Can stitches come apart after a caesarean section? Uterine rupture along a scar: a serious and dangerous complication during pregnancy

The suture on the uterus after a cesarean section may come apart both soon after the operation and during the next birth.

Types of sutures after cesarean

The “classic” option is a longitudinal or vertical section. In modern practice, it is abandoned because it takes longer to heal and has a greater likelihood of suture rupture in the future. Today, a vertical incision is used in the most urgent cases, if there is a threat to the life of the baby or mother, and the birth needs to be carried out as quickly as possible. A longitudinal incision allows you to quickly remove the baby and avoid danger.

The second type is a transverse or horizontal cut. It is carried out horizontally in the lower part of the uterus, heals faster, and has a low probability of suture dehiscence in the future - from 1% to 6%.

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

The healing time of sutures is mainly individual and depends on many factors: health status, compliance with hygiene rules and postoperative behavior, etc.

The type of suture also affects: if a transverse incision was made during the operation, the suture heals on average about six weeks, if longitudinal - about eight.

Thus, the average healing time for sutures after a cesarean section is six to eight weeks. But the stitch may hurt longer. It can make itself felt even after a few months or a whole year.

Reasons why sutures on the uterus may come apart

The sutures on the uterus may come apart during postoperative recovery if the woman in labor does not follow the recommendations given to her by the doctor. In this case, the cause of the rupture may be physical activity (sports), heavy lifting (if the mother lifts the stroller alone, carries heavy bags from the store).

In addition, the suture on the uterus may come apart during the next pregnancy. This can happen both in the later stages of pregnancy and during the birth process itself. In this case, the suture rupture is caused by an insufficiently long interval between births (you can give birth without the risk of rupture at least three years after a cesarean operation), the woman’s age (after 30, the elasticity of the tissue is lost, the risk of rupture increases), and a vertical suture. In addition, rupture can occur due to medical fault.

Also, the risk of uterine suture rupture during childbirth increases if drugs were used to induce labor.

Symptoms of uterine suture dehiscence

It is very difficult to determine a rupture of a suture on the uterus by external signs. It is usually accompanied by pain in the suture area, and vaginal bleeding is possible.

If a rupture occurs during a second pregnancy, the baby's heartbeat changes.

A ruptured suture in the uterus can be diagnosed using an ultrasound, and an experienced specialist can detect it in time during childbirth.

Possible consequences

If during childbirth or pregnancy the doctor detected a rupture of the suture on the uterus in time and took appropriate measures, the risk is minimal.

Otherwise, uterine rupture can have dire consequences - death for the baby or for the mother. But statistics say that this happens extremely rarely.

How to protect yourself from seam splitting

Follow all the doctor’s recommendations after surgery: during the recovery period, avoid physical activity and do not lift heavy objects.

Do not plan a new pregnancy earlier than three years after your cesarean section.

If there is severe pain or vaginal bleeding, consult a doctor immediately.

If you are going to give birth again and are planning a natural birth, pay special attention to the suture during the ultrasound.

Significant changes after childbirth occur in the entire reproductive system of the mother, and most of all in the uterus. After the birth of the baby, the female body returns to normal for a long period of time. In the first postpartum weeks, the uterus resembles a huge stretched muscular sac. Gradually, all internal mechanisms and organs are restored. But it should be understood that this process can continue for several months and even a year or two. Therefore, proper care, daily hygiene, supervision by a gynecologist-obstetrician and an optimistic attitude should become your daily rule.

It is not always possible for a woman to give birth to a child naturally. Today, the number of women in labor who gave birth to a baby via Caesarean section is increasing. This operation is no longer complicated; surgery can be performed using either full or partial anesthesia. But after a cesarean section, a woman will have to be patient, because the restoration of her body, especially the uterus, will take more than one week.

Condition of the uterus in the postpartum period

Immediately after childbirth, the uterus of every woman is enlarged in volume, stretched in size and resembles a continuous bleeding wound. Its bottom is located approximately 4-5 cm below the navel, and its diameter is 10-12 cm. Gradually, uterine contractions help to reduce it and heal the inner surface.

Both after and after a cesarean section, contractions of the cervix are very weak and intensify until the end of the postpartum period. However, in a woman who has undergone surgery, the uterus recovers more slowly, and her weight decreases gradually. For some time, minor postpartum bleeding is observed from the uterus, which is scientifically called lochia.

