if the healing took place without pathologies and at an accelerated pace. Most often in young women, the regeneration process is faster.
Scar thickness after CS
As it turned out, the first two years after surgery, the scar is most likely untenable. The scar on the uterus after cesarean is thin, its rate is about 1 mm. The regeneration process continues for a long time. In rare cases, the doctor diagnoses the consistency of the suture earlier. In terms of thickness, a wealthy scar differs from an insolvent one. Its dimensions are more than 3.5 mm.
If the doctor sees that the thickness of the scar has begun to reach the size of the usual tissues of the uterine wall, then he is free to assume that the formation has reached solvency and it is possible to plan a pregnancy in the near future. Earlier 2 years after a cesarean section, women can hear this only if they carefully followed the doctor's recommendations, were in a state of physical and mental rest, drank prescribed medications and hormones.
An important role is played by the body's ability to quickly recover. This property is more common in young women. Strong organism ready to recover in as soon as possible and endure more than one pregnancy. After the second birth with the help of KS, doctors do not recommend getting pregnant anymore. Since the risk that the uterus will not withstand, and there will be a rupture, is very high.
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