Uterine rupture along a scar: what you need to know about the problem? Uterine rupture along a scar: a serious and dangerous complication during pregnancy

Types Features of the recovery period In the hospital Home care Complications Subsequent pregnancies

A caesarean section is a delivery surgery during which the baby is removed through an incision in the uterus. Despite all its advantages and sufficient popularity today, young mothers are worried about how the suture after a cesarean section will look after a while (isn’t it ugly?), how noticeable it will be and how long the healing process will take. This depends on what kind of incision the surgeon made, whether complications will arise during the postpartum period, and how competently the woman cares for the operated area of ​​her body. The more informed a woman is, the fewer problems she will have in the future.

Kinds

The reasons why a doctor decides to perform a cesarean section can be very different. Depending on the delivery process and complications encountered during the delivery, incisions may be made in different ways, resulting in different types of sutures that require special care.

Vertical seam

If acute fetal hypoxia is diagnosed or the woman in labor begins to experience heavy bleeding, a caesarean section is performed, which is called corporal. The result of this operation is a vertical suture starting from the navel and ending in the pubic area. It is no different in beauty and in the future it will spoil the appearance of the body quite strongly, since the scars are nodular in nature, very noticeable against the background of the abdomen, and are prone to compaction in the future. This type of operation is performed quite rarely, only in emergency cases.

Horizontal seam

If the operation is performed planned, a Pfannenstiel laparotomy is performed. An incision is made transversely, above the pubis. Its advantages are that it is located in a natural fold of skin, the abdominal cavity remains unopened. Therefore, a neat, continuous (special application technique), intradermal (so that there are no external manifestations) cosmetic suture after a cesarean section is invisible on the body.

Internal seams

Internal sutures on the wall of the uterus in both cases vary in the way they are applied. The doctor is guided here by the goal of achieving the best possible conditions for faster wound healing without complications and reducing blood loss. You cannot make a mistake here, since the course of subsequent pregnancies depends on this. During a corporal operation, a longitudinal internal suture is made after a cesarean section; during a Pfannenstiel laparotomy, a transverse suture is made:

the uterus is stitched with a continuous single-row suture made of synthetic, very durable, self-absorbing material; the peritoneum, like the muscles, is sutured with continuous catgut stitches after cesarean section; the aponeurosis (muscle connective tissue) is sutured with absorbable synthetic threads.

The speed of healing, features of care, various complications - all these important points directly depend on what kind of incision was made during the caesarean section. After childbirth, doctors advise patients on all issues that cause them doubts, anxieties and fears.

About personalities. Hermann Johannes Pfannenstiel (1862–1909) was a German gynecologist who first introduced the surgical transverse incision, which received his name.

Features of the recovery period

It is the type of incision made that will determine how long the suture takes to heal after a cesarean section in terms of pain and other consequences of the operation. With a longitudinal one you will have to tinker longer, and the risk of complications will be much higher than with a transverse one.

Pain

After childbirth, a wound remains on the uterus, as well as on the anterior wall of the peritoneum, so it is not surprising that after a cesarean section the suture hurts (even severely) in the first weeks, or even months. This is a natural reaction of the tissue to the incision made, so the pain syndrome can be blocked with the most common painkillers:

immediately after the operation, analgesics (narcotics) are prescribed: morphine and its varieties, tramadol, omnopon; in the subsequent period, you can use analgin, supplemented with ketane, diphenhydramine and other anti-inflammatory non-steroidal drugs.

At the same time, do not forget that the painkillers used should be prescribed by a doctor, taking into account the lactation period. As for the question of how long the stitch hurts after a cesarean section, it depends on its type. The longitudinal one will bother you for about 2 months, the transverse one - 6 weeks with proper care and without complications. However, for another year, a woman may feel a pulling, unpleasant sensation in the operated area.

Hardness

Many people are concerned about the fact that after a caesarean section the suture is hard and painful: within 2 months this is quite normal. Tissue healing occurs. In this case, the scar does not immediately become soft and invisible. You need to come to terms with the fact that some time must pass, which can be calculated not even in months, but in years.

A vertical (longitudinal) hard scar lasts 1.5 years. Only after this period has passed will the tissues gradually begin to soften. Horizontal (transverse) cosmetic heals faster, so hardness and compaction above the seam (adhesions, tissue scarring) should go away within a year. Many people notice that over time a characteristic fold forms over the suture, which in the absence of pain and suppuration does not pose a problem. This causes scarring of nearby tissues. To avoid unpleasant consequences, it is recommended to do an ultrasound. It is much more serious if a lump appears above the suture after a cesarean section. Some people notice it already in the first year, while for others it manifests itself much later. The sizes can be completely different: from a small pea to a walnut. Most often it is crimson or purple in color. In this case, a visit to a doctor and an ultrasound scan are mandatory. This can be either harmless tissue scarring or fistula, inflammation, suppuration and even cancer formation.

The hardness of the scar, all kinds of folds and compactions around it in the first year after surgery are a fairly common phenomenon. If all this is not accompanied by severe pain and suppuration, there is no need to worry. But as soon as a lump appears on the seam and the above symptoms appear, consultation with a specialist and treatment are inevitable.

Discharge

If the suture after a caesarean section oozes ichor (clear liquid) in the first week, there is no need to worry. This is how healing occurs, it is a natural process. But as soon as the discharge becomes purulent or bleeding, begins to emit an unpleasant odor, or flows for too long, you should immediately contact a specialist.

Itching

For everyone who has had a caesarean section, the scar is very itchy after a week, which frightens some. In fact, this indicates the healing of the wound and nothing more. This is an indicator that everything is going its way. However, touching and scratching the belly is strictly prohibited. Now, if the scar not only itches, but already burns and bakes, causing suffering, you must definitely tell the doctor about it.