The postpartum period after cesarean section lasts up to 60 days. Why is the uterus in no hurry to contract? After the operation, the integrity of the muscle fibers of the uterus, its vessels and nerve endings is disrupted. That is why the rate of contraction, or involution (this is what doctors call this process), slows down. If necessary, the woman is prescribed special drug therapy. Medicines should stimulate the contractile activity of the uterine muscles, as well as reduce bleeding from vessels damaged during the incision.

The uterus contracts slowly, so the woman does not recover very quickly. This may cause the mother and baby to be discharged from the hospital a little later after a cesarean section. At home, another type of discomfort arises: it is difficult for a woman to turn over on her side, it is painful to cough and sneeze, to get up on her feet, and to walk. Intestinal gases are tormenting, the stomach is swollen, and sometimes there is acute pain. Such discomfort leads to difficulties during breastfeeding, because finding a comfortable position is extremely difficult.

Possible complications after cesarean section

If during a natural birth a woman loses up to 300 ml of blood, then during a cesarean section the volume of blood loss increases to an average of 500-1000 ml. In the first case, the mother’s body independently restores the lost blood volume, but in the second, it cannot cope with the problem on its own. That is why during and after the operation the woman is injected with blood replacement solutions.

It should be understood that a caesarean section is the same operation as others, and after it some complications are possible:

• the integrity of the intestinal peritoneum is compromised;
• adhesions occur- adhesions between intestinal loops and other internal organs. This causes abdominal pain, discomfort when sitting, walking, or any other movements;
• endomyometritis- inflammation of the uterus. During the operation, there is direct contact of the uterine cavity with air, the complete sterility of which is difficult to achieve. To prevent endomyometritis after surgery, the mother is prescribed antibiotics;
• subinvolution- violation of uterine contraction. In this case, the doctor prescribes 2-5 days of therapy aimed at improving uterine contractility.

Restoration of the uterus after cesarean section

Whatever the nature of childbirth, in any case it can be compared to hard work, after which the female body needs a good rest.

After the operation, the mother spends the first 24 hours in a special postpartum ward. Doctors are constantly monitoring the woman in labor. The nurse daily treats the postoperative suture with an antiseptic solution and changes the bandages. An ice pack is placed on the mother's stomach: this stimulates the uterus to contract and helps stop bleeding. The woman is also prescribed painkillers that help contract the uterus, and drugs to restore the function of the gastrointestinal tract. The mother must remember that her body must fully recover, and a durable scar must form on the uterus. Therefore, doctors recommend resuming sexual activity after a cesarean section two to three months after the operation. It is better to plan your next pregnancy in a year or two, but not earlier. It is believed that the scar is finally formed by the end of the first year after a cesarean section and does not change further.

Visit your gynecologist, do an ultrasound to make sure that the body's recovery process is proceeding normally, and ask about acceptable methods of contraception. If you are planning another pregnancy, your doctor will advise you to do a hysterography - x-rays in frontal and lateral projections taken after the injection of a contrast agent into the uterus. You can also undergo hysteroscopy - this is a visual examination and study of the scar on the uterus, which is carried out using an endoscope inserted into the uterine cavity 8-12 months after the operation.

Restoration of the uterus after surgery largely depends on how the pregnancy proceeded, on the woman’s age, physique, and even the conditions under which the operation took place. Unfortunately, every mother who gave birth by cesarean section must be psychologically prepared for the fact that she will have to endure pain for some time. Unpleasant sensations may occur due to internal wounds and contractions of the uterus.

Suture on the uterus after cesarean section

During birth by cesarean section, doctors use several. Currently there are three types:

• transverse section of the uterus. The most commonly practiced and produced is 10-12 cm long in the lower segment. It is less traumatic, with less blood loss, and also facilitates wound healing and reduces the risk of postpartum infection. The scar has almost no effect on subsequent pregnancies, and childbirth can occur naturally;
• classic cut. It is carried out vertically in the upper part of the uterus, where a huge number of blood vessels are located, and therefore is accompanied by severe bleeding. For this reason, doctors rarely do it;
• vertical section. It is performed only in extreme cases, with some abnormal development of the uterus and premature birth.

