Uterine rupture along the scar: a serious and dangerous complication during pregnancy. Causes of uterine rupture along a scar in pregnant women

An operative method of delivery becomes inevitable when the fetus occupies the wrong place in the uterus or complications such as placenta previa or umbilical cord entanglement are present. Sometimes there are no direct indications for a cesarean section; it’s just that a woman, for example, no longer plans to have children and wants to undergo surgical sterilization during the operation.

Regardless of the reasons for delivery through surgery, it should be remembered that cesarean is an extensive abdominal intervention. During obstetrics, in order to remove the baby from the uterus, doctors have to make several incisions layer by layer. After the operation, the woman’s abdominal cavity is also sutured in layers, as a result of which a scar will remain on the anterior abdominal wall for life.

Types of sutures after cesarean

Depending on the technique used to make the tissue incision, a woman may receive different types of sutures:

vertical - applied when the incision is made vertically, from the navel to the pubic area;
transverse - the incision is made along the bikini line, called in medicine Jow-Cohen laparotomy;
in the form of an arc - the incision is made in the area of the skin fold above the pubis (Pfannenstiel laparotomy).

Suture care after cesarean section: treatment, ointments, creams

Treatment of the postoperative wound and sutures is carried out several times a day in the maternity hospital, and this procedure is performed by a nurse. To prevent weeping and the development of inflammatory processes in the suture area, the incision site is treated with a brilliant green solution twice a day, and then covered with a sterile gauze bandage.

Approximately on the 7th day, the sutures are removed, but the postpartum mother must continue to treat the wound with brilliant green at home until it is completely healed. After complete healing and scar formation, the incision site can be treated with an anti-inflammatory cream, which contains components that accelerate skin regeneration.

When suturing the wound surface with self-absorbing threads, there is no need to remove the sutures, however, to speed up their resorption, the doctor may recommend the use of special ointments and creams. These drugs will prevent the formation of compactions and swelling in the suture area.

How long does it take for a stitch to heal after a cesarean section?

The formation of a scar at the incision site is observed already by the end of the first week after delivery. From about this point on, the woman is allowed to take a shower and soap the seam area without making sudden movements or pressing on the incision site with a bathing sponge.

Complications on the suture after cesarean section

Unfortunately, the incision site does not always heal and does not bother the patient; some young mothers have to face complications.

The stitch after cesarean section hurts

Pain in the area where stitches are applied can bother a woman for several months. After complete healing of the wound surface, the suture may bother the patient when the weather changes, loads, or wearing tight clothes. Such sensations are normal and do not require the use of medications. The following symptoms are a reason to immediately seek medical help:

redness of the skin around the stitch;
local increase in body temperature;
swelling and sharp pain at the suture site;
discharge from the suture of fluid mixed with blood or pus;
a sudden increase in body temperature, accompanied by the above symptoms in the suture area.

Suture after cesarean section: festering, oozing

In the first few days after the operation, the suture may ooze clear liquid, but there should be no pus or scarlet blood coming out! Treatment with a solution of brilliant green will help prevent the development of complications.

If pus or bloody discharge appears from the suture a few days or weeks after a cesarean section, the woman should seek medical help; perhaps an infection has entered the wound and provoked the development of an inflammatory process.

Suture after cesarean: itchy

Itching in the suture area after surgical delivery occurs as a result of the formation of a postoperative scar. This process is accompanied by increased skin dryness and tissue tension, which leads to discomfort. In order not to accidentally introduce an infection into the wound, it is not recommended to touch the stitches with your hands; the use of special soothing anti-inflammatory creams and ointments will help reduce the itching of the skin.

Hematoma, lump on the suture, sealing of the suture after cesarean section

As a result of suturing and traumatizing the blood vessels in the area of the wound surface, a woman may develop a hematoma. Most often this occurs on the inner surface of the uterus, and the pathology can only be diagnosed through ultrasound. If the hematoma is not treated, then over time a compaction may form, which interferes with the normal nutrition of tissues in this area and is a predisposing factor to the development of inflammatory processes.

Having gone through surgical delivery, a woman should be prepared for the fact that the suture on the anterior abdominal wall will not immediately become invisible and painless. In the first months and even years, the formation of bumps and various seals in the suture area is acceptable, which is associated with tissue healing processes. Such lumps will completely resolve only 1-2 years after the intervention, which the patient simply needs to come to terms with.

Can a uterine suture come apart after a cesarean section?

After a caesarean section, you should be extremely attentive to your health. Lifting weights, strenuous physical activity and early sexual activity can lead to dehiscence. A new pregnancy also poses a danger: due to the incompetence of the scar and as the uterus grows, there is a strong tension in the tissue, as a result of which the internal sutures can separate at the site of the incision. A new pregnancy after surgical delivery can be planned no earlier than 3 years after cesarean section.

Ligature fistula after cesarean section

The formation of a ligature fistula occurs as a result of the use of poor quality suture material or the woman’s individual intolerance to the used threads. The complication is characterized by an inflammatory process of the skin around the suture, which develops several weeks or months after surgery.

As the pathology progresses, a hole forms near the suture site, through which pus is released when pressed. Treatment of the hole and a course of antibiotics do not give the desired result, and treatment of this complication is carried out only surgically; during the intervention, the doctor will remove the ligature and the wound will soon heal.

Adhesions after caesarean section

Adhesions form after any surgical intervention; their formation is aimed at preventing purulent-septic processes in the pelvis. When adhesions form in excess, they speak of the development of adhesive disease, which can lead to subsequent ectopic pregnancies, intestinal obstruction, and infertility.