In order for the recovery period after cesarean to proceed without undesirable consequences and complications, a woman needs to learn how to properly care for the operated area.

More details about recovery after cesarean section in our separate article.

Through the pages of history. The name of the caesarean section operation goes back to the Latin language and is literally translated as “royal incision” (caesarea sectio).

In the hospital

The first treatment of the suture after a caesarean section is carried out in the hospital.

After the examination, the doctor decides how to treat the seam: to avoid infection, antiseptic solutions are prescribed (the same brilliant green belongs to them). All procedures are carried out by a nurse. The bandage is changed daily after a cesarean section. All this is done over the course of about a week. After a week (approximately), the sutures are removed, unless, of course, they are absorbable. First, the knot that holds them is plucked off from the edge with a special tool, and then the thread is pulled out. Regarding the question of whether it is painful to remove stitches after a caesarean section, the answer is unlikely to be clear. This depends on different pain threshold levels. But in most cases, the procedure is comparable to eyebrow plucking: at least the sensations are very similar. In some cases, an ultrasound scan of the suture is prescribed after surgery to understand how the healing is progressing and whether there are any abnormalities.

But even in the hospital, before discharge, no one will be able to tell you exactly how long the suture will take to heal after a caesarean section: the process is definitely individual for everyone and can follow its own, separate trajectory. Much will also depend on how high-quality and competent the home care for the operated area will be.

Home care

Before being discharged home, a young mother needs to find out from a doctor how to care for a suture after a cesarean section without medical assistance, at home, where there will be no qualified medical personnel and professional aids.

Do not lift heavy objects (anything that exceeds the weight of the newborn). Avoid heavy physical activity. Do not lie down constantly after a cesarean section, walk as much and as often as possible. If there are any complications, you will need to treat the seam at home with brilliant green or iodine, but this can only be done with the doctor’s permission if the scar gets wet and oozes even after discharge from the hospital. If necessary, watch a special video or ask your doctor to tell you in detail how to treat the seam at home. At first, it is not the scar itself that is wetted, but only the area of ​​skin around it, so as not to burn the fresh wound. As for the timing of how long the suture needs to be treated after a cesarean section, this is determined by the nature of the discharge and other features of scar healing. If everything is in order, a week after discharge will be enough. In other cases, the time is determined by the doctor. To prevent seam divergence, wear a bandage that secures the abdomen. Avoid mechanical damage after cesarean section: so that the scar is not subjected to pressure and rubbing. Many people doubt whether it is possible to wet a stitch: after discharge from the hospital, you can shower at home without a doubt. However, there is no need to rub it with a washcloth. Eat right for faster tissue restoration and faster healing of scars. By the end of the 1st month, when the wound has healed and the scar has formed, you can ask your doctor how to coat the suture after a cesarean section so that it is not so noticeable. Pharmacies now sell all kinds of creams, ointments, patches and films that improve skin restoration. You can safely apply ampoule vitamin E directly to the scar: it will speed up healing. A good ointment for sutures, which is often recommended for use after cesarean section, is Contratubes. Several times a day (2-3) for at least half an hour, expose your stomach: air baths are very useful. Check with your doctor regularly. It is he who will tell you how to avoid complications, what can and cannot be done, when to do an ultrasound of the suture and whether it is necessary.

So caring for a suture after a cesarean section at home does not require any special efforts or supernatural procedures. If there are no problems, you just need to follow these simple rules and pay attention to any, even minor, deviations from the norm. You should immediately report them to your doctor: only he can prevent complications.

This is interesting! Not long ago, scientists concluded that if the peritoneum is not sutured during a cesarean section, the subsequent risk of speck formation is reduced to almost zero.

Complications

Complications and serious problems with the suture after a cesarean section can occur in a woman at any time: both during the recovery period and several years later.

Early complications

If a hematoma has formed on the suture or it is bleeding, most likely, medical errors were made during its application, in particular, the blood vessels were poorly sutured. Although often such a complication occurs due to improper treatment or careless change of the dressing, when a fresh scar has been roughly disturbed. Sometimes this phenomenon is observed due to the fact that the sutures were removed either too early or not very carefully.

A fairly rare complication is suture dehiscence, when the incision begins to creep in different directions. This can happen after a caesarean section on days 6-11, since the threads are removed within this period. The reasons why the suture came apart could be an infection that prevents the full fusion of tissues, or weights over 4 kg that the woman lifted during this period.

Inflammation of the suture after cesarean section is often diagnosed due to insufficient care or infection. Alarming symptoms in this case are:

elevated temperature; if the suture festers or bleeds; its swelling; redness.

So what should you do if the suture after a cesarean section becomes inflamed and festers? Self-medication is not only useless, but also dangerous. In this case, it is necessary to consult a doctor promptly. In this case, antibiotic therapy (ointments and tablets) is prescribed. Advanced forms of the disease can only be eliminated through surgery.

Late complications

Ligature fistulas are diagnosed when inflammation begins around the thread used to stitch blood vessels during a caesarean section. They form if the body rejects the suture material or the ligature becomes infected. This inflammation manifests itself months later as a hot, red, painful lump, from which pus may leak from a small hole. Local processing in this case will be ineffective. Only a doctor can remove the ligature.

Hernia is a rare complication after cesarean section. Occurs with a longitudinal incision, 2 operations in a row, several pregnancies.