No less important is the operation of suturing the uterus after the incision

The uterine incision is usually closed with a single or double row suture without interruption. In this case, doctors use special materials that completely dissolve on their own over the course of several weeks to 3-4 months. This can be dexon, monocryl, vicryl, caproag and other suture threads. After childbirth, doctors monitor the wound healing process and make sure that the suture after a cesarean section does not become inflamed.

The postoperative scar will take longer to heal: up to six months, and in some women - up to a year. Again, this is a long process, and it is due to the fact that the integrity of the nerve endings was damaged during the surgical incision.

After the operation, you should take painkillers for several days, as the suture causes pain. The skin scar takes about 6-7 days to form, so a woman will be able to take a shower on her own only after a week. To alleviate discomfort, women are advised to bandage their belly with a diaper or wear a special postpartum bandage.

Physical activity can begin no earlier than 2-3 months after birth. Exercises should not be difficult and painless. And remember that after a cesarean section you should not lift any weights! If you overexert your abdominal muscles, it can affect the healing process of the post-operative scar, even leading to the formation of hernias. Take care of yourself and your baby!

Especially for Nadezhda Zaitseva

As a result of a cesarean section, a suture remains on the body of the uterus, which over time transforms into a scar. It can cause complications during repeated pregnancy and childbirth, so it should be promptly examined by a doctor. After assessing the structure and type of scar, the gynecologist decides on the possibility of natural childbirth after surgery.

What is a scar and the reasons for its appearance

The uterine scar is a structural formation that consists of myometrial fibers (muscle tissue of the uterus) and connective tissue. It turns out as a result of violation of the integrity of the uterine wall and its subsequent plastic surgery with a medical suture.

As a rule, the incision in the uterus is closed with a special continuous suture (double-row or single-row). The process uses self-absorbable suture threads: Caproag, Vicryl, Monocryl, Dexon and others. The sutures heal and completely dissolve in a few weeks or months, which depends on the individual body’s ability to regenerate tissue. After childbirth, the gynecologist must monitor the healing process of the suture using ultrasound to prevent internal inflammation.

After approximately 6–12 months, a scar forms at the site of the suture. The process of its formation is long, since during a cesarean section not only the mucous surface is damaged, but also the nerve endings. That is why for several days after surgery it is recommended to take systemic painkillers that do not affect the lactation process.

In addition to cesarean surgery, there are other factors for the appearance of a scar on the uterus.

1. Abortion. After curettage, wall perforation and fibrosis may appear in the cavity of a hollow organ, resulting in small scars remaining in the tissue.
2. Removal of formations: benign (cysts, polyps, fibroids) or malignant (uterine cancer). Such operations are always accompanied by a violation of the integrity of the uterine walls.
3. Uterine rupture. Damage to a hollow organ can occur during hyperstimulation of labor, rapid pathological labor, multiple pregnancy, etc.
4. Ruptures of the perineum, birth canal, uterine cervix. When a third degree cervical rupture occurs during natural childbirth, the uterine walls are damaged, which requires suturing.
5. Treatment of erosion. Any therapy for pathology (including surgical or laser removal, taking medications) leads to the formation of a scar at the site of erosion.
6. Ectopic pregnancy. Surgical excision is used to remove the fetus from the fallopian tube or cervix, leaving scars on the wall of the hollow organ.
7. Plastic restorative procedures. The suture also appears after uterine plastic surgery, for example, as a result of amputation of the horn.

Within a year after a cesarean section, it is extremely undesirable to terminate a new pregnancy by curettage, since in the process the doctor may damage the fresh scar.

Types of scars on the uterus

Uterine scars after cesarean section differ in structure and method of formation. The possibility of subsequent natural childbirth, the risk of pregnancy pathologies, ruptures, etc. depend on their shape and type.

The structure of the scar can be consistent or insolvent. And depending on the method of making the incision, a transverse or longitudinal suture is formed.

Successful and unsuccessful scar

A healthy post-operative scar is natural and normal with a sufficient level of elasticity. Its composition is dominated by muscle rather than connective cells, which makes the scar closest to the natural tissue of the uterine wall. Such a scar can withstand the pressure of the fetus during a second pregnancy and its passage through the birth canal. The thickness of the formation should normally be 5 millimeters. It will gradually thin out during subsequent pregnancies and 3mm will be considered a good indication of thickness. Many doctors claim that even with 1 mm at the end of the 3rd trimester, the risk of suture dehiscence is negligible.

What does a full-fledged uterine scar look like after a cesarean section?

