Difficult environmental conditions and constant stress quite often lead to a situation where a woman’s pregnancy ends with surgery. Therefore, doctors are currently antenatal clinic People often hear the question: “How long before you can get pregnant after caesarean section? Typically, reconception and childbirth are easier. However, if a woman already has a history of surgery, she faces a number of problems. First of all, the reason for the patient’s caesarean section is important.
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When can you reschedule your baby?
Most young mothers who have undergone surgery during childbirth are concerned with the question: “When can you get pregnant after a cesarean section?” The last word always remains with the specialists.
If surgical delivery was carried out for a reason unrelated to the chronic pathology of the female body, and its prerequisites were incorrect position fetus, placental abruption or moderate to severe preeclampsia, the threat to subsequent pregnancies is almost minimal.
Currently, the rate of surgical intervention during childbirth averages 25 - 30%. This indicates that such an operation is widely introduced into the practice of obstetricians and gynecologists at various levels, is sufficiently practiced and does not pose a threat to the patient and her baby.
However, there are a number of reasons why, when asked how long it will take to give birth after a cesarean section, experts talk about 2 - 2.5 years of abstinence from re-pregnancy:
- This is primarily due to the fatigue of the mother’s body after the first pregnancy, surgery and possible breastfeeding. A young mother is simply not emotionally ready for such a feat; the hormonal and endocrine systems are in a state of restructuring, which with a high degree of probability can lead to termination of pregnancy in the first or second trimester.
- The uterine cavity, and especially the condition of the placenta, is not able to provide an adequate level of stay for the new fetus, hence the high risk of placental abruption and uterine bleeding, which will not only lead to the death of the unborn child but also poses a great danger to the woman’s life.
- And the most important thing! After a cesarean section, a scar made of connective tissue remains on the muscle layer of the uterus. In order for it to withstand the stress of a new pregnancy, at least 12 to 16 months of recovery are required.
It should be taken into account that the female body is weakened after surgery, so regeneration processes in it proceed more slowly.
If a second attempt to carry a child occurs after 6 - 9 months, then the risk of uterine rupture and the appearance of a mortal threat for the young mother will exceed 75%.
Considering possible complications, planning is extremely important for a woman future pregnancy after surgery during childbirth.
Rules for preparing for pregnancy after cesarean
If a woman decides to give birth after undergoing surgery, then independence is fraught with harmful consequences. It is necessary to contact an antenatal clinic, where specialists will give all the recommendations on how and when you can give birth after a caesarean section.
At the beginning, the young mother must undergo a full course of examination. As mentioned above, not all patients can afford childbirth after surgery for health reasons. If from the outside internal organs, the endocrine and hormonal system will not reveal any serious abnormalities, doctors will first help the expectant mother choose the right and available method contraception.
Such a contingent of women can begin preparing for a new pregnancy only two years after a cesarean section. In addition, during this period there will be preventive treatment the pathology that led to complicated childbirth and surgery last time.
Before the long-awaited pregnancy occurs, the doctor will definitely conduct research on the condition of the uterine scar using modern medical equipment. For this purpose, the arsenal of modern antenatal clinics and medical centers is quite wide: from ultrasound to MRI and computed tomography.
Only clear planning of future pregnancy, constant monitoring of the patient’s condition from the outside medical workers and scrupulous compliance with their requirements will allow the young woman to calmly conceive and bear a child.
Features of pregnancy after surgery
If antenatal clinic specialists have allowed a woman to conceive after a cesarean section, it is necessary to understand that the scope of examinations and the level of monitoring of the course of gestation in this case will differ from the previous pregnancy. When the first two lines appear on the test, the young woman should register with an obstetrician-gynecologist at her place of residence. There she will receive clear instructions about the work and rest schedule, diet and possible physical activity for the entire period of bearing the child. If there is a scar on the uterus, the level of physical activity should be two times lower than during a normal pregnancy.
The gestation period will differ from the standard only in more frequent examinations, laboratory research and constant ultrasound examination of the scar.
The appearance of nagging pain in the abdomen or a feeling of discomfort is a direct indication for hospitalization of a pregnant woman in the pathology department to create a sanitary and protective regime.
The question of possible independent childbirth will be decided before the onset of the last weeks of gestation. If a few years ago the presence of a scar on the uterus was an absolute indication for a repeat cesarean section, now the trend has changed somewhat. More and more obstetricians are recommending that this group of patients undergo natural childbirth.
There is a lot of evidence in the literature for and against such bold decisions, but any woman can refuse vaginal birth and request a second operation on a planned basis. In this case, the risk of uterine rupture and other complications will be reduced to almost zero.
