Scar in the uterus: Is the conception possible. Pregnancy and childbirth with a scar in the uterus

According to testing, a woman can give a re-natural way in 80% of cases, if the first was a cesarean section. In most situations after cesarean, it is safe to give birth naturally than using the operation. But when women are configured to standard generic activities, they meet with indignations of doctors. Oncestrapers are convinced that if there is a seam on the organ, it is unacceptable to give birth independently. There is a rupture of the uterus on the header during pregnancy.

The scar in the uterus is called the formation created from connective tissues. Located in the place where there was a violation and resumption of the organ walls during the operation. Pregnancy with adhesions are different from ordinary. Seam will remain not only after the cesarean section. The walls of the organ are broken after other surgical interventions.

There are insolvent and wealthy scar in the uterus. The wealthy seam is stretched, declining, withstands certain pressure when entering the fetus and confusion, elastic. A muscle tissue prevails here, which is similar to the natural tissues of the organ.

What scar on the uterus is considered wealthy? The optimal thickness is 3 mm, but is allowed 2.5 mm. Spike becomes wealthy in three years.

The untenabolic scar of non-ielastic, is not capable of reduction, it is broken, as the muscle tissue and vessels are underdeveloped. The body grows while waiting for the child, and the spike becomes fine. The seam subtlety cannot be controlled and treated. If the inconsistency of the scar is brightly visible and the thickness is less than 1 mm, then there are prohibitions on the planning of children. It is possible to understand what a scar in the uterus is possible according to ultrasound, MRI, X-ray, hysteroscopy.

Diagnostics:

1. Ultrasound shows the dimensions, unreasonable areas, the form of the organ;
2. the inner species is estimated by an x-ray;
3. hysteroscopy allows you to find out the form and color;
4. MRI determines the ratio between the tissues.

These methods help to diagnose the problem., But no method makes the right conclusions about the seam. This is checked in the process of waiting for labor.

Causes

The inconsistency of the seam carries a serious threat, both for a woman and for the fetus. Spike on the body is the cause of the wrong position of the placenta. With an abnormal increment of the placenta when the embryo attachment is observed on the scar of the uterus, the pregnancy is interrupted at any time.

Quite often, it is impossible to convey the child. When the baby is waited, the change in the seam is monitored by ultrasound. If there are the slightest doubts, the doctor advises the woman inpatient treatment before the delivery.

Because of what the scar is thinned in the uterus:

1. complications after Kesarean: decay rotation, inflammation;
2. use during the operation of low-quality materials;
3. development of infectious diseases;
4. the implementation of several operations on the organ.

Where to check the scar on the uterus? To track the symptoms of thinning of the scar on the uterus during pregnancy, it is necessary to be systematically examined after entering the fetus and operations. Monthly examinations of the gynecologist are important, the passage of ultrasound. Due to this, timely treatment is carried out.

Signs of the failed scar:

• pain in the scar on the uterus;
• stitching pain during sexual intercourse;
• difficulty when urination;
• nausea and vomiting.

If suddenly showed signs of the insolvency of the scar on the uterus, you need to urgently contact the doctor. Often postoperative seams diverged during the period of menstruation. The organ is filled with blood clots, and when there is an inflammatory process, thin areas diverge.

Signs

If the seam is diverged during re-delivery, this is a dangerous phenomenon for the mother and child. Here is urgent surgical intervention. With horizontal dissection, seam is rarely separated. Many operations are carried out at the bottom of the uterus, the scar is less subjected to breaking in subsequent births.

Barriers occur from previously conducted Cesarean, as there is an insolvent scar in the uterus during pregnancy. The possibility of breaking the seam affects the type of cut during the operation. If this is a standard vertical cut - between the pubic and navel, it will work faster.

Vertical incision is rarely used, except in emergency situations. It is used when there is a threat to the life of the baby, if the child lies across, or you need to quickly react to save your mother and fruit. A similar seam is broken in 5-8% of cases. With several children, the risk of breaks are increased. Dangerous when the scar is thinning and is redistributed.

Signs of the beginning of the gap:

1. the uterus is tense;
2. sharp pain when touching the abdomen;
3. non-cultural cuts;
4. abundant blood discharge;
5. the child is disturbed by heartbeat.

When the gap occurred, symptoms are added:

• severe abdominal pain;
• reduced pressure;
• vomiting, nausea;
• fight contractions.

As a result, the fetus lacks oxygen, the mother has hemorrhagic shock, the child is dying, the organ is removed. The consequences of the rear spike break during childbirth are the most unpredictable. When tissue breaks, caesarean is carried out, since it is necessary to urgently save the life of women and the fetus.

Symptoms of discrepancy during pregnancy

Birth with the presence of a scar in the uterus during the second pregnancy is carried out without complications, but a certain percentage of the seam discrepancy is present. An important moment at the second pregnancy is the age of fen, a small break between the conceptions. Moms who gave birth with an insolvent scar in the uterus, tolerate re-operation.

When re-enhancing caesarean some women, even with a standard cut on the organ. Statistics of uterine ruptures on the header says that the vertical and horizontal lower cuts are broken in 5-7% of cases. The risks of breaks affect its form. The seams on the organ resemble the letters J and T, even the form of an inverted letter T. In 5-8% T-similar scars diverge.

When the child, a complex state is observed during the baby tooling, which contributes to the death of both. The main reason for the manifestation of complications is the inconsistency of the scar on the uterus after delivery. The main complexity is the impossibility of predicting the discrepancy of the seams. After all, the body is broken, both in the delivery and pregnancy, even after childbearing in a few days. The obster immediately determines the discrepancy in the fights.

Can the scar on the uterus sick? Yes, there is discomfort when tensile. Insolvent seam always hurts, the discrepancy is accompanied by nausea and the presence of vomiting.

1. beginning;
2. threatening rupture of the uterus on the heading;
3. follow

The factors affecting the beginning or the seam rupture already occurred are noted. The fever feels bad, she has severe pain, bleeding develops.

Symptoms:

• between the fights there are severe pain;
• fights weak and not intense;
• sore scar in the uterus in pregnancy;
• the baby is moving in another direction;
• the head of the fetus went beam over the borders.

When the child's non-standard heartbeat is observed, the heart rhythm slows down, the pulse decreases, then these are the symptoms of discrepancy. There are cases that after breaking, the birth continues, the contractions also remain intense. Seah ripped, and signs of gaps of the scar in the uterus during pregnancy are not even observed.

Threat rupture

Situations of discrepancies are systematically studied. If you monitor this type of birth, to diagnose the seam break and make an urgent operation, you can avoid serious complications or minimize them. When organizing unplanned caesarean, the risk of child death is reduced due to the gap of the spikes during childbirth. They distinguish the gap of the rear spike after childbirth, damage to the walls of the vagina, the skin of the perineum and muscles, as well as the disturbance of the rectum and its walls.

When a woman is observed the entire period of tolerance, experienced hospital obsteckers with the presence of the necessary equipment are involved in childbirth. Under the control of childbirth undergo without complications for the guinea and child.