If the formed scar after a cesarean section is up to 1 mm thick, then it is said to be incompetent. This formation is heterogeneous in structure, has various depressions or thickenings around the perimeter, and threads. It is dominated by connective inelastic tissue where there should be muscle tissue along with an active plexus of blood vessels. An incomplete thinned scar is a contraindication for a second pregnancy, since as the uterus enlarges, its tissue will not stretch, but will tear. As a result, intrauterine bleeding may develop and have dangerous health consequences. Unfortunately, the thinning of the uterine scar is not controlled and cannot be treated.

There are risk factors that provoke the formation of an incompetent scar:

• corporal CS (an incision is made along the uterus, as well as CME with dissection of its tissues);
• inflammation of the suture during postoperative rehabilitation;
• new pregnancy in the first two years after CS;
• abortion with curettage during the rehabilitation period (about a year).

In order for the scar to fully form, you should wait the recommended period before repeat pregnancy or abortion - at least 2 years. During this time, it is advisable to protect yourself using hormonal or barrier contraception (except for the intrauterine device).

The thickness of an incompetent scar after a cesarean section is a danger of planning a subsequent pregnancy

Transverse and longitudinal

During a planned CS, a transverse incision is made in the lower part of the uterus. This results in neat and even cut edges, which can then be easily compared and fused using suture material.

A longitudinal incision is used in case of urgent delivery using the CS method (internal bleeding, acute fetal hypoxia, umbilical cord entanglement, etc.). In this case, the edges of the incision are difficult to compare, and the wound may heal unevenly.

Management of pregnancy and childbirth if a scar is present

Gynecologists have named the optimal period between a cesarean section and planning a new pregnancy - 2 years. During this time, a good, wealthy scar is formed that retains its elasticity. Taking a break for more than 4 years is also not recommended, since over time the ability of the suture to stretch decreases (muscle fibers gradually weaken and atrophy). It must be taken into account that a longitudinal scar is more susceptible to degenerative changes.

What risks should pregnant women with a postoperative scar on the uterus expect?

1. Incorrect placenta previa (marginal, low, complete).
2. Pathological fusion of the placenta with the myometrium, the basal or outer layer of the uterus.
3. Attachment of the fertilized egg in the scar area, which greatly increases the risk of miscarriage or premature birth.

If a woman becomes pregnant, but the scar has thinned and become defective, then she is admitted to the hospital for preservation from the 34th week. With a full-fledged scar, observation is necessary a couple of weeks before the PDR. The attending physician assesses the condition of the uterine walls and makes a decision on the possibility and advisability of natural childbirth, tactics of its management, etc.

Repeated caesarean section

It is known that in case of an incompetent scar on the uterus, in most cases a planned CS is performed. As a rule, after the previous operation, the same relative indications for surgical delivery remain, for example:

• anatomically or clinically (large child) narrow pelvis;
• damage to the birth canal;
• isthmic-cervical insufficiency of the cervix;
• polyhydramnios;
• multiple pregnancy;
• placenta previa;
• breech presentation of the baby.

In these cases, a planned cesarean section is prescribed, and the consistency of the scar does not matter.

Also, the absolute indications for each subsequent CS are:

• scar after longitudinal CS;
• more than one postoperative scars on the uterus;
• scar failure confirmed by ultrasound;
• placing the placenta or baby in the postoperative scar area, which increases the likelihood of uterine tissue rupture during natural contractions;
• weak or absent labor in patients with a wealthy scar.

Many patients worry that after each cesarean operation the risk of miscarriage and spontaneous abortion increases. In practice, after the second CS on the scar, the question arises about the possible sterilization of a woman using tubal ligation to guarantee the prevention of pregnancy. With each new operation, the risk of scar deficiency increases, which threatens with dangerous consequences for the life and health of a woman. And as you know, most women ignore regular visits to an uzist in the postpartum period and become pregnant with an inferior scar.

Natural childbirth

After a CS, natural labor is allowed if the following requirements are met:

• no more than one abdominal operation on the uterus in the entire medical history;
• transverse wealthy scar, which is confirmed by ultrasound and gynecological examination;
• location of the placenta and attachment of the fetus outside the scar area;
• correct presentation of the fetus;
• singleton pregnancy;
• absence of indications for planned CS, complications and pathologies of pregnancy.