A keloid scar is a cosmetic defect, does not pose a threat to health, and does not cause discomfort. The reason is uneven tissue growth due to the individual characteristics of the skin. It looks very unaesthetic, like an uneven, wide, rough scar. Modern cosmetology offers women several ways to make it less noticeable:

conservative methods: laser, cryo-impact (liquid nitrogen), hormones, ointments, creams, ultrasound, microdermabrasion, chemical peeling; surgical: scar excision.

Cosmetic suture plastic surgery is selected by the doctor in accordance with the type of incision and individual characteristics. In most cases, everything goes well, so that no external consequences of cesarean are practically visible. Any, even the most serious, complications can be prevented, treated and corrected in time. And those women who will give birth after the CS need to be especially careful.

Wow! If a woman no longer plans to have children, the scar after a planned cesarean can be hidden under... the most ordinary, but very elegant and beautiful tattoo.

Subsequent pregnancies

Modern medicine does not prohibit women from giving birth again after a cesarean section. However, there are certain nuances relating specifically to the seam that you will have to deal with when carrying subsequent children.

The most common problem is that the suture after a cesarean section hurts during the second pregnancy, especially in its corners in the third trimester. Moreover, the sensations can be so strong, as if he is about to break apart. This causes panic for many young mothers. If you know what dictates this pain syndrome, your fears will go away. If a period of 2 years was maintained between the cesarean and subsequent conceptions, a discrepancy is excluded. It's all about the adhesions that form during the restoration of wounded tissue. They are stretched by the increased size of the abdomen - hence the unpleasant, nagging pain. You will need to inform your gynecologist about this so that he can examine the condition of the scar using an ultrasound. He can recommend some pain relief and emollient ointment.

You need to understand: the healing of a suture after a cesarean section is very individual, it happens differently for everyone and depends on many factors: the process of childbirth, the type of incision, the state of health of the mother, proper care in the postoperative period. If you keep all these nuances in mind, you can prevent many problems and avoid unwanted complications. After all, at this stage it is so important to give all your strength and health to the baby.

Everyone knows that after childbirth through a cesarean section, a scar remains on the abdomen, since during this operation, doctors make an incision in the soft tissues of the abdominal cavity and the wall of the uterus. In this case, the incision is quite large so that the baby can be easily pulled out into the light without injuring him.

The types of incisions during a caesarean section directly depend on the course of labor, for example, in case of acute fetal hypoxia or heavy bleeding in the expectant mother, the doctor may decide to perform corporal caesarean section. This means that the incision on the abdomen will be vertically from the navel to the pubic area.

And the wall of the uterus is opened with a longitudinal incision. However, this type of cesarean section is performed quite rarely, since such a suture after a cesarean section is not particularly beautiful - it is very noticeable, tends to become thicker over time, and increases in size.

Typically, a caesarean section is performed Pfannenstiel laparotomy. This is an incision into the skin and subcutaneous fat tissue in the transverse direction, passing along the suprapubic fold. In this case, the abdominal cavity is not opened, and due to the transverse direction of the incision and the fact that it is located inside a natural skin fold, the cesarean section scar will subsequently become almost invisible.

Cosmetic seam after a caesarean section, it is usually applied precisely with a Pfannenstiel incision. With a corporal incision, the strength of tissue joining must be very high, which requires interrupted sutures, and a cosmetic suture after such a cesarean section is absolutely not suitable.

Internal seams, which are applied to the wall of the uterus, have a large number of options, for example, you can use the hardware technique of applying ligatures. The main thing here is to achieve better conditions for the healing of the uterus and reduce blood loss, since the outcome of subsequent pregnancies depends on the strength of the sutures.

Pain relief after caesarean section

As a rule, so that the suture after a cesarean section does not hurt too much, the woman in labor is prescribed painkillers. They are usually used only in the first days, and then they are gradually abandoned. In addition to painkillers, antibiotics may also be prescribed to avoid complications caused by infection.

Also, after a cesarean section, one cannot do without medications that will promote contraction of the uterus and help normalize the functions of the gastrointestinal tract. After the third day, almost all women in labor refuse to use drugs, and already six days after a cesarean section, the sutures are removed, unless, of course, they are self-absorbing.

After the suture heals, it will become almost invisible and will not cause unnecessary trouble to the mother. Of course, if she follows the doctor’s recommendations and takes proper care of him.

How to care for caesarean section stitches?

While you are in the maternity hospital, daily dressings and antiseptic treatment of the post-cesarean suture will be carried out by the medical staff, and after discharge the doctor will tell you how to care for the postoperative suture yourself at home.

The main thing is to remember that doctors will allow you to pamper yourself with a shower only a day after the stitches are removed, and to rub the stitch with a washcloth after a week. If the postoperative period is accompanied by complications, the doctor may prescribe special ointments that will help the suture heal as quickly as possible.

What complications can there be in the postoperative period?

These may be early complications or those that appear after some time. Usually early complications manifest themselves even before the removal of stitches placed after a caesarean section - in the maternity hospital. These include minor bruises and bleeding. You will easily notice them - the bandage on the seam will get wet with blood. If this happens, immediately inform the medical staff so that the wound does not begin to fester.

It may also occur seam divergence. This complication is dangerous 1-2 days after removal of the ligatures, that is, 7-10 days after cesarean section. To prevent this from happening, avoid strenuous exercise. If you notice a seam divergence even in a small area, do not try to treat it yourself, but immediately seek qualified help.

Still possible suppuration of the suture. In order to prevent this, you undergo antibacterial therapy in the maternity hospital, but despite this, in some cases the suture still begins to fester.

First, swelling and redness appear, painful sensations are possible, and the skin around the suture left after a cesarean section is tense, then the medical staff makes dressings with a special antibacterial solution, and if the mother’s condition worsens - the temperature rises, the general condition worsens, then doctors can prescribe antibiotics and send you to the gynecological department for treatment.