If suddenly, for some reason, conception occurs in the first 6 months after the birth of the baby, then in most cases the woman will be offered an abortion operation. medical indications. The risk from an abortion will be less than if you leave the pregnancy and allow the possibility of uterine rupture.
If more than 5 years have passed after giving birth, the management of such pregnant women is practically no different from all other women. Only the question of independent childbirth will remain open until the end of pregnancy.
Caesarean section is usually performed in two cases:
- a threat to the health of the expectant mother due to the presence of various chronic pathologies from the internal organs;
- a real threat to the life of the mother and fetus that arose directly in last weeks pregnancy or during childbirth.
The list of reasons requiring doctors to perform surgical delivery in the first case is quite extensive. This includes diseases of the heart and blood vessels in women. Chronic heart defects, rheumatism, myocarditis, chronic heart failure not only threaten complications during childbirth for the expectant mother, but can also lead to intrauterine death of the fetus and placental abruption with heavy uterine bleeding.
No less dangerous for physiological labor are problems with the respiratory system of a woman in labor. Bronchial asthma, tuberculosis and others chronic diseases lungs during pushing lead to hypoxia of the mother and child, which is fraught with various complications after childbirth.
We must not forget about kidney pathology, endocrine system and severe diabetes mellitus.
A woman’s history of such diseases is not only an absolute indication for a cesarean section, but also prohibits subsequent pregnancies. Typically, each patient resolves such issues with the doctors of the antenatal clinic and maternity hospital on an individual basis.
If there are contraindications to re-pregnancy, the woman in labor may be offered surgical sterilization or bandaging fallopian tubes. If, due to any reasons of a religious or psychological nature, a woman refuses such an offer, after giving birth they will find another one for her.
What if you want a third or more baby?
A fairly large percentage of women, due to religious beliefs or home environment are not ready to limit the number of pregnancies. Then a logical question arises: “How long can you give birth after a caesarean section?”
In medical practice, it often happens that a patient gives birth on her own after a previous operation. However, if a woman already has two cesarean sections in her medical history, no doctor will be willing to perform a natural physiological birth.
After each operation, the wall of the uterus and the scar area become thinner by approximately 15 - 20%, which creates a threat when carrying a child and directly during childbirth. Usually, in this case, specialists do not wait until 40 weeks to perform the operation (35-36 weeks of pregnancy are considered sufficient for nursing a baby). The operation is most often carried out as planned using full monitoring of the condition of the woman and the unborn child.
Three caesarean sections are currently considered the physiological limit for the uterus, so sterilization is usually recommended after the third operation.
The medical literature describes cases of pregnancy and surgical intervention after three previous operations, but most experts consider such a risk to be extremely unjustified.
When, after surgical delivery, a woman is diagnosed with a multiple pregnancy, management of the gestation period is carried out purely individually. A stay in the pathology department for constant control of the scar is considered mandatory, and childbirth is carried out exclusively surgically.
If a young mother’s first birth of a baby ended in a caesarean section, during subsequent pregnancies constant supervision by a specialist is mandatory. This is the only way to avoid big and small problems for a woman and her child during pregnancy.
After surgical birth, doctors strongly recommend waiting time before the next conception. The body needs to return to normal, the muscle tissue around the uterine scar needs to recover. It is not always possible to follow the doctor's recommendations. Getting pregnant one year after a cesarean section carries certain risks. What to do if you couldn’t wait for the time? What forecasts do doctors give?
After surgical delivery, a woman needs to fully recover
Surgical intervention during labor is usually caused by complications of the current pregnancy. If the reason does not lie in the health of the mother, having children in the future is not prohibited. True, one should not allow the pregnancy to recur too quickly.
Surgical delivery is a common method of delivery. This is not an easy operation. Caesarean surgery involves cutting through the tissues of the uterus and abdominal cavity. It takes time to restore them. The period of bearing a baby weakens the female body: organs and systems need rest. Considering the characteristics of the female body, doctors are categorically against repeat pregnancy for the next two to three years. On average, 24 months are needed for complete regeneration of muscle tissue at the site of the scar. The suture in the lower abdomen is completely tightened after six months.
Healing of internal tissues is an individual matter. Much depends on the progress of the operation, complications in postoperative period. If a woman does not want to wait three years after a CS, she needs to consult a doctor about the possibility of getting pregnant earlier.
Gynecologists always have a negative attitude towards pregnancy that occurs before 18 months after surgical birth: the risks are too high. To protect yourself from conception in the first few years after a CS, you need to contact your personal gynecologist to select reliable contraceptives. This will allow us to resume sex life without fear of consequences.