According to medical statistics, only 30% of patients have a clear scar after surgery and the possibility of subsequent natural childbirth. The latter are carried out in a specialized maternity hospital, where there is not only a maternity ward, but also an obstetric hospital with surgical, neonatal and anesthesiological services. In the event of a uterine rupture, the woman in labor must receive emergency surgical care within 10 minutes - this is an important condition for natural childbirth. The process is necessarily accompanied by cardiac monitoring, which allows recording the fetal cardiac activity for prompt detection of hypoxia.

After a natural birth, the doctor must palpate the uterine walls to exclude cracks and incomplete ruptures in the scar area. During the examination, temporary intravenous anesthesia is used. If during the examination a complete or partial divergence of the suture walls is discovered, then an urgent operation is prescribed to suturing the rupture, which will prevent intra-abdominal bleeding.

Uterine rupture along an old scar

It is the most common cause of damage to the integrity of the uterus during childbirth. Unfortunately, it often occurs without specific symptoms, so the risk of postpartum complications increases.

What factors may indicate the divergence of an old scar:

• thinning (thickness less than 1 mm) and overstretching of the scar;
• hypertonicity of the uterus;
• severe pain in the lower abdomen;
• arrhythmic contractions;
• vaginal bleeding;
• fluctuations in fetal heart rate.

After the scar has ruptured, the following symptoms appear:

• acute unbearable pain in the abdomen;
• fever;
• a sharp drop in pressure;
• vomit;
• weakening or complete cessation of labor.

In medicine, there are 3 stages of rupture of the uterine walls along the scar.

1. Threatening. The integrity of the walls of the hollow organ has not yet been broken, but a crack in the scar is observed. A pregnant woman may feel pain in the lower abdomen on the right, especially when palpating the suture area. The listed symptoms are indications for a planned CS. If the pathology is detected during childbirth, then painful and weak contractions are observed, which practically do not contribute to the opening of the cervix. Doctors stop labor and perform an emergency CS.
2. Started. In a pregnant woman, a hematoma (a cavity with blood) forms in the area of ​​the uterine scar rupture, which can come out of the vagina in the form of bloody clots. The pregnant woman notes uterine tone and pain in the scar area. An ultrasound specialist can diagnose weak cardiac activity and fetal hypoxia. During the labor period, the uterus is constantly tense and does not relax; severe pain in the abdomen and lumbosacral region and vaginal bleeding may occur. Attempts are also weak and painful.
3. Accomplished. Internal bleeding and classic symptoms develop: pale skin, dilated pupils and sunken eyes, tachycardia or arrhythmia, shallow breathing, vomiting, confusion or loss of consciousness. Complete rupture of the uterus often leads to the fact that the child, along with the placenta, ends up in the abdominal cavity.

The second and third stages of rupture involve a cesarean section, as a result of which the baby and placenta are removed, and reliable suture material is applied to the rupture site. Sometimes damage to the uterine walls takes up a large area and threatens the woman’s health, which is an indication for emergency amputation of a hollow organ. After the CS, the patient is transferred to the intensive care unit.

If the scar ruptures during pregnancy and natural childbirth, what consequences can be expected:

• premature birth;
• acute hypoxia of the child, disruption of his respiratory function;
• hemorrhagic shock in the mother (a condition caused by internal bleeding);
• intrauterine fetal death;
• early miscarriages;
• uterus removal.

Monitoring the condition of the uterine scar

The first year after CS, the patient should visit specialists to monitor the resorption of sutures and scar formation. This is necessary to identify possible risks and pathologies during a new pregnancy and childbirth.

The following methods are used to assess the structure of the scar.

1. Ultrasound. The main study, which allows you to reliably determine the dimensions of the scar (thickness and length), shape, location, structure (presence of niches or bulges). It is thanks to ultrasound that the consistency of the scar is determined, and a crack or threatening rupture can also be identified.
2. Hysterography. X-ray examination of a hollow organ is accurate, but not entirely safe. It is used when it is necessary to consider the internal structure of the scar and assess the risks of ruptures.
3. Hysteroscopy. Minimally invasive examination of the organ cavity, for which a hysteroscope device is used. Allows you to more accurately determine the shape of the scar, its color, and the quality of the vascular network in the tissues.
4. MRI of the uterus. This method is used to additionally assess the proportions of muscle and connective tissue in the structure of the scar.

Scars after CS: quantity, can they be removed?