There are women who wish to give birth at home. They should know that the discrepancy between the seam may occur, so it is not recommended to conduct childbirth at home. If a woman will give birth naturally in a non-state institution, then it is required to clarify whether the equipment for conducting an urgent operation is in this hospital.

There are signs that increase the risk of rupture of scars:

• at childbirth, oxytocin and drugs are used, which stimulate the cutting of the uterus;
• in the previous operation, there was a single-layer seam, instead of a reliable double;
• re-pregnancy has come earlier than 24 months after the previous one;
• woman for 30 years;
• presence of vertical dissection;
• the woman survived two and more caesarean.

There are techniques that diagnose the seam break. The electronic device is watching the child's condition. There are obstecra who use a fetoscope or doppler study, but did not prove that these methods are effective. In institutions, they are advised to use electronic devices to observe the state of the fetus.

Treatment and prevention

The treatment of scars in the uterus includes re-surgical intervention, but there are few invasive methods for eliminating anomaly. In no case should not refuse therapy.

In case of refusal to treatment, complications arise:

• breaking when heated or during childbirth;
• increased body tone;
• blooding scar on the uterus;
• severe pains, it is impossible to even lie on the stomach;
• the risk of rotation of the placenta increases;
• lack of oxygen for the fetus.

It is easy to diagnose complication. When the organ breaks, the stomach changes the shape, the uterus looks like a hourglass. Mom is concerned about, fainting, the pulse is almost not tugged, bleeding opens, swells the vagina. It is impossible to listen to the heartbeat of the fetus, as hypoxia appears and, as a result, the death of a child.

A woman is issued at the hospital, examine and make an operation. First, the patient's blood loss is excluded. During the operation, remove the uterus and restore blood loss. After the procedure, the prevention of blood clots and low hemoglobin is carried out. If the newborn survived, then it is sent to intensive care and leaning under the devices.

How to treat scar on the uterus:

1. operation;
2. laparoscopy - excision of an existing untenable seam and crosslinking of the organ wall;
3. metroplastics - the destruction of the partition inside the organ in the presence of a set of niches.

To prevent uterine breaks, you should plan to plan in advance, while being examined. If a woman had an abortion or an operation, then the body should recover. At the occurrence of conception with the scar, the uterus is recommended to urgently put into account the doctor.

When the patient is responsible for the long-awaited generic activity, chooses a suitable doctor, carefully monitors health during the second pregnancy, then the appearance of a child will be really joyful. There are mothers who have two scars in the uterus and the third pregnancy for them is a common phenomenon. Women are ready to make such a responsible step. Discuss the seam and how you can pass the childbirth with an obstetrician in advance.

The scar in the uterus arises due to healing after surgery. There are two types: wealthy and untenable. The latter has a high risk of rupture, so when diagnosing such a scar, it is not recommended to be pregnant without plastic surgery. When carrying a child with a plot of fibrous fabric in the uterus, a woman is constantly under the supervision of a doctor. It is recommended to regularly conduct an ultrasound in the third trimester.

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  Pathogenesis

  The scar in the uterus is a modified piece of fabric, which was formed due to the damage to the myometrium. The reason is injuries and surgical operations. Outside pregnancy has no clinical symptoms. In gestation and childbirth can lead to the uterus. Therefore, in recent terms, the diagnostic methods that help prevent possible complications are used to evaluate the structure of the tissues. Pathology is not treated, but is the main factor in the choice of the method of delivery.

  The formation of a scar is a natural healing process after damage. Depending on the level of reactivity of the body and the length of the cut or punctures, the regeneration occurs in several ways: full recovery (restitution) or defective (substitution).

  In the first case, the damage plot is replaced by a myometrium, in the second - large bunches of fibrous tissue (looks like a scar). The risk of the appearance of the scar is increasing in the presence of an inflammatory process. For complete ripening of the fabric, you must at least two years. The functional state of the organs depends on the nature of the healing.

  Classification

  In medical practice, scars are classified relative to the type of fabric that replaces the area of \u200b\u200bdamage. Distinguish two types of scars:

  • Weissive. Formed from the fibers of myometrium, elastic plots. They have the ability to decline at the moment of stress of the uterus, can resist the loads. The norm of the thickness of the scar from 5 mm.
  • Insolvent. They are formed by a connective tissue, have a small elasticity, they are not able to shrink in the battles, they have low resiliques of ruptures. Diagnosed with a thickness of 1 mm.

  When the plan of the survey and the obstetric tactics of pregnancy is determined, it is important to take into account the localization of the scar. It can be located in the body of the uterus, at its lower part or in a neck with an area adjacent to the inner zev.

  

  Signs of the disease

  By itself, the scar is not manifested. Clinical symptoms appear when the uterus breaks. The latter has serious consequences. A woman complains of pain at the bottom of the abdomen, bleeding, periodic nehydramic contractions. The state worsens, systolic pressure drops, tachycardia, nausea and vomiting appear.

  Manifestations depend on the location of the scar and the clinical stage:

  

  Causes

  The main reasons for the appearance of the scar are:

  Cause	Description
  Cesarean section	The scar appears on the scene of the uterine wall to extract the child, mainly this is the bottom third
  Momectomy	Removal of moma - a benign growth of the muscular layer. In its localization area, it is significantly fed and can be replaced by a scar cloth
  Perforation	The walls of the uterus are pierced during scraping or abortion
  Restorative operation	Such interventions are carried out after breaking the uterus or due to the removal of rudimentary horns. The latter means a malformation, in which the uterus has two separate parts
  Ectopic pregnancy	Removing the place where the embryo was attached may include a part of the uterus if implantation occurred in its neck and the area of \u200b\u200bthe phallopyye tube, which is located near the uterus itself

  Features of an insolvent scar

  The main reason for the formation of such a scar is a reduction in the portions of myometrium, the presence of a large amount of fibrous tissue. Such pathology is most dangerous in the first 14 days after the intervention, since there is an increased risk of inflammation. With such pathology, there is a high probability of developing hemorrhage in peritoneum or in the uterine cavity, the attachment of infection with the development of sepsis. In the last periods, the scar can lead to ruptures (during childbirth), the development of the focus of inflammation.

  Causes of education:

  • emergency Cesarean;
  • inflammation of the seams;
  • abortion scraping;
  • postoperative complications;
  • conception in early time after Cesarean.

  If the inconsistency of the scar is required urgent hospitalization. This is associated with a high chance of interrupting pregnancy and the appearance of other pathologies.

  In the presence of an untenabolic scar (estimated by ultrasound diagnostics) and the desire to give birth to re-recommended a laparoscopic operation on the excision of fabric and the imposition of a full-fledged seam that will not prevent normal pregnancy.

  The appearance of a scar in any organs means a violation of their normal operation. This is due to the deterioration of blood supply and innervation of tissues. With repeated pregnancies, a woman is necessarily observed at a gynecologist.