Not all patients adhere to the recommendations to avoid pregnancy for the first three years after surgical birth. Many women begin to think about their next pregnancy within a year after surgery. Why? There are several reasons why medical orders are ignored:
- it seems to the woman that the body has fully recovered (the judgment is based on the healing of the external suture and the absence of postoperative health problems);
- the family wants children of the same age;
- The woman is over 35 years old, she is afraid of the growing likelihood of pregnancy complications and the occurrence of pathologies in the unborn child.
The issue of planning should be discussed in advance with the attending gynecologist.
Reproduction issues should only be resolved with a doctor. It is worth voicing your desire to repeat the pregnancy as early as possible. The doctor will examine the patient’s medical history, conduct a general diagnosis of the body, assess the condition of the uterine scar and give recommendations on when to plan conception. Before a year from the date of surgery, and even exactly one year later, doctors prohibit getting pregnant due to the high likelihood of complications occurring during pregnancy and during delivery.
Early pregnancy after CS is accidental in 90%. For example, summer came, the couple went on vacation and forgot about caution. TO common reasons early conception include violation of intake birth control pills or switching to a less reliable method of contraception. After a CS, a woman receives recommendations on contraception while still in the maternity hospital; it is important to adhere to them, and if she wants to change something, consult a doctor.
Risks of early conception after CS
Why is it repeated after a cesarean section? interesting situation» undesirable for the next two years? Early conception after surgical birth is associated with certain risks:
- Uterine rupture. The scar that appears on the uterus after surgical childbirth takes a long time to heal: on average, a year and a half passes from the moment of surgery to complete healing. Early conception carries a load that tissues that have not fully recovered may not be able to cope with. As the fetus grows, the walls of the organ will stretch, which can lead to cicatricial rupture of the uterus. It is very dangerous.
- Fetal death due to placental abruption. Successful pregnancy and subsequent successful delivery depend on the condition of the placenta. If pregnancy occurs a year after the previous one, a weak placenta may form. This provokes its detachment and other problems that lead to intrauterine death child.
- Miscarriage. Spontaneous interruption occurs if the body is weakened. When pregnancies occur one after another, the body does not have time to recover. After a CS, recovery takes a long time. Surgical delivery is accompanied by significant blood loss compared to natural delivery. This is fraught with iron deficiency in the mother’s body, which is so necessary for the growth of the fetus and its development according to the norms. Lack of resources to support a new life leads to miscarriages, intrauterine formation various pathologies.
The likelihood of an unfavorable outcome is very high. However, concerns may remain concerns. Much depends on the exact time that has passed since the surgical birth: in this case there is a significant difference between a year and a year and a half.
Forecasts
Caesarean was performed less than a year ago, and another pregnancy occurred - future mom automatically falls into the risk zone. The sooner after the operation conception occurs, the higher the likelihood that a suture rupture of the uterus will occur in the later stages or during labor.
Doctors treat pregnancies that occur early after surgical birth with special caution. They do not always advise continuing the pregnancy. The gynecologist gives recommendations after examining the patient’s health status and examining the uterine suture.
The sooner the pregnancy occurs after the operation, the higher the likelihood that the doctor will insist on an abortion. Termination of a secondary pregnancy is mandatory if less than six months have passed since the CS.
It is very important for the expectant mother to include in her diet fresh vegetables and fruits
After a year, gestation may not even differ from the previous one. Do not forget about the individuality factor: if the scar is weak, then the gynecologist may recommend terminating the pregnancy, even when 12 months can be counted from the date of the operation.
You should definitely listen to the opinion of a specialist. Especially when the surgical birth took place less than eighteen months ago. Accept correct solution- the main task of a woman. Early pregnancy does not always end in miscarriage, complications, or ruptures. If a year has passed since the CS and the condition of the scar can be called satisfactory, there is a chance of bearing a child. The expectant mother will have to take care of herself more than during her first pregnancy in order for everything to end well. You need to remember about the likelihood of a favorable outcome when learning about an early second pregnancy: this will help you make an informed decision.
A year ago operation provides an alternative. There are periods that do not leave this alternative: if a woman becomes pregnant four to five months after surgical birth. By this time, only the outer seam has healed, and the inner one remains insolvent. The load on it poses a danger to the life and health of the patient. That's why doctors insist on abortion. A woman can leave a child solely at her own peril and risk.
How to maintain pregnancy
If only a year has passed between caesarean section and conception, and the woman has firmly decided to keep the baby, she must understand that she will have to make efforts to maintain an “interesting situation.” They will help with this simple rules:
- You need to make an appointment with a doctor as soon as you suspect you are pregnant. This will allow you to monitor the condition of the mother and child, and take timely measures if something goes wrong.
