Where does scar come from and what is it like?
Most often, the scar is a trace of a cesarean section in the lower segment of the uterus; This option is considered the most favorable. Less common is a corporal incision along the body of the uterus, which is performed in emergency situations: it heals worse and almost always requires a planned cesarean section in the future. A separate group is scars after conservative myomectomy, especially if the uterine cavity was opened. It is important for the doctor to know not only the fact of the operation, but also its type, the course of the postoperative period and the presence of complications, so the discharge from the hospital should be kept.
- Scar after cesarean section in the lower segment is the most common
- Corporal scar after incision along the body of the uterus
- Scar after removal of myomatous nodes
- Scar after suturing uterine perforation
- Scars after surgery for ectopic pregnancy in the uterine horn
What is rumen consistency?
A scar in which muscle tissue predominates and the thickness of the lower segment is sufficient and uniform is called a wealthy scar. An incompetent scar is thinned, contains a lot of connective tissue, and sometimes a niche is visible in it. There are no exact universal thickness figures at which natural childbirth can be unambiguously allowed or prohibited, so the doctor evaluates the totality of data: structure, uniformity, presence of pain, number of previous operations and healing characteristics. It is optimal to evaluate the scar before pregnancy, in the second phase of the cycle.
- Predominance of muscle tissue is a good sign
- Uniform thickness of the lower segment
- Niche and pronounced thinning are signs of failure
- It is best to evaluate before pregnancy
- There is no single threshold thickness value
- The number of previous operations is taken into account
Possible complications
The main thing that doctors fear is uterine rupture along the scar, but with a scar in the lower segment and one cesarean in the past, this is a rare complication. Pathology of the placenta is much more common: it can be located low, block the internal os, or grow into the scar area. That is why the location of the placenta must be clarified at each ultrasound. Another option is pregnancy in the rumen, when the fertilized egg is attached directly in the niche; this condition is detected early and requires urgent help.
- Uterine rupture along a scar is a rare but dangerous complication
- Placenta previa
- Placenta accreta into the scar area
- Pregnancy in the scar in the early stages
- Dense placenta and bleeding during childbirth
Monitoring during pregnancy
This pregnancy is managed with more frequent visits. At the first ultrasound, the location of the fertilized egg is clarified and pregnancy in the scar is excluded. From the second trimester, the location of the placenta is assessed, and in the third trimester, the thickness and structure of the lower segment is assessed, usually several times. A woman is advised to avoid heavy loads and contact immediately if pain appears in the scar area. Planned hospitalization is scheduled in advance so that labor does not begin at home. If placenta accreta is suspected, the delivery plan is discussed by an extended team of doctors.
- Early ultrasound to exclude pregnancy in the scar
- Monitoring the location of the placenta in the second trimester
- Assessment of the lower segment in the third trimester
- Dopplerography according to indications
- More frequent visits to the obstetrician-gynecologist
- Planned antenatal hospitalization
Childbirth: cesarean or natural
Natural birth after one cesarean section is possible if the scar is in the lower segment, it is strong, the fetus is in cephalic presentation, there are no placenta previa and other indications for surgery, and the hospital is ready for emergency intervention. Such births are carried out under continuous monitoring of the fetal heartbeat and without aggressive stimulation. A planned cesarean section is chosen for two or more previous operations, corporal scar, signs of incompetence, breech presentation and placental pathology. It is advisable to maintain an interval between pregnancies of at least one and a half to two years.
- Natural birth is possible after one cesarean section with a healthy scar
- Continuous monitoring of the fetal heart rate is mandatory
- Planned caesarean section for two or more operations
- Corporal scar - indication for surgery
- Childbirth only in a hospital with a 24-hour operating room
- The optimal interval between pregnancies is from one and a half years