  Effects

  The scar in the uterus can lead to the formation of such pathologies as:

  • Endometriosis. It is the growth of the cells of the mucosa. A particularly unpleasant situation is observed if the centers appear on the RubE. In this case, surgery is most often required.
  • Endometritis. Inflammatory process in the field of endometrial. The disease in chronic form can lead to infertility and even the need to remove the uterus.
  • Miometrite (muscular shell inflammation).
  • Parameter (pathology of connective tissue).
  • Dysmenorrhea (painful periods).
  • Spontaneous abortion.
  • Prelation of the placenta.
  • Painful childbirth.
  • Cervical erosion.
  • Hypoxia fetal.

  Diagnostics

  The main task of assessing the functionality of the uterus is the study of the vastness of the scar. Informative methods in this case are:

  • Hysterography. The procedure provides for the introduction of a contrast substance and research using X-ray.
  • Hysteroscopy. It is to introduce a thin tube with a video camera at the end. Hysteroscope is used to inspect the inner shell, scraping and, if necessary, removal of formations.
  • GynecologicalUltrasound. The uterine cavity is conducted, which shows an intermittent and uneven contour in the scar area with source endometrial.

  The data obtained is taken into account during the second pregnancy. From the end of the second trimester spend once every 7-10 days of ultrasound.

  With the symptoms of the threatening gap during childbirth, an obstetric examination is carried out and the risk is evaluated by assessing the form of the uterus and its contractile activity. The ultrasound is watching the condition of the fabric, the defects of the myometrium and the region of its thinning are distinguished.

  The fruit is observed using cardiotockography or ultrasound with Dopplerometry. When breaking, the differential diagnosis is carried out with inflammation of the appendix, renal columns or starting childbirth. Additionally, you may need an examination of the surgeon.

  Pregnancy and scar

  For about two years, it is necessary to fully formed a wealthy seam in the uterus. This time is recommended to wait until the next attempts become pregnant. Not the best option is a long break, after four years, the scar begins to gradually lose elasticity.

  Pregnancy with a seam on the uterus passes necessarily under the control of the obstetrician-gynecologist.

  Complications

  The thinning of the scar is normal, but may affect the state of the embryo. Due to the atrophied area, the predatory placenta may develop or its increment on any part of the organ wall. If the embryo implantation occurs in the scar area is a bad sign. There is a high risk of early childbirth or spontaneous abortion.

  The most serious complication is the gap. Due to the breaking, a woman arises a hemorrhagic shock that can lead to death. In order to save the patient, hospitalization is carried out, the opening of the transverse section and scraping. Hypoxia has arisen with a large probability of probability can lead to a child's death.

  Roda

  There are two types of opening of the uterine cavity:

  • Cross-section. Made with a planned operation.
  • Corporate. Performed with the necessary urgent delivery, childbirth until the 28th week, hypoxia or bleeding.

  Re-pregnancy most often leads to Cesarean. However, more and more patients with the scar are sent to natural childbirth. This is possible in the absence of contraindications, conducting a survey and hospitalization before the start of birth at the 37-38th week.

  There are conditions that need to be observed that the woman can give birth independently:

  • relative readings for the first operation (large fruit, weakness of generic activity, hypoxia, aggravation of chronic infections, improper presence of the fetus);
  • lack of pathology at the first child;
  • safe pregnancy;
  • the presence of a wealthy scar in a single amount;
  • conducting the first operation by cross-incision, provided that healing proceeded without complications;
  • the estimated mass of the fetus is less than 3.5-4 kg and the absence of pathologies;
  • the lack of signs of the insolvency of the scar on ultrasound examination.

  Indication	Description
  Long Rubet	The probability of unfavorable outcome in this case is significantly higher.
  The presence of two scars and more	Pregnancy after two cesarean and more resolved surgically
  Some interventions in the reproductive system	Momectomy of the rear wall of the uterus, plastic with violations of the organ development, operation about ectopic pregnancy in the field of the uterine cervical
  Anamnesis gap	Natural childbirth is contraindicated if the previous pregnancy was accompanied by a gap
  Failure of the scar	Signs of a significant amount of scar tissue have a bad forecast
  Pathology placenta	The operation is carried out in the preservation of the placenta or its localization in the scar formation zone
  Narrow pelvis	Loads that provokes fruit when passing through the generic paths exacerbate the state and provoke a break

  If a threat of a break appeared in natural labor with the scar, the operation is made in an emergency order. After Cesarean, the defect of the wall of the organ. With strong bleeding with the impossibility of stitching or massive hematoma, the uterus is extirpation.

  Therapy

  With normally proceeding pregnancy and childbirth, no treatment is required. In the case of an insolvent scar, a woman does not advise the pregnancy in the future. It can provoke serious complications.

  The only effective method of therapy is considered operation. Drug or other methods of treatment of the scar are ineffective. Due to the location of the body, it is not possible to resort to more gentle techniques.

  Metroplasty

  The indication of the plastic is to thinning the walls of the muscular layer of the uterus to 3 mm or the deformation of the seam. The essence of the metroplasty is to remove the scar tissue with the imposition of seams. Laparoscopically and laparotomic can be carried out.

  The open operation is caused by the need to access the body of the organ, which is located in the zone of strong blood circulation. The choice of surgical intervention is associated with a high risk of hemorrhage during intervention. The intervention is accompanied by the release of large veins and arteries and the imposition of clamps on them to prevent bleeding. After excision, the scar is carried out plastic. The advantages of the technique lies in low invasiveness and low risk. It has a slight recovery period.

  Prevention of scar

  When planning pregnancy and prepare for it, it is necessary to identify and treat all chronic diseases. It is recommended to attempt to conceive at least 24 months after surgery in the uterus. It is important to register up to 12 weeks. During pregnancy, a regular visit to the obstetrician gynecologist is made. In the first trimester - Once a month, every 14 days - in the second trimester, once a week - in the third.

  The risk factors of the uterus break are determined in advance. Carefully watch the scar with the help of ultrasound. When comparing all factors and research data, the question of the planned caesarean section is resolved.

The scar in the uterus is a serious problem of modern obstetrics, especially if we consider that the frequency of the delivery by the operation of the cesarean section is constantly growing.

About the scar in the uterus they say when prompt intervention was performed on the uterus. The scar can never have a muscular structure like a myometrium. It is always associated with the formation of connective tissue. If it is much, then it has a significant impact on the contractile activity of the uterus, sharply disturbing it. This is due to the fact that the connecting tissue to the reduction is not capable.

The scar on the uterus during pregnancy in a woman may be a consequence of such operational interventions in the past as:

- conservative momectomy (removal of the myomatous node, followed by stroke of the uterus wall);

- stitching the wall of the uterus after perforation produced during the medical abortion.

A number of factors are influenced by the form of suture material, the body's features regarding the formation of a certain type of collagen, from which the connecting fabric, the presence or absence of infection in the postoperative wound; That qualitable wound healing).

What is an insolvent scar in the uterus?