Aesthetic correction of a suture after a caesarean section

A scar after a cesarean section, especially if the incision was made vertically, often becomes a reason for the formation of complexes in a woman, so she tries in every way to get rid of it.

How to remove a scar after a caesarean section?

First of all, in order to make the scar less noticeable, immediately after the wounds have healed, you should begin performing cosmetic procedures - a cream containing mumiyo must be rubbed into the scar twice a day. According to patient reviews, over time the scar becomes pale and less noticeable.

Suture repair after caesarean section

If a woman is dissatisfied with the results of caring for the suture area and she is still not satisfied with the appearance of the anterior abdominal wall, she can decide on a radical procedure - plastic surgery. Before you undergo such an intervention, soberly assess the possible risks, since, like a caesarean section, plastic surgery has its disadvantages.

Is it possible to get a tattoo on a cesarean scar?

Many women decide to correct the appearance of the anterior abdominal wall by tattooing the suture area. This is not prohibited, but you should wait until a normal scar has formed and the tissue has completely healed.

Irina Levchenko, obstetrician-gynecologist, website specially for the site

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After a cesarean section, a scar of connective tissue remains on the uterus. During the next birth, it can lead to a very dangerous complication - uterine rupture. This phenomenon causes severe bleeding, severe traumatic and hemorrhagic shock. It is difficult to save a woman in labor and her fetus in such conditions. Read more about why the uterus ruptures along the scar during pregnancy, what are the symptoms of this dangerous phenomenon, and how to prevent it.

Causes of uterine rupture along a scar

Although uterine ruptures are relatively uncommon, they are one of the leading causes of death in women during or shortly after childbirth. The main factors causing this most dangerous complication are:

Pathological atrophic processes in the muscular uterine lining (myometrium), occurring after miscarriages, unsuccessful abortions, and various inflammations.
Not very high-quality operations to remove tumors from the muscular uterine tissue (fibroids) using laparoscopy.
Poor suture material, due to which the muscle and connective fibers of the uterus do not grow together normally.
Suturing the uterine walls with an unreliable single-layer rather than a two-layer suture.
The woman in labor has already had more than two caesarean sections.
Doctors used oxytocin, misoprostol and other drugs that help the body produce hormone-like substances prostaglandins that stimulate uterine contractions during childbirth.
Medical negligence and the use of outdated techniques during childbirth, leading to incoordination (impaired contractions of the uterine walls). For example, to remove the fetus from the mother's womb, obstetricians may press too hard on the abdomen or use various "ancient" auxiliary tools, such as forceps. And at the same time, completely ignore the atrophic processes in the uterine muscles.
Stimulation of labor due to the fact that there is hypertonicity in the muscular uterine lining, and labor contractions are not intense enough due to pathologies in the structure of the uterine walls.
In some cases, obstetricians are still trying to change the location of the fetus. This very often ends not only in uterine rupture, but also in death.
Abnormally large size of the baby's head relative to the pelvic floor. Recently, this problem has become very relevant, as the number of women with too narrow pelvises has increased. Gigantism of the fetal head is especially dangerous for women of small stature.
The age of women in labor also plays an important role: the older the woman, the more frequent the ruptures.
The risk also increases if the new pregnancy occurs just a few years after the cesarean section.
The location where the incision is made is another important factor. Lacerations are rare if the baby is removed from the mother's womb using a vertical (rather than horizontal) incision made between the pubic bone and the navel in the lower uterine segment.

Symptoms

When the uterus ruptures during childbirth, a woman:

blood may begin to flow from the vagina;
when touching the stomach, the woman experiences strong painful sensations;
intense colic is felt in the peritoneal area;
the baby’s head stops moving towards the exit of the birth canal and seems to go back;
severe pain appears in the scar area. Between individual contractions it is especially intense;
a bulge may appear in the area of the pubic bone due to the fact that the fetal head “breaks through” the uterine suture;
the fetus begins to experience abnormalities in cardiac activity (very low pulse, decreased heart rate);
the uterus contracts unnaturally often. And he does it irregularly.

To prevent a serious complication, specialists use ultrasound to determine the size of the scar, and at the time of birth they carefully monitor the strength of contractions. Such measures do not always help to fix a uterine rupture in time. It happens that contractions do not disappear even after the scar has ruptured.

Uterine rupture occurs not only during childbirth, but also before and after it.

How often does this happen?

There is a misconception that women with a healed “post-cesarean” lesion cannot give birth at all. This is wrong. Numerous studies have shown that scar problems in women who have had a caesarean section occur relatively infrequently - in approximately one case out of 100-150. True, the quality of medical care plays a big role here. If it is low, the likelihood of uterine rupture increases 5-7 times.

How often uterine rupture occurs during pregnancy largely depends on where the suture is located and what its type is:

The most popular today, horizontal incision in the lower region is relatively safe - because of it, ruptures occur in only 1-5% of cases.
If the incision was made vertically, the risks of scar rupture are approximately the same - 1-5%.
The latest overseas studies have shown that the most dangerous is the “classic” cesarean incision in the lower segment. With it, a rupture occurs in approximately 5-7% of cases. Nowadays, the lower segmental incision is resorted to only in extreme circumstances, when the life of the fetus and mother is in mortal danger.

The likelihood of a dangerous phenomenon also depends on the shape of the scar. Cuts made in a J or T shape are considered safer than those that look like an inverted T.

The number of caesarean sections also plays an important role. Recent studies conducted in the USA show that during the following births the scar diverges:

in 0.5-0.7% after one cesarean section. This is less than the risk of rupture due to other major birth complications - fetal distress, prolapsed umbilical cord or placenta detached before the baby is born;
in 1.8 - 2.0% after several births, which were accompanied by an incision of the uterus and abdominal wall;
in 1.2-1.5% after three cesarean births.