- You need to do an ultrasound more often than during a normal pregnancy. This is necessary to monitor the development of the baby. Besides ultrasound diagnostics allows you to assess the condition of the uterine scar and prevent suture rupture.
- Avoid excessive physical activity. Because of them, the inner seam may come apart. A patient who underwent surgical delivery a year ago is advised to rest throughout her subsequent pregnancy. This rule must be followed even if the scar is determined to be healthy after examination.
A woman’s well-being during pregnancy 12 months after surgical birth is not remarkable: gestation proceeds as usual. The appearance of any warning symptoms requires immediate consultation with a doctor. If conception occurred too early (less than a year has passed since the operation) and the woman decided to keep the baby, the entire period of gestation may be accompanied by severe nagging pain in the lower back/lower abdomen. Sometimes painful sensations unbearable, the expectant mother cannot cope with them without medication.
Childbirth: is there a choice?
The joy of motherhood - highest degree manifestations of love
It is a myth that natural childbirth is contraindicated after a CS. You can give birth on your own even if pregnancy occurs early after the operation - after a year or a year and a half. However, doctors give permission for EP with such a short period of time between the CS and conception only if the condition of the uterine scar is beyond doubt. By assessing the internal suture, the gynecologist determines whether the scar is ready to cope with the stress that accompanies natural childbirth. According to statistics, only 20% of women heal so quickly. When early pregnancy occurs after a CS, surgical delivery is almost always indicated.
If the “interesting situation” recurs when less than a year has passed since the operation, doctors advise terminating the pregnancy. The woman has the right to keep the baby. Under such circumstances, natural childbirth is strictly prohibited. The time recommended by gynecologists between pregnancies is not waited - you need to prepare for a planned surgical intervention if you manage to carry the baby to term.
Regardless of the statute of limitations of the CS, the next pregnancy must end with surgical birth if:
- multiple pregnancy;
- there are risks of muscle tissue divergence;
- pregnancy is complicated pathological conditions mother/baby;
- two or more CS in history;
- the age of the woman in labor exceeds 35 years;
- after a previous CS, complications related to scar healing arose.
ABOUT possible options It is important to consult your doctor before giving birth. Gynecologist-obstetricians welcome natural childbirth and do everything possible to make it a reality in each specific case. However, sometimes this option of delivery is not possible due to high risks for the mother/fetus. You should always listen to doctors. Especially in early pregnancy after a CS. Failure to follow the recommendations can lead to uterine rupture, which can lead to complications and death.
We stick to the rules
Pregnancy after surgical birth is important to plan. This will allow you to re-experience the happiness of motherhood without exposing yourself and your unborn child to danger. Complications of pregnancy and the risks of uterine rupture are not “horror stories” of doctors, but a reality faced by women who become pregnant earlier than two years after a CS. Therefore, the recommended “pause” should be followed. To avoid unforeseen situations, you need to choose a reliable contraceptive option.
How to properly plan conception after a previous CS? You should definitely visit a doctor and tell him your desire to repeat the pregnancy. Permission to conceive can be obtained only after a complete examination: tests, gynecological examination, hysteroscopy and suture hysterography. If a woman does not want to take a long break between pregnancies and plans to conceive in a year, she must first obtain a doctor’s permission. The scar is in perfect condition - the doctor will not dissuade you.
Endoscopic examination of the suture can be done eight to ten months after surgery, and gesterography is allowed after six months. These diagnostic methods help determine when pregnancy can be repeated and whether the condition carries risks.
If pregnancy occurs when only a year has passed since the surgical birth, there is no need to panic for fear of complications. You need to immediately contact your gynecologist: only a doctor can objectively assess all factors and give accurate prognoses.
According to statistics, doctors decide on cesarean section in 10-20% of births. But many women do not want to stop there and are planning another child. New pregnancy after a caesarean section there is a certain risk for the woman. Which, however, does not mean that you need to give up the idea of becoming a mother again. But carrying a baby will be safe only if a number of conditions are met.
In some cases, doctors categorically prohibit getting pregnant again after a cesarean section. This is always associated with serious diseases:
- Diseases of the genitourinary system, for example, chronic pyelonephritis, bladder stones.
- Asthma, chronic bronchitis
- Diabetes
- Severe thyroid diseases
- Heart diseases
In all these cases, doctors, even in the maternity hospital, warn the young mother that she should not have any more children: this threatens the woman’s life. If you are generally healthy, then you can get pregnant again.