Late complications

Such complications do not appear immediately; it may take more than one month. The most common complication among them is ligature fistulas. This complication after cesarean section occurs in many women in labor. It occurs due to the body’s rejection of suture material.

The process of developing ligature fistulas is quite long: first there is swelling, then redness, pain, and then pus breaks out. If you carefully examine the wound, you can see in it the culprit of all the troubles - the remaining ligature. Treating it yourself - applying antiseptic solutions and creams - is useless; the fistula will either close or burst again. Therefore, you need to contact a specialist to remove the thread.

Methods for correcting scars after cesarean section

Usually, when performing a caesarean section, doctors try to make the suture as carefully as possible so that after eight to twelve months it becomes almost invisible. However, an operation is an operation, and in any case, after it the scar will be less noticeable for some and more noticeable for others. Therefore, a few months after surgery, you will begin to wonder whether how to remove a scar, left after a caesarean section.

Today, special aesthetic surgery clinics cope with this problem very effectively, where in a few sessions you will get rid of scar tissue using a laser. Before you go for laser correction, you should consult with your doctor so that he can determine, based on the condition of the seam, when it would be best to undergo the procedure.

The healing time of sutures on the uterus primarily depends on two points - on the direction in which the incision was made, and on the type of suture material used to suturing the walls of the uterus.

In practice, a horizontal incision is mainly used on both the abdominal wall and the uterine wall. It is produced in an area poor in blood vessels. Thanks to this, the muscle layer of the uterus is practically not injured, and healing proceeds much faster.

Absorbable synthetic suture material is used to stitch the edges of the wound, which tightly holds the edges in the desired position for several months. This material is convenient in that it dissolves gradually, and by the time it completely disappears, a strong suture will have formed on the uterus, which can withstand a new pregnancy, and in some cases, ensure independent childbirth.

Provided that the healing process proceeded without complications, complete restoration of the uterine wall occurs within 6-8 weeks from the date of surgery. If the recovery period was accompanied by inflammatory reactions or suture dehiscence occurred, the time frame for the final restoration of all layers of the uterus is extended and can reach 10 weeks.

If a woman’s first birth, for various reasons, ended in surgery, then the second and subsequent births require the inclusion of this pregnant woman in the risk group. Suture dehiscence after cesarean section is a fairly serious problem in 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 on such women was unequivocal: if there is a history of this type of delivery, then all subsequent births should be carried out only surgically. This was associated with a high risk of uterine rupture along the old scar during the natural process. What are the reasons for such a complication?

Probability of uterine rupture depending on the scar

For a long time, many obstetrician-gynecologists used a classic vertical suture, which was used to suture the muscular wall of the uterus in its upper third. Such tactics during a caesarean section were 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, such a technique gave a fairly high percentage of rupture of the uterine wall along the old scar during pregnancy and subsequent childbirth through the natural birth canal.

The dehiscence of the suture on the uterus after cesarean in this case ranged from 4 to 12%, according to various authors. This forced specialists to recommend that the woman go back to 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 has virtually no effect on the incidence of postoperative complications.

The anatomical structure of the female uterus is such that muscle incisions in this area heal much faster and are less likely to create preconditions for tissue damage. When performing such operations, the probability of suture divergence on the uterine wall is sharply reduced and amounts to no more than 1 - 6%. It is these figures that allow modern specialists to allow up to 80% of women who have undergone surgical delivery to have a natural vaginal birth.

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

Types of suture after cesarean section

Who is at risk of uterine rupture during childbirth?

As mentioned above, about 4 - 5% of women in labor run the risk of experiencing possible divergence of the old scar during vaginal birth. 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 excessive stress on the old scar during pregnancy and childbirth can be fatal.

It is also very important to maintain the required intervals between births. To form a full-fledged tight suture, the female body requires from 12 to 18 months, therefore, repeated pregnancy in a woman who has undergone a cesarean section is recommended no earlier than 2 years after the operation.

Pregnant women who do not have a history of surgical delivery may be at risk of uterine rupture. Quite often, such complications occur when a woman in labor enters the delivery room for the 5th, 6th 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 labor management tactics.

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

Signs of violation of the integrity of the uterine scar

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 suture dehiscence after cesarean section during 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 the woman, when performing a vaginal birth in a pregnant woman with a uterine scar, it is necessary to monitor the condition of the fetus. For this purpose, modern medical institutions are equipped with appropriate equipment. This may include the use of Doppler ultrasound or a fetoscope.

The medical literature describes situations where there are practically no symptoms of suture dehiscence after cesarean section. 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 the doctor conducting childbirth in a woman with a similar pathology can play a big role.

Uterine rupture is considered a severe complication, ranking among the leading 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 suture can come apart after a caesarean section. 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 a 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 becomes overgrown predominantly with connective tissue, then the structure of the muscular layer of the uterine wall is disrupted. 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 doctor’s basic recommendations, physical activity on the abdominal wall exceeded acceptable standards, and there were certain errors and shortcomings in diet and lifestyle. Finally, various chronic diseases and a decrease in the body’s immune forces can cause a weak scar on the uterus.

A specialist usually discovers a similar problem when performing an ultrasound of the uterus and the suture on it. It is he who gives an opinion about possible independent childbirth after a cesarean section.

We recommend reading the article about complications with sutures after cesarean section. From it you will learn about the types of sutures during surgery, methods of scar care, possible complications, the use of healing agents, and the need for suture correction.

Uterine scar and second pregnancy

When there are no problems with the scar on the uterus, pregnancy does not affect the woman’s condition in any way. Until 32 - 33 weeks, a pregnant woman does not have any clinical manifestations of the existing pathology. Only in the later stages of pregnancy may mild pain appear 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, it is 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 period.