The results of a study conducted by specialists from the British Royal College do not differ much from the data of their American colleagues: 0.3-0.4% of rupture cases.

However, according to the same data, repeat cesarean is still more reliable. With it, the risk of ruptures drops to 0.2%.

What to do?

If a uterine rupture occurs, the main thing is to provide qualified assistance as quickly as possible. According to one well-known American clinic, a woman can be saved if she is treated no later than 15-20 minutes after the suture ruptures.

If it is not known for sure whether there is a rupture, doctors will conduct the following tests:

Ultrasound. With its help, the doctor will check what is happening to the muscle fibers in the scar area and whether they are intact.
Magnetic resonance imaging. This diagnostic method will allow you to carefully study the area of artificial tissue fusion.
X-ray of the uterus.

Why is suture dehiscence dangerous for mother and child?

Seam separation can kill both mother and baby. To prevent this from happening, a woman expecting a baby should listen especially carefully to her feelings, stay close to the medical facility and not be left alone.

How to prevent a breakup?

A woman who is preparing to give birth after a cesarean section cannot do without regular visits to the antenatal clinic. It is there that they will help her determine how high the risk of failure of the operation is.

It is especially important to regularly check:

whether the fetus has macrosomia (larger than normal), as this increases the risk of ruptures. To avoid macrosomia, you need to avoid eating foods that contain a lot of sugar;
whether the expectant mother has a narrowing of the bony pelvis and flattening in the sacral area;
whether premature discharge of amniotic fluid has begun.

Women with a uterine scar are highly discouraged from giving birth outside the clinic. Recent studies by American and British specialists have shown that “home” births sharply increase the likelihood of suture dehiscence. It is better for women with a scar to go to the hospital a week and a half before the possible onset of labor.

In order to prevent such a dangerous situation as scar separation on the uterus, a pregnant woman needs constant medical supervision, research and diagnostics using modern methods and equipment.

Although previously considered a rather dangerous operation, caesarean section is now often used during pregnancy and childbirth. Although the operation itself is safe because it is always performed only by qualified doctors, its consequences can harm the woman’s health. Most often this happens due to the fact that the suture has come apart after a cesarean section.

Types of sutures after cesarean section

Caesarean section as an operation consists of two stages. The first is an incision to access the muscular frame, and the second is an incision to access directly the uterus. Accordingly, after it there are two seams left - internal and external. But operations are also divided according to the type of external incisions:

Horizontal cut. Typically, this type of incision is used during a planned operation. As a rule, self-absorbable threads called catgut are used to apply such sutures, and the scars after them heal quite quickly, with a minimum of traces.
Vertical cut. This type of incision is usually used if any complications occur during childbirth. It allows for easier passage of the baby and ensures normal delivery. In terms of healing, such an incision is less comfortable due to the inability to use a self-absorbing thread, as well as the scar remaining after the operation.

Thus, after a cesarean section, a woman is left with two stitches: one on the uterus, and the second on the anterior abdominal wall. Both seams, if you do not follow the doctor’s recommendations during the rehabilitation period, may separate. But it is the internal discrepancy that is considered the most dangerous. Moreover, the risk of this happening is quite small - only fifteen percent.

Rupture of threads in the abdominal cavity

Another complication that women who have undergone a cesarean section may encounter is the divergence of the threads in the abdominal areas. The external suture heals quite quickly after a cesarean section, but despite this, it can still be damaged. Most often this is caused by physical exertion or failure to sterilely process the threads. The edges of the wound should be regularly cleaned using sterile cotton swabs or swabs. It is important to be careful when doing this, as incorrect movement can result in tearing of the seams.

Also, in the area of the incision, separation of the abdominal muscles after a cesarean section can occur due to wearing tight, compressive clothing. This is due to the fact that the muscle corset has not yet strengthened after the operation. The muscles cannot withstand the same tension as before surgery, so tight clothing causes the threads at the seams to break.

Dehiscence of the suture on the uterus after cesarean section

The most serious complication that can occur after surgery is a rupture of the uterine suture or internal suture. This most often happens to women during their second and subsequent pregnancies that end in caesarean section. This is due to the fact that scar tissue is less well supplied with blood than normal tissue. Therefore, in a place that has been recut and healed, tissue density is lower and ruptures occur more often. The most common causes are physical activity and heavy lifting. Also, a gap can occur due to a short break between pregnancies. Doctors recommend taking a break for at least three years.

There are usually three types of violation of the integrity of the suture after surgery:

Threatening uterine rupture. An asymptomatic injury that is usually detected only through .
The old seam begins to tear apart. Symptomatically expressed by pain in the suture area and symptoms inherent in painful shock: cold sweat, drop in pressure, tachycardia.
Uterine rupture. Includes symptoms of the previous complication, as well as severe abdominal pain and bleeding.

Symptoms of seam dehiscence

Most often, the symptoms of suture dehiscence are quite noticeable, they are immediately felt and bring severe discomfort and pain. During the procedure, which usually lasts about two weeks, and if necessary and individual characteristics even longer, pain persists at the site of the suture. But if it does not disappear or weaken after this period, this is a reason to consult a doctor.

It is also worth paying attention to vaginal discharge. They usually begin to appear immediately after surgery. In case of any damage to the seam, their number quickly increases. They may also be red in color. This is a very dangerous signal, indicating that the patient needs urgent medical attention. Also, the discharge consists of two parts - liquid and lochia.

Do you have symptoms of seam dehiscence?