Medical statistics show that if the first birth was carried out using surgery, then subsequent ones are likely to have indications for it. At the same time, many patients worry about how many scars will remain on the uterus after each cesarean section.

Normally, during a subsequent operation, the doctor excises the old scar, removes adhesions and forms a new one. Thus, it reduces the area of ​​possible damage during each surgical intervention. But there are situations when you have to make a new second, third, etc. suture on the uterus. For example, if a woman has a multiple pregnancy or a large fetus, which leads to overstretching of the uterus and a change in its position. Or the next caesarean section may not be planned, but emergency, which will require the doctor to apply not a transverse, but a second longitudinal suture. This situation is also possible with a breech presentation of the fetus.

It is difficult to predict how many scars will remain on the uterus and abdomen after a series of CS. Each case is individual, and often the doctor makes a decision during the operation.

Patients are also interested in whether it is possible to remove all these scars in order to get pregnant normally and carry a child to term. First of all, the possibility of removal will depend on the condition of the scar.

Formed in 3 stages. The first scar appears - reddish-pink, uneven. On the second, it thickens and acquires a purple tint. In the third stage, the scar becomes overgrown with connective tissue and turns white (the process takes about a year). After this period, the doctor uses ultrasound or MRI to assess the condition of the scar.

If the scar turns out to be ineffective, and a new pregnancy poses a danger to the woman’s life, then the doctor may suggest hysteroscopic metroplasty - an operation to excise the old scar on the uterus. Under anesthesia, using special devices, the doctor excises the scar and forms a new one using reliable suture material. In the absence of the rush characteristic of a cesarean section, the surgeon can make smooth edges of the suture that are easily compared, leaving a high probability of the formation of a wealthy thick scar. That is, it is possible to remove a scar on the uterus, but only strictly for medical reasons.

A scar on the uterus is a mandatory consequence of a cesarean section. It is not considered a contraindication for a new pregnancy, but the formation must take place under the supervision of a doctor. If the scar is incompetent or thinned, special tactics for managing pregnancy and childbirth are required to prevent uterine rupture.

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

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

Kinds

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

Vertical seam

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

Horizontal seam

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

Internal seams

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

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

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

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

Features of the recovery period

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

Pain

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

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

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

Hardness

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

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

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

Discharge

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

Itching

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

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

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

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

In the hospital

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

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

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

Home care

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

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

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

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

Complications

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

Early complications

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

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

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

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

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

Late complications

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

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

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

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

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

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

Subsequent pregnancies

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

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

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

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

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

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

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

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

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

Pain relief after caesarean section

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

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

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

How to care for caesarean section stitches?

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

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

What complications can there be in the postoperative period?

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

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

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

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

Late complications

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

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

Methods for correcting scars after cesarean section

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

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

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

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

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

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

If a woman’s first birth, for various reasons, ended in surgery, then the second and subsequent births require the inclusion of this pregnant woman in the risk group. Suture dehiscence after cesarean section is a fairly serious problem in modern obstetrics, although many approaches to the management of such patients have recently changed quite a lot. Even 10 - 15 years ago, the verdict of specialists on such women was unequivocal: if there is a history of this type of delivery, then all subsequent births should be carried out only surgically. This was associated with a high risk of uterine rupture along the old scar during the natural process. What are the reasons for such a complication?

Probability of uterine rupture depending on the scar

For a long time, many obstetrician-gynecologists used a classic vertical suture, which was used to suture the muscular wall of the uterus in its upper third. Such tactics during a caesarean section were considered generally accepted.

Technically, such a delivery was quite simple: the surgeon made a vertical incision, the abdominal cavity was opened between the pubic bone and the navel. However, this technique gave a fairly high percentage of rupture of the uterine wall along the old scar during pregnancy and subsequent childbirth through the natural birth canal.

The dehiscence of the suture on the uterus after cesarean in this case ranged from 4 to 12%, according to various authors. This forced specialists to recommend that the woman go back to the operating table.

Currently, all major maternity hospitals and perinatal centers have abandoned this technique. During the operation, an incision is made on the uterus in the lower segment. The scar can be longitudinal or transverse, which has virtually no effect on the incidence of postoperative complications.

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

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

Types of suture after cesarean section

Who is at risk of uterine rupture during childbirth?