According to modern canons, ultrasound for a woman who has had a history of cesarean section is mandatory throughout pregnancy. It is this examination method that allows obstetricians-gynecologists to decide whether a repeat operation is necessary. Another 28 - 29 weeks determine the location and size of the baby, the placenta attachment site in the uterine cavity, which is necessary to avoid the risk of rupture of the scar of the muscle wall.

From the 31st week, the ultrasound doctor constantly monitors the condition of the scar, and if there is a suspicion of its insolvency, he immediately raises the question of performing a new operation. The same period coincides with the period of hospitalization of such a pregnant woman in the pathology department.

In modern protocols, the time from diagnosis of uterine rupture to emergency cesarean 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 to have a natural birth, the woman should be informed about the possible emergency operation and the certain risks of such tactics. In addition, pain relief therapy and artificial induction of labor cannot be administered to such a contingent of women in labor. The doctor simply does not interfere in the course of childbirth; his task is to recognize possible complications and take appropriate measures.

Every pregnant woman with a uterine scar has to decide whether to give birth herself or undergo a second operation. There are situations when specialists make decisions for her, but in 70% of cases this is the choice of the woman herself. The doctor’s task in this situation is to give her the full amount of information and support any of her decisions.

A histologically altered area of ​​the uterine wall, formed after its damage during surgical and diagnostic interventions or trauma. It is not clinically evident in non-pregnant women. During gestation and childbirth, it may be complicated by a rupture with corresponding symptoms. To assess the condition of scar tissue, hysterography, hysteroscopy, and ultrasound of the pelvic organs are used. In case of threatening rupture, methods of dynamic monitoring of the condition of the fetus are recommended (CTG, Dopplerography of uteroplacental blood flow, ultrasound of the fetus). Pathology cannot be treated, but is one of the key factors influencing the choice of natural or surgical delivery.

Complications

Cicatricial changes in the uterine wall cause abnormalities in the location and attachment of the placenta - its low location, presentation, tight attachment, accretion, ingrowth and sprouting. In such pregnant women, signs of fetoplacental insufficiency and fetal hypoxia are more often observed. With a significant size of the scar and its localization in the isthmic-corporal department, the threat of placental abruption, spontaneous abortion and premature birth increases. The most serious threat for pregnant women with scar changes in the uterine wall is uterine rupture during childbirth. This pathological condition is often accompanied by massive internal hemorrhage, disseminated intravascular coagulation syndrome, hypovolemic shock and, in the vast majority of cases, antenatal fetal death.

Diagnostics

The key task of the diagnostic stage in patients with a suspected uterine scar is to assess its consistency. The most informative examination methods in this case are:

• Hysterography. The failure of scar tissue is evidenced by the altered position of the uterus in the pelvic cavity (usually with its significant displacement forward), filling defects, thinning and jagged contours of the inner surface in the area of ​​possible scar.
• Hysteroscopy. In the area of ​​scarring, retraction may be observed, indicating thinning of the myometrium, thickening and whitish coloration in the presence of a large mass of connective tissue.
• Gynecological ultrasound. The connective tissue scar has an uneven or discontinuous contour, and the myometrium is usually thinned. There are many hyperechoic inclusions in the uterine wall.

The data obtained during the research is taken into account when planning the next pregnancy and developing a plan for its management. From the end of the 2nd trimester, such pregnant women undergo an ultrasound scan of the uterine scar every 7-10 days. Fetal ultrasound and Dopplerography of placental blood flow are recommended. If a threatening rupture along the birth scar is suspected, the shape of the uterus and its contractile activity are assessed using an external obstetric examination. During ultrasound, the condition of the scar tissue is determined, areas of thinning of the myometrium or its defects are identified. Ultrasound with Doppler and cardiotocography are used to monitor the fetus. Differential diagnosis is carried out with threatened abortion, premature birth, renal colic, acute appendicitis. In doubtful cases, examination by a urologist and surgeon is recommended.

Treatment of uterine scar

Currently, there are no specific methods for treating scar changes on the uterus. Obstetric tactics and the preferred method of delivery are determined by the condition of the scar zone, the characteristics of the gestational period and childbirth. If an ultrasound scan has determined that the fertilized egg has attached to the wall of the uterus in the area of ​​the postoperative scar, the woman is recommended to terminate the pregnancy using a vacuum aspirator. If the patient refuses an abortion, regular monitoring of the condition of the uterus and developing fetus is ensured.

Prognosis and prevention

Choosing the right obstetric tactics and dynamic monitoring of the pregnant woman minimizes the likelihood of complications during pregnancy and during childbirth. For a woman who has undergone a cesarean section or gynecological surgery, it is important to plan a pregnancy no earlier than 2 years after surgery, and if pregnancy occurs, regularly visit an obstetrician-gynecologist and follow his recommendations. To prevent re-rupture, it is necessary to ensure a competent examination of the patient and constant monitoring of the scar, to choose the optimal method of delivery, taking into account possible indications and contraindications.

After a caesarean section, women are concerned about the health of the child, as well as their own, namely, the suture on the uterus - when it will be removed, how long it will take for it to heal, and what difficulties may arise with this, how to deal with them and which doctor to contact. How long it takes for a suture to heal after a cesarean section on the uterus depends on several factors: the threads that were used, the individual characteristics of the woman’s tissue regeneration, wound care in the postoperative period, the method of suturing, etc. Unfortunately, the scar that remains cannot be will be removed in any non-surgical way. Only a repeat operation, but after it there will again be a scar. But if you decide to have a second child, then in case of repeated surgery you will most likely not have a new scar. The doctors will make the same incision as before.