YesNo

They protect the mucous cavity from infection and viruses and are removed regularly. If they stop being released, this indicates that they have entered the abdominal cavity, which can lead to infection.

Another symptom is the development of inflammation of the suture. It usually becomes noticeable as the temperature rises. This symptom may signal a small discrepancy in which other symptoms are mild.

Signs

If the integrity of the seams is violated, the signs of divergence are usually similar. But the problem here is that it is very difficult to predict the possibility of such damage. To avoid problems, a woman needs to be under constant supervision by a doctor who will record changes in her condition.

When a suture on the uterus diverges after a cesarean section, there are usually three degrees of disruption of the integrity of the scar: threatening damage, the beginning of divergence, and complete divergence of the sutures on the uterus. The most important danger is that the first stage of damage, threatening uterine rupture, does not make any special announcement; it can only be determined by ultrasound. That is why after the operation the patient needs to undergo diagnostics for some time in order to be absolutely sure of the integrity of the suture, even if she is not bothered by any pain symptoms.

The onset of discrepancy is usually characterized by increased pain in the area of the operation and symptoms similar to painful shock: cold sweat and tachycardia. A rupture of the uterine wall that occurs is an extremely dangerous injury. Statistically, it is the most common cause of death for mother and child. They can only be saved with urgent surgery.

However, sometimes damage to the uterus is not accompanied by any symptoms at all. That is why it is very important to constantly monitor the condition of the woman in labor after the operation in order to avoid problems in the future.

Prevention of scar dehiscence

As with any surgical procedure, a postoperative recovery period is indicated after a cesarean section. Although it is not very large for this particular operation, it is important to follow all the doctor’s instructions, because neglecting them can lead to serious complications. The main points to remember are:

Prohibition on lifting heavy objects. Any physical activity after surgery can cause the suture to simply come apart. It is not even recommended to pick up a child, which is usually prohibited by doctors in the first days after surgery.
It is important to treat sutures and take antibacterial drugs.

These rules should never be neglected, because any violation threatens to lead to rupture of the walls of the uterus, which is an extremely serious and dangerous injury that can even lead to death.

In addition, the seam may become inflamed. It is also necessary to follow all the rules and sterility of suture care at home:

You can use special ointments and gels to speed up healing. Levomekol and Panthenol help a lot, accelerating the healing of external sutures. You can also use sea buckthorn oil and milk thistle oil.
You also need to remember about hygiene. If necessary, a sterile bandage must be applied to the seams, which must also be done with clean hands.

Attention! Before using any ointments, consult your doctor!

Scar ointment

How long does it take for a stitch to heal?

Complete scarring internal suture usually occurs on the seventh day after surgery. To avoid possible complications, the threads from the outer seam are removed at the same time. If self-dissolving catgut is used, it remains in the wound in small “pieces” for 70-80 days until completely dissolved.

After this, a week later, discharge usually occurs. As a rule, possible complications during the healing process of the suture at this stage are prevented by carrying out routine hygiene measures. Usually, if the wound is not bleeding and no discharge comes out of it, then the procedures are limited to simply changing the sterile dressing. The suture heals quite quickly; after complete healing, cosmetic surgeries can also be performed to give the scar a more attractive appearance. You can do the same, this is another good way to hide traces of the operation.

What to do if the stitch breaks after a cesarean section

But what to do in a situation if the seam breaks or some other damage to the scar occurs?

During recovery, various problems may arise, but most of them still require medical intervention:

Bleeding. If bloody discharge begins to ooze from the wound, it must be treated and then consult a doctor.
Inflammation. If the wound begins to become inflamed, this may indicate infection.
Suppuration. The accumulation of pus in the wound may indicate infection in a vulnerable area. To prevent its spread, the doctor installs a drainage to get rid of the pus.
Discrepancy. After the muscles are pulled apart during surgery, they are held together with sutures. One of the most common complications is their divergence from loads.

The most important advice to the question “What to do if the stitch breaks after a caesarean section” - do not panic. From stress, the body itself can aggravate the situation, so you just need to seek medical help in time and eliminate the problem.

Doctors' opinions in emergency situations

Because caesarean section is a very common operation, the greatest risk occurs not during the procedure, but during postoperative recovery. This is due to the risk of complications that occur under a variety of circumstances. Another problem is that almost all injuries that appear after surgery require medical attention. That is why doctors urge you to follow the doctor’s recommendations after discharge to avoid possible complications.

In the case of one of the most common injuries - when the suture comes apart after a caesarean section - it is worth seeking medical help in a timely manner. In such a situation, there is a high risk of wound damage or infection. If you have concerns or suspicions about internal injuries, you should seek help immediately, especially if this is your second pregnancy and the patient has already had a cesarean section, because if complaints are ignored, the consequences can be catastrophic.

At the first sign of infection in the wound, you should also immediately go to the doctor. Inflammation or suppuration can lead to infection of the entire body, which is dangerous for the life of the mother in labor. In most cases, you should not try to help yourself on your own - due to the lack of the necessary knowledge and skills, you may not only fail to help, but also harm yourself.

Conclusion

Caesarean section carries several dangers during the healing period. Due to the risk of suture dehiscence after cesarean section, you should refrain from physical activity for a certain period, and in order to protect the scar from bacteria, it is necessary to strictly observe the hygiene of the postoperative suture. But at the same time, damage to the wound after surgery is usually quite rare, and serious injuries, such as a ruptured internal suture, are especially not common. Such a pathology occurs only in five percent of all cases, and timely medical care saves from it, as well as from its consequences. But at the same time, throughout the entire period of wound healing, a woman must carefully follow all the doctor’s recommendations. Although a woman should not be afraid of either the postoperative period or the operation itself - operations are carried out with painkillers, and during recovery, the pain syndrome is relieved with certain medications. However, you need to be warned in order to know about possible problems and prevent them in time.