How to plan a new pregnancy
Preparations begin with choosing reliable contraception, because you cannot get pregnant right away. An important question: how long before you can get pregnant after a cesarean section.
It is possible to carry a fetus for the second time after a cesarean section after 2 years. Early pregnancy can be dangerous.
The fact is that the scar that appears after surgery is not yet strong enough to withstand repeated stress. Scar failure can lead to uterine rupture during pregnancy or birth.
Keep in mind that over time, the scar loses its strength, so you shouldn’t delay your second pregnancy either. The optimal period is 2-4 years after the CS. Maximum - 10 years.
However, much depends on the individual characteristics of the organism. If a woman wants to get pregnant earlier than two years after a cesarean section, she is recommended to undergo a full examination by a gynecologist. It is also necessary to do an ultrasound of the uterus in order to find out what condition the scar is in. In addition to ultrasound, there are techniques that can accurately assess the condition of the scar - its structure and thickness.
- Hysteroscopy. A special device, an endoscope, is inserted into the uterus. The doctor will examine the scar and determine whether it has healed sufficiently. The procedure is most often performed under local anesthesia. It's not painful, but rather unpleasant. In commercial centers, the price of such a procedure starts from 3,000 rubles.
- Hysterosalpingography. The scar is examined using x-rays. A special contrast agent is used and injected into the uterus. The procedure is usually performed without anesthesia. According to reviews on the forums, it is a bit painful, but tolerable. Price – from 4000 rubles.
Both of these methods are only suitable for non-pregnant women. If the scar is strong enough, pregnancy is allowed.
So, the universal answer to the question of when you can get pregnant after a caesarean section is 2 years. But individual “amendments” in one direction or another are possible.
How to get pregnant after cesarean? If you got pregnant easily the first time, if the operation went without complications, menstrual cycle regular, then most likely there will be no problems with conception. The norm is to conceive within a year of regular sexual activity without contraception. If you have had more attempts, consult a doctor - you need to be examined.
“Thin ice”: what to do if you get pregnant earlier
But what to do if pregnancy occurs earlier than the period prescribed by doctors? Is it really impossible to save the child, and will you have to have an abortion? Time is of the essence here.
One and a half years after the CS
Don't worry. Most likely, the pregnancy will go well. Two years for the formation of a strong scar is a period “with a reserve”. Of course, pregnancy after a year and a half means walking around. thin ice. But the chances of a successful outcome are good. The doctor will probably allow you to carry the child. You just need to visit your doctor regularly, follow all his recommendations and take care of yourself.
One year after CS
What should you do if you accidentally become pregnant a year after your caesarean section? Previously, doctors sent such mothers for abortion without talking. Now that medicine has reached a different level, there is a good chance that everything will go well and a healthy child will be born.
It is important for you to register for pregnancy as soon as possible and follow all doctor’s recommendations. During pregnancy you will have to wear a bandage. In the third trimester, be prepared to go to bed. Most likely, you won’t be able to give birth on your own; you will have to undergo a repeat cesarean section (although there are exceptions). Your obstetrician-gynecologist will decide.
However, if the caesarean section was corporal (it is performed infrequently, the only indication for it is the transverse position of the fetus), then usually a year is not enough for the scar to heal. Such a pregnancy will be risky.
6-9 months after CS
If pregnancy occurs 9 months after cesarean, and even more so after six months, this is a serious situation. The decision about whether to continue the pregnancy or not should be made carefully together with your obstetrician-gynecologist. If it is decided to keep the child, the pregnancy will take place under constant monitoring of the condition of the suture. In the third trimester, hospitalization is required.
2-4 months after CS
Pregnancy immediately after cesarean section is impossible: reproductive function has not yet been restored. Yes, and sexual relations are prohibited until postpartum bleeding has stopped. But already two months after cesarean section, the first ovulation is possible (provided that you are not breastfeeding). Most often, your period comes 3 months after a cesarean section. This means pregnancy is possible. However, both 2 months and 3 months after the cesarean suture are completely unprepared for repeated loads. During pregnancy, it can disperse, and this is a risk to the life of the expectant mother.
Therefore, if pregnancy occurs early after a CS, you need to have an abortion.
If pregnancy occurs 4 months after cesarean section or earlier, then surgical abortion dangerous for reproductive function. Pregnancy is terminated early with the help of medications. If you delay going to the doctor, you will have to have a surgical abortion. And this is fraught with infertility.
In any case, if a woman is pregnant, she needs to urgently consult a doctor, he will decide what to do: terminate the pregnancy or continue.