But this is a remote problem, the same as pregnancy and childbirth. It is likely that problems will arise immediately after surgery. For example, what to do when the suture on the uterus hurts after a cesarean section, if you have already been discharged from the maternity hospital? Of course, you need to see a doctor. Urgently if pus appears, redness appears, body temperature rises. Perhaps a ligature fistula has appeared and needs to be removed. The doctor may prescribe a course of antibiotics.

The scar is fully formed 2 years after the operation, and then the second pregnancy with a suture on the uterus after cesarean becomes the safest. The suture is usually removed 7-9 days after surgery. A ligature fistula often forms if threads remain in the wound. This is possible, because sutures are also applied with “self-absorbing” threads.

By the way, the speed of healing of the suture is affected by where in the uterus the incision is made. And doctors pay attention to this same point if a patient comes to them wanting to get pregnant, or even give birth on her own after a cesarean section. Failure of a suture on the uterus after a cesarean section is when there is a high probability of uterine rupture along the scar during pregnancy or childbirth; it most often occurs if a woman has a vertical incision, from the navel. Such a seam heals worse, this is the reason.

A horizontal incision in the lower segment of the uterus is most favorable. He is healing better. And in some cases, pregnancy can be planned with it even earlier than after the 2 years recommended by doctors. But only if the ultrasound of the suture on the uterus after a cesarean section shows normal thickness and structure. You need to undergo this study through transvaginal access from a good specialist. Although many doctors are inclined to believe that even a sufficiently thick scar should not be a reason for conceiving too early after surgery. It's better to play it safe and wait up to 2 years. Moreover, the mother’s body needs rest. As for what size of suture on the uterus after a cesarean section is considered normal - the issue is under discussion, the opinions of specialists here vary. Moreover, this is not the only criterion that is looked at on ultrasound. Normally, the scar should be more than 4 millimeters thick. At the same time, do not have any thinning along its length.

After pregnancy has occurred, it is advisable for a woman to have regular ultrasounds to see the thickness of the scar. By the end of pregnancy it normally becomes thinner. But if thinning occurs very quickly, pain or other dangerous symptoms of suture dehiscence on the uterus appear after a cesarean section, the woman is given an emergency delivery through a repeat operation. Natural childbirth is possible only if the scar is in ideal condition, if there is only one birth in the anamnesis, and the postpartum period proceeded well. Be sure to look at the real obstetric situation. To do this, a woman is admitted to the maternity hospital in advance, usually 2 weeks before the expected date of birth. Natural childbirth will be impossible if the fetus is large (more than 4 kg approximate weight), the placenta is located in the scar area, the pelvis is narrow, there is no possibility of emergency surgery if the situation occurs that the sutures on the uterus come apart after a cesarean section. There are a lot of nuances. And therefore, in Russia, it is extremely rare for doctors to agree to conduct natural childbirth in patients after cesarean section, even if the scar is in ideal condition.

Caesarean section is currently a simple abdominal operation. If, for medical reasons, the expectant mother cannot give birth on her own, then a caesarean section is the only way to experience the happiness of motherhood. As with any surgery, you should be aware of possible risks and complications after childbirth. Of course, if the operation was successful and the mother in labor was provided with competent postoperative care, then unpleasant consequences are unlikely. But it’s better to find out about them in advance so that you can be mentally and physically prepared for everything.

The temperature rose after a cesarean section. What to do?

After the operation, the happy mother is observed in the hospital for about seven days and then discharged. So you came home and suddenly felt bad. We took our temperature, and the mercury shows a disappointingly high level. The most common causes of high temperature in a woman in labor are inflammatory processes and lactostasis. If you are breastfeeding and suddenly notice lumps and pain in your breasts, then it is quite possible that the milk duct is blocked, which leads to a rise in body temperature. Do not forget that with lactostasis, the temperature is measured in the elbow or armpit, after covering the chest area with a folded towel. If you have no problems feeding your baby, and the body temperature is high, then inflammatory processes may have developed after the operation. These include:

• Endometritis;
• Suture inflammation

Endometritis is one of the severe consequences of cesarean section. During surgery, microbes can enter the uterine cavity along with air, thereby causing inflammation. Symptoms of endometritis are as follows:

1. Lower abdominal pain;
2. High body temperature and chills;
3. Loss of sleep and appetite, weakness;
4. The pulse quickens;
5. Discharge is brown in color with an unpleasant odor, sometimes containing pus.

Treatment of endometritis is prescribed by a doctor and involves a course of antibiotics.

Inflammation of the suture is possible due to infection during surgery or due to improper postoperative care. For seven days after the operation in the hospital, the woman in labor undergoes daily dressing and suture treatment. After the woman is discharged, she needs to treat the stitch with brilliant green for another 10 days. If you notice redness of the suture area, discharge from it, and your body temperature has risen, then inflammation of the suture may have occurred. If these symptoms occur, you should immediately contact your doctor and start taking antibiotics. Otherwise, the suture may fester and then surgical intervention is inevitable.

Spikes

Disruption of connective tissue during surgery leads to the formation of adhesions or adhesions inside the abdomen. This is a natural protective function of the body from purulent processes, but sometimes adhesions impede the functioning of various organs, and this already leads to adhesive disease. At first, many women are not even able to identify insidious adhesions, because abdominal pain, increased gas formation and problems with stool can always be attributed to the consequences of poor nutrition. But intestinal obstruction is perhaps the most harmless consequence of the formation of adhesions. The launch of the adhesive process leads to secondary infertility and endometriosis. So, if after discharge you are bothered by abdominal pain or have problems with stool, it is better to be examined by a doctor for the presence of adhesions in the body.