During the delivery process, in the presence of pathologies of the uterus (and not only) a cesarean section is performed. This is a surgical operation in which the anterior abdominal wall and body of the uterus are cut to remove the fetus. It can be either planned or emergency.

There are a number of main pathological changes in the uterus for which a planned cesarean section is recommended:

Myomatous nodes on the cervix and in the body of the uterus;
The presence of scars after a previous delivery (failure of the scar or a large number of them);
Deformation of the reproductive organs;
Tumors, etc.

Types of sutures on the uterus

Depending on how the birth process proceeds, the doctor determines how the incision will be made to remove the baby:

Vertical

Such an incision into the walls of the uterus is very traumatic. It is performed exclusively in emergency cases, for example in case of premature birth. With this incision, the upper part of the uterus is dissected, where there is a large accumulation of blood vessels, which causes heavy blood loss in the woman in labor. The suture formed as a result of such an incision does not imply subsequent independent delivery. There is a high risk of infection.

Horizontal

Performed in normal situations. The incision is made in the suprapubic region, in the lower part of the uterine body. Blood loss is minimal (in the absence of complications), the wound heals fairly quickly. In the future, there is a high probability of spontaneous childbirth.

All sutures are placed using absorbable materials. Healing and scar formation occurs within six months.

Control of the scar is carried out through ultrasound diagnostics. Doctors recommend planning your next pregnancy 1-2 years after a cesarean section.

During pregnancy, the uterus stretches greatly due to the elasticity of its walls. Therefore, after childbirth, it should return to its original state - shrink. Full recovery may take up to 2 months.

The suture on the walls of the uterus after a cesarean section does not contribute to rapid contraction, but, on the contrary, slows down the process. The muscle layer is damaged. Nerve endings and blood vessels are dissected. All this interferes with the restoration of the organ.

Timely contraction of the uterus to normal size may be hampered by the presence of adhesions, since due to them the organ may be displaced. With heavy blood loss, the uterus is susceptible to hypotonicity, which affects its contractility. Infections in the uterine cavity pose a danger to its normal recovery.

If the uterus contracts slowly, drug therapy is prescribed, using drugs that have a stimulating effect on its smooth muscles.

Common drugs:

Ergotal;
Hyfotocin;
Desaminooxytocin;
Pituitrin;
Oxytacin, etc.

After childbirth, the inner surface of the uterus is a continuous wound, since the mucous membrane is injured. An indicator of a normal recovery process will be uterine bleeding and clots, which are called “lochia”. Such discharge is a wound secretion that is separated from the inner layer of the uterus. The first few days, lochia may be bright red due to a large accumulation of red blood cells, then they become pale.

Important! Normal lochia does not have a pronounced odor. If there is a putrid odor, you must immediately inform your doctor. This indicates their stagnation or process.

After a cesarean section, prolonged release of lochia is possible, since postpartum involution is slow.

The external suture and internal sutures on the uterus are painful. However, it is important for a woman to move a lot within a few hours after surgery. Painkillers will be prescribed for several days. Due to prolonged lying or sitting, the uterus, which already contracts poorly, may become bent anteriorly. This will lead to narrowing of the birth canal at the bend and will prevent the removal of lochia. The rejected material is an ideal environment for pathogens, such as saprophytes. The accumulated blood decomposes, toxins and breakdown products enter the general bloodstream, which leads to infection.

Regular bowel movements will also help prevent the uterus from bending anteriorly. If stool abnormalities, such as constipation, are detected, it is necessary to take mild laxatives and review the postpartum diet.

The formation of a scar on the uterus in the postpartum period is important. The connective tissue that forms at the site of the incision does not have sufficient elasticity; this can prevent subsequent spontaneous childbirth. It is necessary that the scar be as thin as possible, and contractions of the uterus, although slightly, still deform it, causing pain. In some cases, a woman in labor may be prescribed physical therapy to better form a postoperative scar.

Oxytocin is a hormone synthesized by the hypothalamus. It is able to improve the contractile activity of the uterus, due to its stimulating effect on its smooth muscles. Increases the tone of the uterus, increases the frequency of contractions, their amplitude, and causes contractions of the cervix during contractions.

Oxytocin is actively released during lactation, helping milk to be released from the breast. That is why during feeding the uterus begins to contract more actively. In this case, a woman may be bothered by her stomach, as during menstruation.

Oxytocin, obtained synthetically, is prescribed intravenously after cesarean section when the uterus contracts weakly.

Endometritis as a complication after cesarean section

The inner layer of the uterus is lined with endometrium; when it is inflamed, this condition is called endometritis.

Postpartum endometritis is a common complication after cesarean section. During emergency surgery it develops much more often than after planned surgery.

A distinctive feature of postpartum endometritis is its extremely severe course, since the initial infection begins in the area of the uterine incision. The inflammatory process quickly spreads to nearby areas, affecting the myometrium and lymphatic system. A suture placed on the uterus can serve as a conduit for the spread of infection in the pelvic organs. Stagnation of lochia, due to “inactive” contraction of the uterus, creates a pathogenic environment for exacerbation of endometritis.

The first symptoms of postpartum endometritis appear within a day after cesarean section. A woman in labor experiences an increase in body temperature of up to 40 degrees; much less frequently, the disease is accompanied by low-grade fever. Tachycardia develops. A general blood test reveals a sharp increase in leukocytes and a high erythrocyte sedimentation rate (ESR). Despite the slow contraction of the uterus, the pain in the lower abdomen intensifies. The color of the uterine discharge becomes cloudy, may contain purulent clots and have a putrid odor.