As mentioned above, about 4 - 5% of women in labor run the risk of experiencing possible divergence of the old scar during vaginal birth. This probability increases significantly with the age of the pregnant woman. Like the tissues of the whole body, the walls of the uterus lose their former elasticity with age, so excessive stress on the old scar during pregnancy and childbirth can be fatal.

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

Pregnant women who do not have a history of surgical delivery may be at risk of uterine rupture. Quite often, such complications occur when a woman in labor enters the delivery room for the 5th, 6th and subsequent births. In such women, the muscular layer of the uterine wall is extremely weakened; such challenges should be taken into account by obstetricians when choosing labor management tactics.

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

Signs of violation of the integrity of the uterine scar

Experts believe that the main difficulty in solving this problem is the difficult prediction of such a complication. Most often this can happen in the last stages of gestation.

Signs of suture dehiscence after cesarean section during pregnancy depend on the stage of development of the process. In modern obstetrics, there are three types of violation of the integrity of the scar:

Type of violation	What's happening
Threatened uterine rupture	Such a complication often does not manifest itself clinically and can only be detected by performing an ultrasound scan of the scar.
Starting rupture of the old seam	It is usually characterized by severe pain in the surgical area; signs of painful shock in a woman are possible: drop in blood pressure, tachycardia, cold sticky sweat. On the part of the child’s body, such a pathology may be accompanied by a decrease in heart rate.
Completed uterine rupture	In addition to the symptoms already listed, it is characterized by sharp pain in the abdomen in the interval between contractions, a change in the movement of the child’s torso in the birth canal, and the development of bleeding from the vagina.

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

The medical literature describes situations where there are practically no symptoms of suture dehiscence after cesarean section. The pain syndrome does not exceed the usual threshold for a woman in labor, the strength and frequency of contractions do not change. In such a situation, the experience and alertness of the doctor conducting childbirth in a woman with a similar pathology can play a big role.

Uterine rupture is considered a severe complication, ranking among the leading causes of fetal death and maternal mortality. In this case, only an emergency operation can save the life of the baby, and most importantly, the mother.

What women need to know about the formation of a suture on the uterus

Quite often, young mothers turn to the antenatal clinic with the question of whether the internal suture can come apart after a caesarean section. In such a situation, much depends on the patient herself.

If after a vaginal birth, after a certain time, the female uterus acquires its original shape, then after a cesarean section, a scar remains on the wall, which can complicate the course of future pregnancies for a young woman. Nature has provided the following method for healing a postoperative scar: in a normal state, the suture site is filled with muscle tissue cells or myocytes, these structures allow the scar to acquire the necessary density and become, as doctors say, wealthy.

If, for various reasons, the suture becomes overgrown predominantly with connective tissue, then the structure of the muscular layer of the uterine wall is disrupted. In subsequent pregnancies with such a scar, various problems may arise.

This pathology usually occurs if a woman, after the first operation, did not follow the doctor’s basic recommendations, physical activity on the abdominal wall exceeded acceptable standards, and there were certain errors and shortcomings in diet and lifestyle. Finally, various chronic diseases and a decrease in the body’s immune forces can cause a weak scar on the uterus.

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

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

Uterine scar and second pregnancy

When there are no problems with the scar on the uterus, pregnancy does not affect the woman’s condition in any way. Until 32 - 33 weeks, a pregnant woman does not have any clinical manifestations of the existing pathology. Only in the later stages of pregnancy may mild pain appear in the area of ​​the old operation. Most often, such a pain syndrome indicates the presence of an adhesive process in the area of ​​surgical intervention, but this may indicate that the scar on the uterus is not elastic enough.

If a woman’s pain is localized in one specific place, it is not affected by a change in body position, analgesics and antispasmodics do not bring the desired effect - this is a reason to immediately seek help from a specialist. This should become the rule for a pregnant woman, regardless of the period.

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

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

In modern protocols, the time from diagnosis of uterine rupture to emergency cesarean section should not exceed 15 - 20 minutes. Only in this case there are good chances to save the baby and his mother.

When specialists decide to allow a pregnant woman with a uterine scar to have a natural birth, the woman should be informed about the possible emergency operation and the certain risks of such tactics. In addition, pain relief therapy and artificial induction of labor cannot be administered to such a contingent of women in labor. The doctor simply does not interfere in the course of childbirth; his task is to recognize possible complications and take appropriate measures.

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

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 suture 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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