The best prevention of the formation of adhesions after surgery is physical activity. It is no coincidence that in the maternity hospital a woman in labor is forced to get out of bed six hours after the operation. And after recovering from anesthesia, do not lie in one position all the time, slowly turn from your back to your side and back, no matter how hard it is. After six hours, get up, take a few steps, rest, and walk again. And walk up gradually. The more you walk, the faster the stitch will heal, and you will protect your body from the formation of unpleasant adhesions. Don't forget to stick to your diet.

Stomach hurts after CS

Abdominal pain after surgery can be caused by various reasons:

1. The stitch hurts after a cesarean section. Pain in the area of ​​the surgical suture is quite normal if there is no sign of inflammation. The abdominal tissues were damaged, and now their recovery will be accompanied by nagging, but quite tolerable pain during the first months after the operation. Unpleasant sensations in the abdominal area can cause laughter, coughing, and sudden movements. You shouldn't be afraid of this, you just have to experience it.
2. Spikes. The formation of adhesions can also be accompanied by abdominal pain.
3. Intestinal problems. A common cause of abdominal pain is disruption of intestinal motility. After the operation, they usually give an enema and force the woman in labor to follow a special diet to start the normal functioning of the digestive system
4. Contraction of the uterus. After childbirth, active contractions of the uterus occur, which may be accompanied by abdominal pain. This process intensifies when the baby is breastfeeding, since stimulation of the nipples entails contraction of the uterus. If at the same time you do not have copious discharge with a pungent odor and an elevated temperature, then there is nothing to worry about.

If the suture oozes after a cesarean section

The healing period of the postoperative suture may be accompanied by slight redness, swelling, and pain. It requires careful care and daily treatment to avoid inflammation. In this case, you can calmly take a shower, of course, without active pressure or rubbing the injured area. But if you suddenly notice severe redness and purulent discharge in the suture area, consult a doctor immediately. Perhaps the stitches were removed poorly, or perhaps tissue inflammation occurred.

The stitch came apart after a caesarean...

Sometimes suture separation occurs after surgery. This may be due to a woman lifting heavy objects, straining her abdominal muscles, or be a sign of a slow-growing infection. To find out the cause of this complication, you need to be examined by a doctor. The wound is usually not sutured again. It heals on its own with secondary intention. Properly organized scar care using healing ointments will eliminate this unpleasant consequence after surgery. To prevent suture dehiscence, avoid physical activity and wear a postoperative bandage.

All these complications after surgery can be avoided if you trust competent specialists and follow their simple recommendations. And then nothing will distract you from the pleasant worries associated with the birth of your small, but such great happiness.

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Modern women experience problems with conception, pregnancy and childbirth more and more often every year. There are many reasons for this: age, inflammatory diseases of the reproductive system, poor health. As a result, pregnancy is often difficult, and childbirth is scheduled by emergency or planned caesarean section, which leaves a scar on the uterus or its cervix.

What is a uterine scar?

An area of ​​dense connective tissue in the uterus that has been damaged in the past during surgery is called a scar. This is a special formation that consists of myometrial fibers that regenerate after damage. The human body is poorly adapted to recovery, so the tears are closed not by the original tissue, but by connective tissue. It does not completely replace the muscle layer, but only restores the integrity of the uterus after the incision.

Symptoms

A postoperative scar has no characteristic symptoms. It does not bother the patient until the uterus ruptures along the scar. This is a very serious pathology, manifested by the following symptoms:

• pain in the lower and middle abdominal cavity;
• irregular and strong contractions of the uterus;
• decreased blood pressure;
• rare pulse;
• pale skin;
• nausea, vomiting.

Causes

More often, a scar appears on the cervix after childbirth. Today, the frequency of cesarean sections in maternity hospitals reaches 25%. In addition, scar defects on the female organ occur as a result of:

• perforation of the uterus during intrauterine examination or artificial termination of pregnancy;
• gynecological surgery to treat adenomyosis or remove fibroids;
• ectopic pregnancy;
• plastic surgery to remove the intrauterine septum or correct a bicornuate or saddle-shaped uterus.

Diagnostics

A woman with a suture on the uterus when planning a child should be examined before conception. Outside of pregnancy, it is necessary to evaluate the consistency of the scar in patients who have undergone operations with opening of the uterine cavity: cesarean section, suturing of the perforation, myomectomy and others. First, the doctor palpates the contours of the walls of the uterus, evaluates the suture, and determines its size.

Further examination is carried out using hysterography (examination using an ultra-precise optical device), hysterosalpingography (X-ray with a contrast agent) and ultrasound. Laboratory tests are also carried out:

• general urine and blood tests;
• blood chemistry;
• hemostasiogram, coagulogram;
• hormonal status of FPC.

Ultrasound of the scar

If a woman is pregnant, then the uterine cavity is examined for the consistency of the scar only using ultrasound. Ultrasound helps to find out the exact dimensions of the suture, the thickness of the uterine wall in this area, the presence of niches, ligatures, unfused areas and the shape of the lower uterine segment. The results will help doctors predict the likelihood of complications during pregnancy. If an ultrasound scan of the uterine scar is performed after a cesarean section or at the planning stage of conception, then days 10-14 of the menstrual cycle are more suitable for this.

Normal myometrial thickness in the scar area

The failure of the suture on the uterus after cesarean can be determined by comparing the indicators with the norm. According to the rules, the thickness of the scar after artificial delivery should be from 5 mm. If there is thinning up to 1 mm, then this indicates its failure. During pregnancy the norms are different. Since the scar becomes thinner due to the enlargement of the uterus, at the end of the term even a thickness of 3 mm will be considered normal.