Diagnosis of postoperative endometritis

If such symptoms are present, the woman in labor is prescribed an echographic examination. This method allows you to see the structure of the myometrium, determine how the involution of the uterus occurs, determine the size and width of its cavity, and determine the accumulation of gas.

With the development of postpartum endometritis, deformation of the uterine cavity occurs at the site of the suture, the structure of the myometrium is loose (reduced echogenicity). Characterized by slow wound healing.

A more accurate method for determining endometritis would be hysteroscopy. During surgery, it is possible to assess the condition of the endometrium. Detect blood clots in the uterine cavity and remove them. Assess in detail the condition of the seam to see the presence of hematomas on it.

During hysteroscopy for endometritis, severe swelling of the uterine mucosa will be visible, the vascular pattern will be enriched, and there will be areas of hemorrhage. With a strong inflammatory process, there will be traces of pus and white plaque on the walls of the uterus as a result of the deposition of fibrin protein.

Treatment

At the beginning of treatment, it is necessary to collect material (culture) from the vagina and uterine cavity in order to identify the causative agents of infection and select the correct antibiotic.

In the treatment of postpartum endometritis, doctors prefer an integrated approach. If conservative treatment is possible, the patient is prescribed drugs that promote uterine contractility; antibiotic therapy will be mandatory. It is important to accompany antibiotic treatment with detoxification and infusion therapy, as well as various vitamin complexes aimed at overall strengthening of the body. You should also take care of your diet. Food should contain a lot of protein.

Depending on the strain that provoked the inflammatory process, adequate antibacterial therapy will be selected. Pathogenic bacteria may be resistant (resistant) to a particular drug.

The standard treatment regimen for endometritis after cesarean section consists of an antibiotic from the lincomytin group. For milder cases of the disease, groups such as macrolides, cephalosporins, and fluoroquinolones can be used. The drugs can be administered intravenously, as an infusion, or orally.

Important! Breastfeeding is contraindicated while taking antibiotics. To maintain lactation, you can use a breast pump. In its absence, you can express yourself manually.

In especially severe cases, with profuse purulent discharge from the uterine cavity, doctors prescribe surgical treatment. It is carried out through hysteroscopy or vacuum aspiration. At the same time, the uterine cavity is also washed. The procedure is possible a week after a caesarean section.

Washing the uterine cavity is not possible if, after delivery by cesarean section, there are signs of suture failure. Also, if an abscess begins or the presence of a strong inflammatory process outside the body of the uterus, with the general serious condition of the woman.

How is the procedure done?

During lavage of the uterine cavity, the patient arrives in a gynecological chair. Access to the cervix is through the vagina using speculum. First of all, you need the uterus. This is done using a special probe. An inflow tube and drainage are inserted into the uterus, reaching its bottom, and the endometrial layers are irrigated with an ice-cold solution of furatsilin. Since a suture is located on the organ after a cesarean section, the drainage and inflow tubes should be inserted with caution, closer to the anterior wall of the uterus. This will prevent damage to the seams in its lower segment. During infusions, it is necessary to carefully monitor the general condition of the woman and the reverse outflow of furatsilin solution from the uterine cavity. If necessary, you can use saline solution and antibiotics after using furatsilin.

The washing procedure is long, about 2 hours. The full course of treatment ranges from 2-6 procedures with simultaneous administration of antibiotics. As soon as the contractile function of the uterus is normalized, the body temperature decreases, and the clinical picture of the general blood test returns to normal, lavage of the uterine cavity should be stopped. Next, the patient may be prescribed anti-inflammatory therapy.

In cases where washing the uterine cavity is impossible, doctors perform hysteroscopy under general anesthesia, removing blood clots and placenta. In the absence of large volumes of accumulation of fluid and clots in the uterus, doctors expand the patient’s cervical canal so that their rejection occurs faster.

After such procedures, a woman needs to pay special attention to personal hygiene in order to prevent relapse of the disease.

Video: Suture after cesarean section of the uterus

Video: Consequences of cesarean section

Modern medicine today helps many women give birth to a child, and babies to be born. The fact is that there are situations, planned or urgent, that require surgical intervention in the process of delivery. However, a caesarean section is a full-fledged operation, so the formation of a scar on the uterus is a serious disadvantage. After all, during the birth process, the doctor makes an incision not only in the abdominal cavity, but also in the woman’s reproductive organ in order to extract the fetus. As women's health recovers after the birth of the baby, doctors must monitor the formation of the scar and the healing of the suture. Rupture of the tissues of the reproductive organ can lead to a risk to the life of a young mother, so it is necessary to carefully monitor the woman’s health after a CS.

Scars on the uterus after cesarean section: types and features

Caesarean section has long been used in gynecology as a way to help a baby come into the world. In many cases, only through surgical intervention do doctors save the life of not only the baby, but also the mother. After all, childbirth is a complex and unpredictable process, when emergency assistance and rapid extraction of the fetus may be needed at any moment.

CS is prescribed to many expectant mothers as a planned operation. This occurs in situations where a woman has absolute contraindications to vaginal birth or the fetus is not located in the uterus in a cephalic presentation.

During a caesarean section, doctors make an incision in the uterus to remove the baby.

Doctors do not deny that after surgical delivery there is a risk of complications, as after any abdominal surgery. However, if we compare saving the life of a woman in labor and a baby, the postoperative consequences are relegated to the background. In most cases, the body’s recovery goes well and quickly, and the young mother happily devotes her time to caring for the baby.