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

Normally, the scar must have a thickness by the end of the ended period of pregnancy equal to 5 centimeters and more. As a rule, it is used to obtain reliable results or a vaginal sensor, or if an abdominal sensor is used, then it is necessary to fill the bladder well. You can evaluate the wealth of the scar on the uterus both during pregnancy and at the stage of its planning. In the latter case, this will allow you to identify an insolvent scar (complete inconsistency), when pregnancy is contraindicated without conducting certain therapeutic measures.

It is possible to indirectly assess the wealth of the scar, and by clarifying the peculiarities of the postoperative period. Some circumstances can talk about increased risk of having an insolvent scar.

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

How does pregnancy occur in the presence of a scar on the uterus?

The scar on the uterus imposes a serious imprint on the features of the course of pregnancy. These features know every obstetrician gynecologist, so takes into account them at the stage of pregnancy. These should be attributed:

- increased frequency of the threat of abortion;

- development of placental insufficiency in the greater percentage of cases than in the overall population of pregnant women;

- Anomalies attaching placenta (tight attachment, true rotation, placenta prelation).

Anomalies attachment placenta are the most serious problem. They can lead to the appearance of bloody secretions during pregnancy during the presence of the placenta or may be the cause of the anomalies of the placenta separation. They, in turn, lead to an increased frequency of manual offices, as well as cases of the removal of the uterus about true rotation.

What a scar is insolvent and the causes of its formation

The scar is considered defective in two cases:

- if its thickness is less than 5 millimeters;

- There are defects (so-called niches).

Usually insolvent, the scar becomes in the case of the development of an inflammatory process or poor operations of the operation (the tissue is restored by the unheated). Certain signs allow you to suspect an insolvent scar on the layout during pregnancy.

- an increase in body temperature in the postoperative period was observed;

- the presence of a pathological separated from the wound, etc.

The suture material also has a direct impact on the wealth of the scar. So, Ketgut most often leads to the development of an insolvent scar. Vincle in this respect is the best suture material, as the fabric is well heal.

Grigory Rubtsov - Last Year's Eyes

How do you give birth with a scar in the uterus?

In the presence of a scarry, childbirth with the scar in the uterus can be dual:

- through natural generic paths (under constant ultrasound monitoring);

- by checking the cesarean section.

It should be understood that vaginal childbirth is possible only if the following conditions are observed:

- no testimony for cesarean section, which were in the first birth;

- the possibility of constant ultrasound observation;

The failure of the scar in childbirth can lead to a fatal outcome of both the mother and the child. Therefore, with any deviation from normal flow, such births should be completed by the operation of cesarean section in urgency.

The effect of cesarean section on the state of the uterus

Each operational intervention in the uterus does not pass without a trace. Therefore, at present, such a concept as a disease of the operated uterus has been formed in gynecology. It lies in the fact that the operation leads to different neurohumoral deviations. As a result, it is accompanied by a disruption of the menstrual cycle, painful syndrome and other unpleasant symptoms.

Thus, the number of operational interventions in the uterus in women in reproductive age should be as low as possible. This will avoid certain problems in the future. Maurina Slavina Maryna Slavina

Attention! No medical services are carried out by the site administration. All materials are only informational. The same applies to the advisory section. No online advice will never replace full-time medical care, which is only in specialized medical institutions. Self-treatment can bring irreparable harm! For any diseases and ailments, contact the clinic to the doctor!

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Scar in the uterus and his effect on pregnancy

If there is a scar on the cervix during pregnancy, many women are concerned about the question of his influence on repeated childbirth and the possibility of passing them naturally.

Causes of appearance

• Cesarean section

The type of operation, as a result of which the scar was formed in the uterus. If damage is the consequence of Cesarean, a woman should have an idea of \u200b\u200bwhich incision was performed. In the presence of a planned cesarean section, a transverse section of the bottom of the uterus is made. In this case, the likelihood of a full-fledged scar is high, which will endure re-pregnancy and childbirth. The rotation of the placenta, emergency childbirth, or a short period of pregnancy, requiring caesarean section lead to the fact that a longitudinal cut is made in the uterus. This condition is unfavorable to the mercury of muscle fibers.

• Other reasons

The reason for the appearance of the scar can be transferred conservative momectomy, suturing perforations on the cervix or removal of the uterine pipe. Damage formed during momectomy is characterized based on the presence of an opening of the uterine. With a small amount of myoma, it is often located outside the uterus and the opening of its cavity is not required. In this case, a wealthy scar is formed and its thickness is sufficient to carry the child in the future. The perforation of the uterus during an abortion leads to positive results, if it was carried out only with the east of the hole itself, without the cut of the uterine wall.

The consistency of the scar

To predict pregnancy and further childbirth in the presence of a scar in the uterus, it is necessary to know the degree of its healing, based on which it is a wealthy (full) or insolvent. The scar in the uterus is wealthy if the muscle fibers after the operation restored completely and its norm ranges from 2.5 mm on the narrow site. This damage has an elastic structure capable of both reducing and stretching, so pregnancy with such a scar passes without complications. If the scar is mainly consisting of connective tissue, it refers to the discharge of defective, since it is not able to stretch or shrink. On how the scar will be restored in the uterus, several factors affect:

Postoperative pregnancy

The time interval between the operation and the onset of pregnancy plays an important role in healing the scar. For optimal formation, it is necessary at least 12 months. However, if pregnancy is planned, then you should not wait for more than 4 years after Cesarean, since the scar will turn the connective tissue and becomes less elastic.

Postoperative period

The flow of the period following the operation, as well as possible complications affect the consistency of the scar. The complications include intrauterine inflammation, weak reduction after childbirth, latency of the lapse followed by cleaning.

Status diagnostics

If you have a scar in the uterus you need to undergo a survey on its consistency even before the pregnancy comes. This is necessary for a more accurate forecasting of pregnancy with the scar and subsequent birth. If there is a risk of the insolvency of the scar, it must be detected outside of pregnancy. For damage survey, several methods are used:

• Hysterosalpingography

A reagent is introduced into the uterus after which the uterus and uterine pipes are investigated on X-ray equipment. Snapshots will show the state of the scar from the inside, its location, as well as the inner shape of the uterus, its neck and degree of deviation from the middle. Unfortunately, this study gives an incomplete picture, therefore, it is used as an additional way to obtain information after cesarean.

• Hysteroscopy.

The most informative method of diagnosis is to examine the internal uterus using a very thin optical device introduced through the vagina. The study can be carried out only 8 months after Cesarean for 4 days of the menstrual cycle. A full-fledged scar must have a homogeneous pink color without white splashes.

This method is used after the pregnancy has come, since other methods are not allowed.