Gestation and childbirth
During pregnancy after a caesarean section, a woman needs to register with a gynecologist as soon as possible. Ultrasound examinations are performed much more often than during normal pregnancies. In the last trimester, you may have to go to bed for preservation.
If a woman becomes pregnant with twins after a cesarean section, she risks stretching the uterus. This is a high risk pregnancy.
A planned cesarean section is performed at 38-40 weeks of pregnancy, taking into account the individual indicators of each patient.
It happens that a repeat pregnancy after a cesarean section ends successfully in a natural birth. Having a baby without surgery increases your chances of having a second and third birth in the future. If childbirth was performed without surgery, the body recovers much faster.
Caesarean section must be repeated in the following situations.
- The woman in labor suffers from chronic diseases.
- Pathologies of pregnancy.
- A woman became pregnant at the age of thirty.
- On abdominal cavity there were more than two operations.
In other cases, the doctor must decide whether to give birth herself or do a cesarean section again.
The question of how many times you can give birth after a cesarean section directly depends on the body of the expectant mother and the condition of her uterus. General rule: CS can be done no more than three times.
So, the answer to the question of when you can get pregnant after a cesarean section depends on a number of factors. These include the condition of the seams, as well as individual characteristics the body of the mother and fetus.
A second pregnancy after a cesarean section is always associated with certain risks, but undergoing surgery does not mean that you will no longer have children, or that you have absolutely no chance of giving birth a second time on your own.
According to statistics, caesarean section is resorted to in 10-20% of all births, depending on the profile of the institution. In maternity hospitals focused on complex childbirth (in regional ones, for example), this percentage is always higher, because a difficult pregnancy means high probability that a woman cannot or will not be allowed to give birth herself.
Depending on the reason why surgical delivery was chosen the first time, the doctor decides whether a second pregnancy is possible after a cesarean section.
Usually, recommendations regarding contraception and plans for the future are given in the maternity hospital. If you were operated on due to a serious general health condition, for example, if you have a serious heart disease, and childbirth is contraindicated in the future, sometimes even before the operation a radical method of solving the issues of preventing a new conception is proposed - sterilization. During the CS, the tubes can be tied, then an unexpected repeat pregnancy after a cesarean section will definitely not threaten you.
If the indications were complications of this particular pregnancy and childbirth, for example, malpresentation fetus or the presence of genital herpes at the time of birth - then there are, of course, no obstacles to having a second or third child in your family in the future.
As a result of CS, a scar remains on the uterus. To remove the baby, doctors have to cut the wall of the uterus in its lower part, and then this wound heals with the formation of dense connective tissue. The scar is characterized by low extensibility and high strength, but it does not immediately become good and dense.
It is believed that the most best time for conceiving a second child, this is 2 years after the intervention. Early pregnancy after cesarean section is dangerous due to the possible failure of the uterine scar. Doctors use this term to describe the inability of the scar to resist the stress of stretching the uterine wall, which can ultimately lead to its rupture during pregnancy or childbirth.
If you do not take protection and pregnancy occurs immediately after a cesarean section, most likely, you will be asked to terminate it in order to avoid this complication, although there are cases where women successfully carried a second baby even if the pregnancy occurred a month after the cesarean section. Such cases should be considered the exception, not the rule, and not expose yourself to risk.
Planning pregnancy after cesarean section
Preparing for pregnancy after a cesarean section begins with... contraception. Carefully protecting yourself is a vital necessity if you want to have a safe birth. The uterus needs peace and the opportunity to heal its wounds, and this takes time.
The incision, of course, will heal quickly, but for a long time the connective tissue here will be tender and not strong. For example, if you get pregnant in the first year after the baby is born, the risk of complications will be slightly higher than if you do it after two years.
A few statistics that will most likely reassure you in many ways:
Doctors have repeatedly and widely studied the problem of uterine rupture along a scar, and almost all studies have confirmed a risk not exceeding 0.5-1% for women who have had only one cesarean section performed in the lower segment of the uterus (this is if the second time the woman give birth on your own). At the same time, all women were included in the studies, even if it was a twin pregnancy after cesarean with independent birth or breech presentation, which in itself significantly increases the risks, or even if pregnancy occurs six months after a cesarean section.
If there was a classic cesarean section with a longitudinal incision of the uterine wall, which is now used extremely rarely, then the risk increases slightly. A third pregnancy after two cesarean sections increases the risk of rupture of the uterine wall along the scar by 3 times, up to 1.8%, so if you have had 2 operations or a corporal cesarean section, be prepared that you will definitely not be allowed to give birth on your own.