Pregnancy and scar

It takes about two years for a strong suture to form in the uterine cavity. During this time, doctors advise women to wait and not plan a pregnancy. However, a break that is too long is not the best option, because four years after the scar has healed, it begins to lose elasticity. For this reason, planning and the course of pregnancy with a suture on the cervix or other part of the female organ should take place under the special supervision of a doctor.

Possible complications of pregnancy

Thinning of the uterine scar during pregnancy is normal. However, its presence can affect the condition of the fetus. Due to the atrophied area, partial, marginal or complete presentation sometimes occurs. Placenta accreta may also appear at any level of the uterine wall. If implantation of the fertilized egg occurs in the area of ​​the connective scar, then this is also a bad sign - in this case there is a very high risk of premature birth or termination of pregnancy.

The most dangerous complication of pregnancy is uterine rupture due to severe thinning of atrophied tissue. This is preceded by certain symptoms:

• hypertonicity of the uterus;
• pain when touching the abdomen;
• arrhythmia in the fetus;
• bleeding from the vagina;
• arrhythmic spasms of the uterus.

After uterine rupture, more serious symptoms are observed: sharp pain in the abdominal cavity, nausea and vomiting, a drop in hemodynamics, and cessation of labor. For the woman and the fetus, these consequences are disastrous. As a rule, the child experiences hypoxia, which leads to his death. A woman suffers from hemorrhagic shock. If measures are not taken in time, there is a high probability of death for the woman in labor. To save a woman, emergency hospitalization, surgical opening of the cavity with a transverse incision and curettage of the uterus are required.

Childbirth with a scar on the uterus

The uterine cavity is opened in two ways: a transverse one, which is made in the lower segment during a full-term pregnancy in a planned manner, and a corporal incision, performed in case of bleeding, during emergency surgery, hypoxia, or in case of premature delivery (up to 28 weeks). When pregnant with a scar in the uterine cavity, a woman usually undergoes a repeat cesarean section. However, medicine does not stand still, and in recent years, more and more women with a scar on the female organ after planned prenatal hospitalization are sent to give birth through natural means.

When is vaginal delivery allowed in the presence of a scar?

In the absence of contraindications, after a comprehensive examination and prenatal hospitalization at 37-38 weeks of pregnancy, a woman is allowed to have a natural birth with a suture on the uterus. However, for this to happen the following conditions must be met:

• the presence of one wealthy scar;
• the first operation was carried out exclusively for relative indications (fetus over 4 kg, weak labor, intrauterine hypoxia, transverse or breech presentation, infectious diseases that worsened shortly before birth);
• the first operation was performed through a transverse incision and was without complications;
• the first child has no pathologies;
• this pregnancy proceeded well;
• There are no signs of an incompetent scar according to ultrasound results;
• the estimated fetal weight does not exceed 3.8 kg;
• no pathologies are observed in the fetus.

Scar after cesarean section

The scar after artificial delivery surgery heals in several stages. In the first week, the primary suture is formed, bright red in color with clear edges. Movement causes severe pain. The second stage is characterized by thickening of the scar. It changes color to a less bright one, it still hurts, but less than in the first week. This stage lasts a month after the operation, by the end of which pain when moving stops. The last phase lasts about a year. The scar changes color to pale pink, looks almost invisible, and becomes elastic. Healing occurs through the production of collagen.

Inconsistency of the uterine scar after cesarean section

The scar after opening the uterine cavity does not always heal well. A complication is an incompetent scar, which is improperly formed tissue at the incision site. The pathology is characterized by unfused cavities, insufficient thickness and the presence of a large amount of scar tissue, which prevents the female organ from stretching normally during the next pregnancy. The pathology is a threat to the full bearing of a child, since there is a strong displacement and change in the shape of the uterus, and a violation of its contractile activity.

Treatment

If pregnancy and childbirth proceed normally, then the uterine scar does not require treatment. In the case of an incompetent scar, the woman is advised not to plan subsequent pregnancies in order to avoid obstetric complications. The only effective treatment for this pathology is laparoscopic metroplasty. Medication or any other schemes for eliminating a failed scar in the uterine cavity are ineffective. Due to the fact that the uterus is located in the abdominal cavity behind the internal organs, it is impossible to resort to a more gentle technique.

Metroplasty after caesarean section

The indication for this operation is thinning of the myometrial walls up to 3 mm and deformation of the suture in the area of ​​the postoperative scar. Its formation is mainly a complication of cesarean section. The essence of laparotomy metroplasty is the excision of a thin scar followed by the application of new sutures. Open surgery is determined by the need to provide access to the defect, which is located under the bladder in an area of ​​strong blood supply. This is associated with the risk of severe bleeding during surgery.

Metroplasty is accompanied by the isolation of large vessels and the application (temporary) of soft clamps to them in order to stop blood flow. After excision of the failed scar, plastic surgery is performed, then the clamps are removed. The advantage of the laparoscopic method is the low degree of invasiveness of surgical intervention and the low risk of formation of adhesions in the abdominal cavity. The method provides short rehabilitation times and a good cosmetic effect.

Prevention

To prevent complications from occurring during pregnancy or childbirth in women with a scar in the uterine cavity, prevention is needed, which includes:

• assessment of the condition of the scar at the stage of pregnancy planning;
• determining the location of the placenta during pregnancy;
• formation of normal conditions for scar healing after cesarean section;
• timely treatment and prevention of pathological complications;
• fetal monitoring during labor;
• CTG and ultrasound control during pregnancy;
• a balanced approach to making a decision about natural childbirth with a scar in the uterine cavity.

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The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.