Indication to independent birth

In most cases, doctors are trying to be reinsured, and pregnancy with the scar ends with Cesarean. However, today the patient can give the opportunity to give birth to the baby in a natural way. The following conditions must be respected:

• Pregnancy has come no earlier than 24 months. After surgery. In this case, we can talk about the consistency of the scar and the ability of the surrounding tissues to withstand the load during the bouts;
• The examination of the ultrasound shows the wealth of the scar;
• The mass of the future child should be small. The rate does not exceed 3.5 kg. Otherwise, the scar on the uterus will not stand the load, the tissue thinning and the placenta detachment will occur;
• Births naturally allowed only in the presence of a head prepay;
• There must be the location of the placenta at the rear winding wall. Otherwise, the uterus can occur, which will lead to the asphyxia of the fetus and his death;
• Compliance with the size of the pelvis and the head of the future kid. Otherwise, high pressure will be rendered to the lower part of the uterus, which will lead to its coloring;
• Pregnancy passes if there is no more than one scar at the uterus;
• The fruit is developing without pathological changes and without the prelation of the placenta;
• The first caesarean occurred unscheduled or pregnancy proceeds with complications.

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Testimony for cesarean sections

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

• Untenable scar

This factor is detected both with the help of an ultrasound and in the presence of a certain symptomatics: the soreness of the scar, pain in the lower uterine segment and discomfort suggests that additional research is needed.

• Pregnancy time

If pregnancy has arrived earlier than 18 months. After Cesarean. The chance of an insolvent scar is quite large, so there may be complications during natural genera.

• Power weight

If the rate of maximum weight of the child is exceeded and the mass is more than 3.5 kg, the front uterine wall is experiencing excessive load and stretching, so natural labor can be dangerous because the scar in the uterus may disperse.

• PREFERENCE OF PERVA

Birth with pelvic or foot prediction is accompanied by a high risk, both for the child himself and for the fempics. If a child lies ore and cross it is an indisputable factor for cesarean, regardless of the fact that pregnancy passes with the scar.

• Placenta location

When preserving the placenta, there is a high risk of its detachment, which will be wrapped with strong bleeding. If the placenta is located low on the front uterine wall, there is a high probability of its attachment to scar tissue, and it threatens chronic fetal hypoxia. Moreover, pregnancy with the scar can be dangerous in that the placenta is going on, and this also threatens the hypoxy of the fetus.

• Width pelvis

If the female has a very narrow pelvis, it can lead to the rupture of the uterus on the header due to excessive tension of the tissues in its area.

• Number of scars

If there is more than one scar in the uterus, which appeared during the cesarean or other operational actions, then natural generic activity is impossible.

• Pathology of fruit

If the fruit is developing with pathological deviations, the delivery without surgery may be dangerous both for him and for the very feminication.

• The testimony of the first cesarean

If the first caesarean was performed in absolute indications, based on the state of health and clinical features, then the second genera cannot be natural.

Maintaining natural labor

Most doctors try to give preference to natural generic activities, but the scar on the uterus refers such fencers to the risk group, because the placenta and the discrepancy between the scar can occur. In this case, the natural generic process can only pass with certain equipment and conditions in the maternity hospital. Committed conditions include:

• Ultrasound and fetal monitoring

As soon as the patient with the scarrier enters the hospital with the fights, it is necessary to immediately conduct an ultrasound study. Based on the results, the doctor will appreciate the position of the baby, the placenta, the state of the scar, as well as a number of other points affecting the natural generic activity. If the rate of all indicators is not exceeded, there is no reason for concerns. To have continuous control over the state of the fetus and listening to his heartbeat, a woman is connected to the CGT apparatus.

• Anesthesia and resuscitation

For smooth disclosure of the cervix and relaxation of muscles, the woman has been needed to make epidural anesthesia. In addition, there must be prepared operating and resuscitation for a woman and the future kid.

Contraindications for natural childbirth

Taking natural childbirth with the scar in the uterus is categorically prohibited:

• Stimulate the generic activity by oxytocin, since rapid labor with the scar can lead to the fact that the uterus will not stand and break;
• Use forceps or turning the fetus with improper preview;
• Wait for more than 15 hours with weak generic activities, the existence of the waters and the absence of the cutting of the cervix;
• The slightest manifestation of disturbing symptoms requires immediate intervention of doctors.

Cesarean section in the process of childbirth

If in the course of natural generic activities, there are difficulties on the part of the women in labor or the fetus are carried out by Emergency Caesarean. Complications include the sharp hypoxia of the fetus, premature oral influence and lack of opening the cervix, detachment of the placenta, the rupture of the uterine muscles, bleeding, the threat of the uterine break, the rotation of the placenta, etc.

Even if there is a scar in the region of the uterus there is a possibility of natural genera. Under all the conditions, the probability of breaking over the head of 1 out of 100 cases is observed. The main thing in time to consult with the doctor. Human birth, health to you and the future baby!

• Are natural childbirth possible?

Where is thin, there and breaks! Do you know such an expression? What is the wealth of scar on the uterus? What is a scar? In what cases does it occur? How much time do you need to fully formed? The thickness of the scar and consistency - whether these concepts are the same? Is it possible to the discrepancy between the scarcation during pregnancy? What are the conditions for natural genera for a woman if there is a scar on the uterus? Is it worth connecting the emotional component? Or is it just sober and competently assessing the situation? Let's analyze these questions in order.

Operational interventions in the body of women and possible consequences

The wonderful idea of \u200b\u200bnature is the creation of a female body in order to fulfill the holy and noble mission, to endure and give birth to a full-fledged offspring! The norm of a full-fledged family is the creation of conditions for fertilization, tooling and the birth of a healthy offspring. However, not every representative of the beautiful half of humanity can boast of pregnancy with full female health. On the way to healthy motherhood, various obstacles may arise, which, with a competent, correct, timely, qualified approach, can be overcome and allowed. We are talking about forced surgical interventions in the body of the women needed to adjust its health.

For example, such an operation as conservative momectomy can restore patients to conception. Delete Mioma, but retain the organ. However, after the surgical intervention produced, a scar is always formed. The scar may occur with the various necessary plastic rehabilitation operations (when the uterine horn is removed, they operate the pipe or cervical pregnancy at the same time with a royal angle). The wall of the uterus will be perforated during the operation for the forced removal of the fetal egg, when hyperimulated labor, a gap can occur. Some women during pregnancy according to the indications when the doctors are impossible to prescribe a planned caesarean section. As a result, the integrity of the uterus is disturbed. After stitching the incisions, punctures or breaks in the uterus is formed by a scar. All this may have consequences during pregnancy.

Restoration of seams after surgery

The scar in the uterus is a special type of education, which consists of myofibrils and connective tissue. It is located in the place where surgery was performed and disruption occurred, and then the restoration of the integrity of the wall of the uterus. It is very important for the further forecast of the state of the woman, the possibility of having a child and independent genera. Analysis of the formation of a scar and recognition of its consistency. For this, there are a number of criteria by which the rate of the formed wealthy scar on the uterus is determined.

What signs characterize a wealthy (full) scar? It is elastic, stretched well during pregnancy. It forms full muscle fibers. When forming a scar, it is especially important what kind of dissection was performed. If the incision passed across muscle fibers, then the chances that they will grow well and restore more than if it was cut along. Plays the role of scar formation. Doctors believe that the best term that must pass after the operation, approximately 1-2 years old. But not more than 4 years, because The scar is converting a connective tissue, and this, in turn, reduces its elasticity.