Planning a pregnancy after a cesarean section requires prior consultation with a doctor, that is, without a visit to the gynecologist, you should not “make” the baby. Usually the woman is examined and an ultrasound of the uterus is prescribed to clarify the condition of the scar. If it is good, dense and durable, of sufficient thickness, the gynecologist will allow pregnancy.
Ideally, you need to plan conception 2-2.5 years after childbirth, at this time the scar is the strongest; postponing pregnancy for a longer period is also not worth it - because over time, the strength of the scar decreases and its atrophy occurs.
How is pregnancy after cesarean?
Signs of pregnancy after a cesarean section in the past are a reason to register with a gynecologist as early as possible. Ultrasound is often done during such a pregnancy, especially in later or if it is unusual, for example, you are carrying two or more babies. Multiple pregnancy after a cesarean section means a slightly greater risk, because the wall of the uterus stretches too quickly, and it is more difficult for the scar to adapt to the rapidly increasing load on it.
You should know that early re-pregnancy after cesarean section, even if it is not wanted, puts doctors in a very difficult position. difficult situation. The fact is that carrying a baby is dangerous, and having an abortion is also dangerous. Medical termination of pregnancy after cesarean for up to 5-6 weeks has almost no risks, as with normal pregnancy, but if the period has already exceeded the permissible period for the use of mifegin and other drugs, and instrumental termination of pregnancy is required, after cesarean this may even call into question your ability to bear children in the future, the risk of complications is very high.
A subsequent pregnancy after a cesarean means that you should never give birth at home. Rupture of the uterus along a scar is not a myth, it is a possible reality, therefore, the child should be born only in a maternity hospital, where you can get help in case of complications. Not all maternity hospitals allow independent childbirth after cesarean section if you want to give birth to a baby naturally, this point must be clarified in advance. One cesarean is always a cesarean, this has long ceased to be true, because most expectant mothers are quite capable of giving birth to a baby naturally.
Childbirth after cesarean is carried out gently, avoiding stimulation. Indications for reoperation in the absence of other direct indications for surgical delivery most often include:
1. Early, too early pregnancy, for example, a year after a cesarean section, when the scar is still weak.
2. Pregnancy after a second caesarean section
3. History of corporal CS
4. Age over 30 years
Possible complications of pregnancy and childbirth:
1. Rupture of the uterus along the scar during pregnancy (late term) and during childbirth. The onset of this complication is manifested by acute pain in the lower abdomen in the area of the scar.
2. True placenta accreta. The complication is associated with the failure of the endometrium of the uterus in the area of the scar; it is thinned here and cannot provide the chorionic villi with the necessary for successful attachment; they grow into the wall of the uterus. The complication is extremely rare, but dangerous, and is detected in the 3rd stage of labor, after the birth of the child.
In most cases, pregnancy and childbirth after a cesarean section proceed safely, ending with the birth of a healthy, full-term baby. Don't worry if you've had surgery in the past, it didn't make you inferior or flawed, no. You can perfectly cope with the task of bearing a child, and even more than one.
Today, pregnancy that occurs after a previous surgical delivery is no longer a rarity. The question is no longer so much the satisfaction of the desire to have another baby, but the interval that a woman needs to endure before this. In addition, when preparing and managing pregnancy after cesarean section, there are important points, and this must be taken into account by the expectant mother.
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What is a caesarean section operation?
Surgical delivery, the essence of which boils down to cutting the wall of the uterus and removing the newborn through it, is called a caesarean section. Stitches are placed on the incised area, and a scar is formed as the wound heals. The wound heals after 3-4 months, but complete restoration of the uterus occurs a year after the operation. To ensure a safe second pregnancy, doctors advise planning it two years after the operation, but not earlier.
Early pregnancy can lead to various pathologies, among which the most common are the following:
- scar divergence during pregnancy or when natural birth;
- attachment of the placenta to the scar;
- placental abruption at any stage of pregnancy;
- low location of the placenta.
If the proper period is maintained between pregnancies, then, as a rule, there are no problems with bearing the baby. IN otherwise there is a high risk of divergence of the uterine suture, which leads to fetal death, and if timely treatment is not provided medical care- and mother.
Features of pregnancy planning
Pregnancy after cesarean section is often a considerable risk, but when the right approach and with constant monitoring by a doctor, it progresses favorably. The decision about the possibility of carrying the baby to in this case taken by a gynecologist, for which the general condition of the woman, the reasons that led to the operation, and, most importantly, the condition of the uterine scar are assessed.
Doctors call contraception the first stage of planning, since a repeated early pregnancy can be terminated for medical reasons, which will have an extremely adverse effect on the condition of the uterine scar.