Recently, more and more expectant mothers are independently asking doctors to prescribe a CS, although they have no indications for delivery through surgery. Women simply do not want to experience pain during labor and natural childbirth. However, doctors warn that natural birth is much preferable for the health of the mother and baby, so if there is a chance to give birth to a baby on your own, you should not refuse it.

During surgical delivery, doctors use different techniques. First of all, this concerns the type of incision in the skin of the abdominal cavity and the tissues of the wall of the reproductive organ through which the baby is removed. The type of incision largely determines the speed of recovery of the body after a CS, as well as the possibility for a woman to independently give birth to another baby or she will again have to have a surgical delivery.

Longitudinal (corporal) scar

The vertical incision is considered classic: it was the one that was performed previously during CS surgery. Modern doctors try to avoid a longitudinal incision of the uterus and abdominal cavity. Today, this type of incision is made only when minutes are counting and it is necessary to urgently remove the fetus from the woman in labor. It is the corporal incision that provides good access to the organs, so the surgeon can act quickly, which is very important during an emergency surgical delivery.

A longitudinal incision on the abdominal wall is about fifteen centimeters in length, and in the area of the uterus, the doctor makes a vertical dissection along the entire body of the reproductive organ.

A vertical incision in the uterus is made in emergency cases

Doctors also highlight some situations when, during surgical delivery, a woman in labor only makes a classic incision on the uterus:

inability to access the lower uterine segment, the presence of adhesions or varicose veins in this area of the reproductive organ;
failure of the vertical scar that remained on the uterus after a previous birth;
the fetus is in a transverse position;
Doctors need to save the baby first, because... the woman in labor dies and her life cannot be saved;
After removing the baby, doctors need to remove the uterus.

Obstetricians-gynecologists highlight the negative aspects of a corporal scar on the uterus:

severe blood loss during surgery;
the possibility of uterine bleeding in the first few days after CS;
longer recovery period: the wound takes longer to heal;
the likelihood of scar divergence during subsequent pregnancies.

Transverse scar

If the CS operation was planned in advance, then during the surgical procedure the doctor makes a transverse incision in the suprapubic region. Then, in the lower part of the uterus, which does not have the ability to contract, the specialist makes the same horizontal incision through which the fetus is removed.

For a young mother, a transverse scar is more preferable. The fact is that with such an incision the doctor has the opportunity to make a cosmetic stitch with special threads. As the seam heals, it becomes less noticeable and aesthetically looks beautiful, which is important for women.

Modern doctors prefer to make a transverse incision in the uterus during a planned CS operation.

Modern specialists prefer to make a horizontal incision on the body of the reproductive organ, because there are a lot of advantages to this:

during the surgical procedure, the woman in labor loses less blood than with a classic incision;
the body returns to normal faster: the suture heals faster, which accelerates the formation of a scar on the uterus;
the risk of developing inflammatory processes is reduced;
the formed scar is stronger and more durable than with a longitudinal incision, so there is less risk that it will rip apart during a subsequent pregnancy.

The only disadvantage of this type of incision is the reduced possibility of access during the CS procedure. That is why, in emergency cases, when the life of the child and mother directly depends on the speed of the doctor’s actions, a transverse incision is not made, but preference is given to the classic version, so that the baby can be quickly removed and the wound sutured.

The horizontal scar on the uterus is stronger, so in subsequent pregnancies the risk of suture dehiscence is reduced.

When not to worry: the normal thickness of the scar on the wall of the uterus after a cesarean section

A cesarean section scar on a woman’s reproductive organ forms four months after surgery. However, doctors do not recommend planning your next pregnancy earlier than two years after giving birth. This is exactly how long it takes for the seam to completely heal and heal.

Today, gynecologists insist that ideally wait thirty-six months to conceive. During this period of time, a strong, not thinned scar should form at the suture site. In order not to risk your health and the life of the unborn baby, it is better to take the necessary pause between the CS and the next pregnancy.

A young mother should not forget about scheduled visits to the women's doctor. The fact is that excellent and rapid healing of the skin of the abdominal cavity does not guarantee that the tissue of the uterus is also well restored, and the suture does not cause concern. Therefore, upon discharge from the maternity hospital, obstetricians-gynecologists must have a conversation with the woman, in which they mention that two, six and twelve months after a cesarean section, she must sign up for an examination at the antenatal clinic.

It is very important that before a couple starts planning to conceive, they also see a doctor who will assess the condition of the suture and give recommendations: is now a favorable time for pregnancy or should you wait a little longer.

First of all, the gynecologist will use an ultrasound to assess the thickness of the suture. Normally it should be 5 mm. Some women get scared when, during pregnancy, as the fetus grows, the suture becomes thinner. This is a normal phenomenon: after all, the uterus is stretching, so it is considered normal if by the thirty-fifth week the thickness of the suture is 3.5 mm. The gynecologist also determines the structure of the scar. Ideally, the suture should consist of muscle tissue: it is very elastic, therefore, with the enlargement of the uterus, it stretches well and this reduces the risk of scar divergence. But every woman’s body is individual, so for some young mothers, connective tissue may predominate in the scar area: it ruptures much more often, because it simply cannot withstand the load as the fetus grows.

What is a failed scar?

Unfortunately, the suture on the uterus does not always scar as doctors and the youngest mother would like. There are situations when, at an appointment, based on the results of the examination, a woman learns that the scar on the uterus is incompetent - incorrectly formed scar tissue in the area of the incision on the wall of the woman’s reproductive organ. Gynecologists identify factors that signal the failure of the uterine scar:

seam thickness is 1 mm;
the suture consists only of connective tissue or mixed tissue, but there is very little muscle;
in the area of the scar there are unfused areas and irregularities. This increases the risk of uterine wall rupture as the organ stretches.