Signs that indicate the inferiority (failure) of the scar, is its irregularity, the outdoor contour is intermittent, it is thinned in less than 3-3.5 mm. If more than 3-4 years after the operation passed, then a lot of connective tissue is formed in it, it becomes inelastic and can dispense with pregnancy.

Types of diagnosis

If the family decided to conceive the child and the woman's uterus at this moment, was already operational effect, it is necessary to diagnose the scar formed for forecasts of the planned pregnancy. If the operation passed not so long ago, the diagnosis will help determine the healing speed, answer the question of how the scar is formed, and evaluate it (the thickness of the scar and its consistency is different concepts!).

In the world, the cesarean section is carried out in 20% of all kinds, in Russia their number also increases and is up to 16%. Mioma Mioma, it is increasingly found in women of fertile age. This leads to an increase in the amount of momectomy, as well as various plastic operations in the uterus. Therefore, doctors increasingly have to observe childbirth with the scar in the uterus. This is a condition that threatens the development of complications during the gestation and delivery period.

Than dangerous scarring for pregnancy

During the second pregnancy, the woman after Cesarean and other operations at the uterus are included in the risk group for the development of the following complications:

• gap in the head;
• (chronic);
• child injury during childbirth;
• antenatal fetal death;
• risk of traumatization of feminine;
• high frequency of maternal and perinatal mortality.

After the transferred operation, the blood supply to individual sections of the organ deteriorates. Implantation of the embryo and the development of chorion can occur in areas with good bloodstream, for example, over the inner zev. At the stage of formation of the placenta, it can migrate in search of a better place. This leads to the prelation of the placenta, low attachment.

A similar mechanism underlies the rotation of the placenta to the scar in the uterus. There is a deep invasion in the wall, which during childbirth is manifested by the lengthening of the third period and bleeding. The condition requires emergency care - they are trying to separate the placenta manually, and with ineffectiveness and diagnosed true increments, the only possible output is an extirpation.

In 1 trimester more often than the rest, the threat of spontaneous miscarriage arises. The reasons for the state and the mechanism of its development are more often associated with the most helacious wound, but with a disadvantage of progesterone, hyperagratenium or antiphospholipid syndrome. Preserving therapy is assigned (about its methods) depending on the main state that caused the threat of miscarriage.

Often there is a combination with Eastic-cervical insufficiency. Pregnant women are prescribed complete, infusion of magnesium sulfate and antispasmodics to reduce the tone of the uterus, it is possible to use the unloading obstetric. Surgical correction ICH does not apply. The failure of the scar in the uterus in combination with a threatening spontaneous miscarriage can lead to a rupture.

The uterus rupture will occur both during the battery period and during childbirth. In the first case, the main cause is dystrophic processes that lead to gradual thinning of tissues. When the rupture during active generic activity, mechanisms are associated with dystrophy and active abbreviations.

Causes and mechanism for the formation of scar tissue

The scar in the uterus is a plot where the surgery was previously carried out. It is formed due to the growth of myocytes and connective tissue, contains hyaline and collagen fibers.

In the overwhelming majority of cases, the defect appears as a result of the first generations by caesarean sections. The incision is performed in several ways:

1. In the lower uterine segment - above the transition site in the neck, used when planned operations.
2. Corporate Ruber - along the body of the uterus, a vertical section is often used in the world in the lower segment, the transverse position of the fetus, varicose placenta.
3. Eastic-corporate - combines two previous methods, it is rarely applied.

The scar can be a consequence of not only cesarean sections, but also other operations in the uterus. The removal of a myomatous node in reproductive age entails the formation of scar changes. Their severity and possible failure depends on the type of surgery, size and location of the Mioma. At an interstitial node, the uterine cavity can be opened, or not. With the subser-interstitial node, the size of the damage depends on the depth of its rustling into the thickness of the organ. After removal of intertwine mioma, scar changes may be minimal.

Also provoking factor is injury to the wall during abortion, scraping or other invasive manipulation. Ectopic pregnancy, which developed in the interstitial pipe of the pipe, on the section of the compound of rudimentary horn or in the neck, after the operation also leads to the formation of connective tissue. Scarmets are formed after plastic operations on the uterus for removing rudimentary horns, plastics with intrauterine partition (what kind of pathology is read).

Education mechanism

The scarring of damage is a biological mechanism for restoring the integrity of the body. The wound after the surgical instrument is cut under compliance with the aseptic rules remains sterile. The exception is infectious postoperative complications - endometritis, parameters.

Healing can occur in two ways:

1. Restitution - a full-fledged scar tissue is formed, which is represented by smooth muscle fibers.
2. The Substitution is defective regeneration, the connecting tissues prevail, which are represented by rude fibers, hyaline deposition.

Final regeneration leads to the formation of an insolvent scar. It has a loose structure, neelastic and is not able to withstand stretching, in this region, the uterus cannot fully shrink.

The predominance of one of the mechanisms for the formation of scar tissue depends on the presence of infectious complications, as well as the individual characteristics of the body. Some women may have a predisposition to the development of connective tissue formations in places of damage.

Survey of women from risk group

Women who are planning a re-pregnancy after surgery in the uterus, optimally pass the survey a few months before conception to eliminate or minimize the risk of rupture on the head and other complications. But after conception, it is necessary to regularly observe and comply with the recommendations of the doctor.

Determination of consistency before pregnancy

Patients with transferred operations in the uterus or childbirth by history, should be on a dispensary accounting from their gynecologist. This will allow you to diamitude to diagnose the development of complications or carry out their treatment. They are recommended high-quality contraception for at least a year after delivery. Preference is given to hormonal methods. Linestrenol is prescribed with nursing moms, lactinet, as less dangerous for the fetus. In the absence of lactation, you can switch to combined oral contraceptives.

The state of the wound is assessed using several diagnostic methods:

1. Hysterography - pictures make 7-8 days of the menstrual cycle after 6 months and more after the transferred operation. Niche is noticeable to them, the displacement of the normal position of the wound. The contours of the uterus in this area can be joined, with defects of filling.
2. It is a more informative diagnostic method. It is carried out on 4-5 days cycle. In this period, the functional layer completely departed, and the former wound is shifted under the basal. Insolvent scar has a compiled shape, a retractability may be noticeable. About the type of tissue says color: white is observed with a connecting tissue formation, there are few vessels in it, and in time there is a niche appearance, shifts. This may be an indicator of thinning scar. Good fabrics have a pinkish shade, rich in blood vessels.
3. Ultrasound before pregnancy is characterized by the following signs: Smooth contour, the thickness of myometrium is more than 3 mm, a minor number of hyperheogenic zones indicates the formation of muscle fibers.

Ultrasound has less informativeness than hysteroscopy, but with the help of Dopplerometry it is possible to estimate the condition of blood flow in the vessels and the organ cavity.

The most accurate results give MRI. The technique allows you to determine the ratio of the connective and muscle tissue, which indicates its spength together with other signs.

All survey results are preserved in the outpatient map of the patient. This is necessary to solve whether it is possible to plan a subsequent pregnancy and are it possible to give birth to naturally.