Not earlier than in six months, but better year after surgical delivery, the following studies are carried out to provide an objective assessment of the condition of the scar:
- Examination by a gynecologist with palpation of the suture, where its general condition is determined. By palpation, the doctor is able to determine whether the scar is sufficiently formed, whether there are softened areas on it, or whether there is pain.
- Hysterography, or x-rays taken in several projections. A contrast agent injected into the uterine cavity before the procedure helps determine the consistency of the scar.
- Hysteroscopy, or visual diagnosis of the uterine cavity, performed using an optical device. This method allows you to diagnose any intrauterine pathology and determine what tissue the scar is formed from.
You cannot think that after a long time, pregnancy after a cesarean section can be planned without undergoing the listed studies. The doctor must examine the scar formed on the uterus, assess its condition and make a conclusion about what tissue it was formed from.
Repeated pregnancy is allowed if it is determined that the scar has formed entirely from muscle tissue, and it should be practically invisible. If connective tissue is present or predominates in the resulting scar, then such a scar is considered invalid, and a second pregnancy in this case will not be allowed. An incompetent scar may diverge when the uterus stretches, since it is not able to withstand the load that pregnancy carries and often softens and diverges.
It is also worth remembering that pregnancy after three cesarean sections is not at all acceptable. After the second operation, the doctor will most likely suggest that the woman in labor use a radical method of contraception - sterilization, or tubal ligation.
Video: Obstetrician-gynecologist about complications from cesarean section and planning pregnancy after surgery.
Pregnancy management
Pregnant women who have undergone a cesarean section belong to the so-called risk group for pregnancy management and subsequent delivery. Such women visit their primary doctor more often and are prescribed additional examination methods, especially in the third trimester of pregnancy:
- During the examination, the gynecologist regularly checks the scar for pain using the palpation method. Any softening or, on the contrary, hardening causes suspicion and gives grounds for hospitalization.
- The condition of the uterine scar is regularly examined using ultrasound diagnostics with a vaginal sensor, so pregnant women at risk are more often prescribed this type of examination.
- Often the placenta is attached to a scar on the uterus, which affects the blood flow and nutrition of the fetus. Dopplerography helps to identify possible risks in a timely manner and prescribe the necessary therapy.
- Particular attention is paid to a pregnant woman if she is expecting two or more babies. The risk of thinning even a correctly and well-formed scar increases.
- At 34-35 weeks of pregnancy after a cesarean section, a woman is offered an inpatient stay, since this is the time of the most intense growth and development of the fetus, leading to increased stretching of the uterus. During this period, the uterine scar withstands the greatest loads, and the risk of its divergence increases significantly. If any pathology is suspected, surgical delivery is performed.
The greatest risk during pregnancy is an incompetent scar that is unable to withstand or resist the stress of stretching the uterus. This leads to the divergence of the scar during the process of bearing a child, so doctors suggest terminating such a pregnancy if this occurs during pregnancy. early stages, or decide on a repeat cesarean section if the threat of suture dehiscence occurs in the third trimester.
Childbirth after caesarean section
Vaginal or natural birth after cesarean section is considered possible if the reason for the previous operation was due to the peculiarities of the pregnancy: for example, abnormal position of the fetus or weak labor activity. In any case, this decision is made only by the doctor based on the research and observations.
If there are no special instructions for a subsequent caesarean section, then a natural birth is preferable for both the woman and the child. However, it is also worth considering that in case of a repeat pregnancy that occurs after a cesarean section in a year or even less, the doctor will not allow vaginal birth, and the delivery will take place by cesarean section. This is another argument in favor of waiting a minimum interval between pregnancies.
The possibility of a natural birth also depends on what kind of caesarean section was performed the previous time. With a longitudinal scar (the so-called classic cesarean section), natural childbirth is considered unacceptable. If a transverse scar is present and there are no contraindications, the possibility of vaginal delivery may be considered.
Natural childbirth is allowed in the following cases:
- the scar is formed correctly, there is no risk of its divergence during childbirth;
- the placenta is not localized on the scar;
- with a transverse scar;
- the weight of the fetus does not exceed 3.5 kg;
- there is one fetus in the uterus;
- the previous caesarean section was caused by the peculiarities of the pregnancy.
Doctors decide on the method of delivery after 35 weeks. To do this, not only the condition of the scar is assessed, but also the size and position of the fetus, the location of the placenta relative to the scar and os of the uterus. It is worth noting that during pregnancy that occurs after two surgical deliveries, the question of natural childbirth is closed for the third time.