Scar failure is a serious pathology that requires timely diagnosis and treatment. Married couples should know that in this case planning a pregnancy is strictly prohibited. Gynecologists explain that the causes of this pathology can be different:

emergency caesarean section, when during the operation a vertical incision was made in the uterus. In this case, the suture heals worse and slower, the scar may form poorly;
development of postoperative endometritis - an inflammatory process of the inner layer of the surface of the reproductive organ;
infection in the suture area or inside the uterus;
too early pregnancy. The fact is that the scar has not yet fully formed, therefore, as the uterus enlarges, the suture quickly becomes thinner;
termination of pregnancy after CS. In case of conception two to four months after the operation, the woman is prescribed an abortion for medical reasons. Also, not all young parents are ready to give birth to children with such a small age difference. During the procedure, the inner layer of the uterus is scraped, which negatively affects the thickness of the scar.

A scar in the area of which there are unfused areas or cavities is considered insolvent: in this case, there is a high probability of suture rupture during gestation

The whole danger of the situation: the consequences of rumen failure

It should be understood that it is not for nothing that doctors strongly recommend carefully planning the next pregnancy if the previous birth ended in surgery. The fact is that the main danger of scar failure is uterine rupture during the period of gestation. As the fetus grows, the uterus also enlarges. This occurs due to stretching of muscle tissue. But if the seam is thin and consists of connective tissue, it cannot withstand the load and it diverges. The consequences of this are very dangerous:

heavy bleeding in a pregnant woman;
fetal death;
death of the expectant mother from extensive blood loss.

Video: what a failed scar looks like on ultrasound

Symptoms of uterine suture dehiscence

Before being discharged from the maternity hospital, the young mother is given a list of recommendations that she must follow in order to avoid postoperative complications. Of course, upon returning home, most of the tasks of caring for the baby will go to the mother, but it is worth thinking about your own health and for at least two months after giving birth, provide yourself with help in the form of a husband, grandmother or nanny.

Some young mothers think that suture rupture can only occur during the next pregnancy. However, if the gynecologist’s recommendations are not followed, the suture may come apart in the first weeks after delivery via CS.

If during the period of bearing a baby, scar divergence occurs due to excessive tension in the tissues of the reproductive organ, then during the recovery period after surgery, the cause of suture rupture is most often excessive physical activity: lifting heavy objects, for example, a baby stroller, carrying a baby for a long time in your arms, etc. d. A young mother should be wary and urgently call an ambulance if the following symptoms occur:

severe pain in the abdominal area. If a woman touches the seam, she experiences sharp pain;
the muscles of the uterus are constantly tense. This is especially noticeable during gestation: the reproductive organ is constantly in good shape;
the young mother feels frequent contractions of the uterus;
the appearance of bloody discharge from the vagina that is not associated with menstruation.

If the scar has already ruptured, the woman’s condition will worsen sharply and will be accompanied by:

sharp, incessant pain in the lower abdomen that cannot be tolerated;
severe vomiting;
lowering blood pressure. This occurs due to blood loss;
loss of consciousness.

In this case, it is necessary to take the woman to the hospital as quickly as possible. Delay and loss of time can cost the life of a young mother.

Despite the fact that the suture in the abdominal area has healed well, the scar on the uterus may not be in such good condition, so you should not neglect the observation of a doctor, so that if there is a risk of rupture of the uterine wall, you can take timely measures

Treatment of uterine scar dehiscence

Before making a decision and making a diagnosis, the woman undergoes an ultrasound. During the examination, the doctor can confidently say in what condition the suture is after the CS. If there is a divergence of scar tissue on the uterus, urgent surgical intervention is necessary. Abdominal surgery will be required so that doctors can assess the extent of the rupture, stop the bleeding and re-suture the suture.

Today, some clinics perform suturing of the scar on the reproductive organ using the laparoscopic method. However, most often an open operation is necessary: an incision in the abdominal wall and subsequent suturing of the uterine wall.

If a woman has lost a large amount of blood, she may need a transfusion. After the operation, the young mother is left in the intensive care unit for several days under the constant supervision of doctors. Further treatment includes the use of antibacterial drugs. In some cases, hormonal therapy is also necessary. The treatment regimen during the rehabilitation period is developed by the doctor depending on the patient’s condition and the presence or absence of postoperative complications.

After discharge, the woman must come for routine examinations to the gynecologist. At each appointment, the doctor will definitely perform an ultrasound to monitor the healing of the uterine scar.

Prevention of scar dehiscence

To protect yourself from such a complication as scar rupture after cesarean section, you need to follow all the doctor’s recommendations:

For at least two months after the operation, physical activity is strictly prohibited. Many young mothers strive to get in shape after pregnancy and childbirth. However, it should be remembered that sports exercises can be performed no earlier than six months after the CS;
Do not miss scheduled examinations with a gynecologist. You should see your doctor eight weeks after surgery, then six and twelve months;
do not plan a subsequent pregnancy earlier than twenty-four months after birth. Ideally, you should wait three years before getting pregnant;
at the slightest symptoms: the appearance of pain, bleeding, do not delay a visit to the doctor.

Caesarean section is a full-fledged operation, after which a scar remains on the reproductive organ. As it heals, it forms and heals, but will not disappear. In some cases, there is a risk of scar divergence. Most often this happens during the next pregnancy, when the fetus grows inside the uterus, the walls of the organ stretch and the suture does not hold up. To protect herself and the unborn baby, a woman should not miss examinations with a gynecologist, undergo an ultrasound examination on time and additional examinations, if necessary.