Examination of pregnant

To prevent the development of complications during the gestation period, you must inform the doctor about the transferred by the cesarean section or other operations in the uterus. The time is taken into account that passed between interference and planned or real pregnancy. Recommended range - 2 years.

When registering, it is necessary to determine the size of the pelvis. In the late period, palpatorially determine the place of the cut, the presence of pain in the RubE. By 38-39 weeks, the intended mass of the fetus is calculated to eliminate the presence of a large child as a risk of gap in childbirth.

Lab diagnostics is the same in any gestation and includes:

• general blood tests and urine;
• biochemistry with urea definition, general protein, glucose, residual nitrogen, enzymes, bilirubin and electrolytes;
• hemostasiogram.

To estimate the fetoplacentage complex, hormones are investigated:

• progesterone;
• placental lactogen;
• estradiol;
• cortislol;
• alpha fetoprotein.

To observe the state of the fetus, regular KTG is carried out. He is prescribed with every appearance to women's consultation after 27 weeks. You can clarify the condition of the child with the help of umbilical cord vessels, aortic, mid-secting artery and placenta. Research is recommended from the end of 2 trimester.

Scar on the uterus in a picture of ultrasound

Ultrasound is the main way to control and timely diagnose deterioration. It is recommended to spend every 10 days. During pregnancy, the scar changes the thickness depending on the period of gestation. At the beginning, it can have a thickness of 5 mm, but by the time of birth gradually thinned. Optimal for independent clans are considered a thickness of 3-4 mm.

With the help of ultrasound, the signs of the vast of the scar are determined:

• homogeneity;
• typical position;
• lack of niches and cavities;
• lack of hematoma, inclusions of connective tissue, liquid in its area;
• good blood flow.

Pregnancy and childbirth tactics

Features of pregnancy planning are to carefully preferably prepare and determine the viability of the scar. The thickness of the scar is normal - 5 mm and more. In the first trimester tactics, the expectant, if there is no progression of the state, are limited to regular ultrasound.

If the fruit egg attached in the RubE, then it is recommended to interrupt the pregnancy by a medication method (as a medicament abortion passes, you can read B) so as not to injure fabrics. If this is not done, then proteolytic enzymes that distinguishes the embryos dissolve the connecting tissues and make them untenable.

When solving maintaining the fruit, tactics are chosen depending on the risk of developing complications. At 22 weeks, the condition of the fetotic placental complex is estimated. With placental insufficiency, treatment is assigned aimed at maintaining the growth of the fetus and eliminating the manifestations of complications. Optimal conditions for treatment - the chamber of the pathology of pregnancy in the hospital.

Second childbirth after cesarean sections

Most doctors have the first births by cesarean sections associated with a re-operation when planning the next pregnancy. But this approach in the civilized world is not used. The correct tactic is a survey in order to determine the state of the scar and a pregnant woman to decide whether a woman can give birth independently. In Western countries, it has been proven that such birth is physiological and have a smaller risk of complications than re-operation.

Normal labor is possible when performing the following conditions:

• the only cesarean cross section is carried out in the lower segment;
• there are no extragnenitial diseases and other testimony to the planned operation;
• wealthy, not a subtle scar;
• the placenta is attached normally, does not affect the scar;
• the fetus head will be pretended;
• the normal sizes of the mother's pelvis correspond to the fetus head.

If the choice is made in favor of natural labor, there must be all the conditions for an emergency operation, if the testimony arises during childbirth.

Births lead in accordance with generally accepted standards. Anesthesia can be carried out both intravenously by the introduction of spasmolitics during the period of disclosure and using.

Stimulation of childbirth with the scar in the uterus is not contraindicated, but it is used extremely careful, to prevent the discordination, hypertonus and gap. With the protracted 2 period, it is possible to perform epizotomy, vacuum extraction of the fetus.

After giving birth, it is necessary to conduct an ultrasound in Rodzale to diagnose a possible gap. If the device is not available, then a manual examination is necessary.

The delivery plan includes the operation of the cesarean section with the following testimony:

• according to the results of diagnostics, the scar is insolvent;
• the previous operation is manufactured corporate;
• two and more cesarean history;
• the pelvic end of the child will be offered;
• prelation of the placenta;
• failure of a woman from childbirth naturally.

The consequences of momectomy, plastic operations and perforations

Patients with a history of the method of delivery are chosen depending on the localization and nature of the Mioma. The deeper in the thickness of the uterus, a node was located, the greater the risk of gap. Births lead through natural ways, except for some indications of surgery:

• mioma was removed during pregnancy;
• the rear wall is damaged after the interstitial or subseroso-interstitial node;
• the intraligative node was removed;
• operation for multiple fibromomy.

If there is no testimony from other diseases or child status, then the birth lead through natural ways.

The decision on the tactics of childbirth after perforation depends on the localization of the opening. Bad forecast when arranged on the back wall or in the coastal area. Women with such pathology often observed:

• hypotonic bleeding;
• pathology of the branch of the placenta;
• rip uterus.

If the perforated hole was located on the front wall, a high-quality embedding was carried out, then the births are conducted through natural paths. After the birth of the lane, a manual examination of the uterine cavity.

Plastic operations are most often conducted with congenital oxygen anomalies. If the operation was about the removal of rudimentary horns, the penetration of the cavity was not required, natural labor is possible. After preference, Caesarean section is given.

Symptoms of gap during baby tool

Grozny complication during pregnancy is the gap on the head. The symptoms of the separation of the scar are associated with the reflex irritation of the walls of the organ, which is accompanied by:

• nausea;
• vomit;
• pain.

The pain syndrome occurs in the epigastric area, then the feeling moves to the lower part of the abdomen. Sometimes the pain is felt more on the right, imitating the attack of acute appendicitis. Less often pain occurs in the lumbar region and resembles a kidney colic.

When palp production, the postoperative scar is felt by local pain, the fingers can be detected in the uterus.

The progression of the state leads to the appearance of hematoma due to the observation of the vessels of the uterus, the hypertonus joins, blood appears from the vagina.

The accomplished gap is characterized by signs of acute blood loss and internal bleeding:

• drop in blood pressure;
• tachycardia;
• cold sweat;
• weakness, dizziness;
• skin pallor.

Stomach pain is sharply enhanced. The fetus appears symptoms of acute hypoxia. After a sudden strengthening of mobility comes the period of silence.

With a bad supply of connective tissue of the scar, the vessels can flow without pronounced bleeding, so the main signs becomes pain syndrome and symptoms of acute hypoxia of the fetus.

Symptoms of break during the period of active generic activity

The risk group includes women with a shaped seam, which has dystrophic changes, as well as multi-venture.

The first signs of the threatening rupture become:

• epigastric pain;
• nausea and vomiting;
• violation of uterine contractions.

After the influence of the accumulating waters, the weakness of generic activity or is appear. The feminine complains of extremely painful contractions, which does not correspond to their strength when recording KTG. Against the background of the full disclosure of the neck, the fruit can stop promotion.

The resulting gap is manifested by a constant voltage of the uterus, hypertonus associated with the appearance of hematoma in its wall. When trying to palpate the lower segment, sharp pain is revealed. The KTG tape appear signs of acute hypoxia of the fetus. Blood sections appear from the genital paths.

From the appearance of the first signs of the threatening break before it began, a few minutes can pass. The state of the fencers is worse rapidly. The accomplished gap is characterized by symptoms of hemorrhagic shock, the antenatal fetal death occurs. During the vaginal study, the displaceable fetus head is determined, which was previously tightly pressed to the entrance in a small pelvis.

The gap during the expulsion of the fruit is more difficult to diagnose:

• fews become weaker;
• fights may stop;
• there is a pain in the stomach, giving in the seats;
• blood sections are observed from the birthway;
• the fruit is dying against the background of acute hypoxia.

Rarely, the gap occurs at the height of the last sweat. This is the most favorable option for the child, he has time to be born without signs of asphyxia. The third period of childbirth flows unchanged, but then symptoms of acute blood loss, weakness, a sharp decline in pressure, pain in the center of the abdomen appear. Diagnose the state during a manual examination.

How to distinguish a gap from other states

In the presence of instructions on the caesarean cross section in history, a woman is subject to better supervision, it is recommended to translate into a specialized hospital.

Differential diagnosis in the initial stages is carried out with acute appendicitis, renal colic. An surgeon can be invited to make a decision.

If the ultrasound and other features have a subtle scar, the risk of insolvency, the woman is in the hospital until the date of birth. If the symptoms increase, then there is an emergency caesarean section.

Different threat of interruption from an insolvent scar. In the first case there are no bloody secretions, pain is observed over the entire surface of the abdomen. In case of threatening miscarriage, bloody sections appear. For breaking, bleeding is typically only in the distant period. In the threat of interrupts during a vaginal study, the cervix is \u200b\u200bdetermined, smoothed or already with the opening.

Uzi confirms the failure of the scar when thinning, the presence of various inclusions, niche, reduction of vascularization.

Tactics in the development of complications in childbirth

What is dangerous niche in the scar in the uterus? Development of gradual flaps of tissues. Tactics in the development of complications in childbirth depends on their period. But it is recommended to give preference to hyperdiagnosis: it is better to behave alert, and at the first signs to change the natural childbirth for an emergency cesarean cross section, than to expect to start breaking the uterus on curtain fabric.

The treatment of the scar on the uterus after the gap can be in the form of excision of tissues and revenue. Conditions for this approach will be timely extraction of the fetus, the size of the injury. The most favorable forecast for incomplete breaks within the wound existing in the past.

If signs of thinning tissues, soreness in the lower segment, the signs of hypoxia of the fetus appear in the first period of delivery, they are completed by the operation. In the second period of childbirth, the operation is practically impossible: the fruit is in the cavity of the small pelvis, so obstetric technicians are chosen to speed up the birth of the child.

In the third period, the diagnosis of possible accomplishment of injury and the choice of a way to eliminate consequences is necessary.

Prevention of gap

To reduce the risk of rupture of the scar and other complications, prevention begins at the stage of pregraving preparation. In some cases, the woman can be offered plastic scar on the uterus. This is a surgical operation that is aimed at restoring the integrity of the tissue site and the formation of a full-fledged scar. As a suture material, it is preferable to use absorbable synthetic threads, sew the cut by separate seams.

After any operation, infectious complications should be avoided, which may cause unsuccessful formation of connective tissue.

Treatment of the scar in the uterus by people, medication methods ineffective.

To reduce the probability of breaking over the head for a woman during pregnancy and in childbirth, careful control is needed, regular and. In childbirth, observation of the palpitations of the fetus and cutouts of the uterus is also required.

The scar in the uterus is a special education consisting of the fibers of myometrium and connective tissue and located where there is a violation and further restoration of the integrity of the uterine wall during surgery. Planning and proxy with the scar in the uterus is somewhat different from ordinary pregnancy.

The reasons for the occurrence of the scar in the uterus are not limited to a cesarean cross section. The integrity of the uterus walls can be violated during other operations: the removal of the misa, perforation of the uterus wall when scrolling, breaking the uterus in hyperming of childbirth, various plastic rehabilitation operations (removal of the uterine horns, the removal of tubular or cereal pregnancy along with the uterine cavity site).

Rubacing varieties

Considerable importance is how the incision was made at the cesarean section. A longitudinal section, which is usually done in case of an emergency cesarean section, is more inclined to insolvency than the transverse in the lower separation of the uterus.

Pregnancy planning with scar in the uterus

Between the operation, due to which the scar was formed in the uterus, and the pregnancy doctors recommend to withstand the gap within two years - so much time is necessary for the formation of a good scar. At the same time, too long a break is undesirable - longer than four years, since even a very good scar can lose elasticity over the years in connection with the atrophy of muscle fibers. The transverse scar is less prone to such negative changes.

Assessment of the state of the scar

It is possible to estimate the state of the scar before planning using ultrasound, x-ray, hysteroscopy or MRI. Each of the methods is valuable in its own way.

Pregnancy with scar on the uterus

1. Need to know that scar on the uterus during pregnancy It may cause the wrong placenta location: low, edge or complete.
2. It is possible a pathological increment of placenta of varying degrees: to a basal layer, muscle, turbulent into a muscular layer or full germination up to the outer layer.
3. In the event that the embryo is attached to the scar area, doctors put adverse predictions - the likelihood of pregnancy interruption is strongly improved.
4. During the pregnancy, there are most often tracking changes in the scar with ultrasound. With the slightest doubts, doctors recommend hospitalization and hospital surveillance up to the delivery.

The most dangerous complication can be a rupture of the uterus on the site of the scar as a result of its thinning and dismantling. Preceded by this dangerous state, characteristic symptoms indicating the beginning of the discrepancy of the scar:

• Voltage of the uterus.
• Sharp pain from touches to the stomach.
• Strong arrhythmic uterine cuts.
• Blood vaginal allocations.
• Fetal heartbeat.

After the incision of the break is added:

• Very severe abdominal pain.
• A sharp decrease in blood pressure.
• Nausea and vomiting.
• Termination of bouts.

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

With a diagnosed break of the uterus on the header to save the life of the mother and the child, an emergency cesarean section is required.

Many worries whether natural is real birth with a scar in the uterus. In accordance with certain requirements, such labor can be resolved: the only cesarean section in the past with a transverse section, an estimated wealthy scar, the normal location of the placenta for the scar area, the absence of any concomitant diseases or obstetric pathology, the head position of the fetus, the lack of a factor that caused the previous one Cesarean sections. It is also important control over the state of the fetus and the presence of all conditions for the emergency cesarean section in the event of a critical situation in the immediate vicinity of the Generic Chamber.

Contraindications to natural clauses with a scar in the uterus are: Caesarean section with a longitudinal cut in the uterus in history, a narrow pelvis, a placenta in the place of the scar, the prediction of the placenta, several scars on the uterus