Suture on the uterus after cesarean section. Uterine rupture along a scar: a serious and dangerous complication during pregnancy

Ideally, after a cesarean section, the sutures are removed 7-10 days later, the scar gradually heals, and within a year the uterus is restored to its original state. Unfortunately, in reality, the postoperative period can be accompanied by various complications.

Suture dehiscence is one of the most common problems during the rehabilitation period.

Doctors warn patients about possible complications even before the operation. If all recommendations are strictly followed and the operation is performed correctly, the likelihood of postoperative complications is very low. But sometimes, having completely devoted themselves to the baby, mothers do not have time to pay due attention to their health, which is why they have to face certain problems. What to do if the stitch breaks after a caesarean section? How to care for a wound so that it heals as quickly as possible?

Postoperative period

As a result of a caesarean section, a woman develops two stitches:

external - or external, located on the stomach,
internal – connecting the walls of the uterus.

After surgery, the wound requires observation and regular antiseptic treatment. During the first week, she is examined daily by a doctor, medicated and the bandage is changed. This allows you to identify possible problems in a timely manner and take appropriate measures.

The uterus heals by the 7th day after the operation. Then the silk threads that tighten the wound are removed.

The incision can be sutured with threads that dissolve 70-80 days after application; they do not need to be removed.

In the first period after surgery, the incision in the uterus causes very severe pain. Women after cesarean section, along with antibiotics, are prescribed intramuscular painkillers to relieve pain. Over time, the pain should decrease. If the pain does not go away, and along with it the temperature rises, then these are very alarming symptoms in which the woman urgently needs to seek medical help.

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

Possible complications

After a cesarean operation, a woman in labor may experience various complications. All of them are conditionally divided into two groups:

early, appearing immediately after surgery or within a week after it,
late, appearing a month or more after surgery.

Early complications include inflammation and suppuration, hematomas and light bleeding, and slight suture dehiscence.

If the dressing becomes wet, you should treat it with peroxide solution or dimexide and immediately consult a doctor. The doctor examines the wound, determines the cause of the suture dehiscence, and makes recommendations for further care.
If the wound begins to fester, the doctor installs a drainage for quick cleaning. It is very important to drain pus, since the inflamed tissues do not heal. In some cases, premature removal of surgical sutures may be necessary.
The suture may come apart within 1-2 days after the ligatures are removed. To prevent this from happening, you should limit physical activity after removing them. Usually, a broken suture is not sutured again, but local treatment is prescribed, which helps the wound heal faster. This process is also called secondary intention. In some cases, the doctor prescribes repeated ligatures, but this happens very rarely.

One type of late complication is the formation of a fistula. It can form if a woman’s body rejects the suture threads. The fistula cavity may close on its own, and in some cases the doctor will have to prescribe a procedure for excision of the fistula tract. In this situation, you should not self-medicate, as this can lead to abscesses; you should consult a doctor.

Problems with the suture can be caused by a woman having diabetes. In this case, emergency hospitalization of the woman in labor is required to treat the emerging complication.

Prevention of scar dehiscence

In order to prevent the seam from coming apart, a woman should follow the following rules.

First of all, it should be remembered that a woman after a cesarean section is prohibited from lifting weights for several months. In the first two to three days after the stitches are removed, it is not recommended to even pick up the baby. If possible, during this period someone close to you should be involved to help care for the child. Overexertion of the abdominal muscles leads to increased intrauterine pressure, which can cause the internal suture to tear apart. To reduce stress, a woman is recommended to wear a postpartum bandage before getting out of bed. It fixes the soft tissues of the abdomen and uterus, preventing them from moving, which reduces pain and tension in muscle tissue.
Antiseptic wound treatment will help prevent infections. It is recommended to treat the seam with a solution of brilliant green, iodinol, and fucorcin. To prevent wound suppuration, the mother in labor is prescribed antibacterial drugs after surgery.
Depending on the physiology of the woman and the professionalism of the surgeon, the incision after surgery takes longer or faster to heal. To speed up the process of regeneration and scar formation, the external seam is treated with sea buckthorn oil, levomekol, and panthenol ointments. Milk thistle oil dissolves scar tissue very well and heals wounds. Once the scar is completely formed, cosmetic surgery can be performed to correct it. In aesthetic surgery clinics, you can perform laser resurfacing or microdermabrasion. Quite often, scar tissue is polished using peels.

How many times can you give birth after a caesarean section?

So, what to do if the seam does come apart? First of all, stop panicking. Medicine knows many cases where women's sutures came apart. But not one of them was left with a through hole in the stomach. See a doctor and sooner or later the wound will heal and everything will work out. And to speed up this process, it is necessary to follow the recommendations of your doctor.

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.

The operation of caesarean section is difficult, but doable. Similar operations are performed today without complications, but during the rehabilitation period cases of pathological disorders are recorded. Due to the presented fact, doctors explain to a woman in advance what to do if suture came apart after caesarean section, as well as methods for preventing the most common complication. The problem with scars is common and dangerous to a woman’s health, and sometimes even to her life. It is also noted that suture dehiscence can occur both during the rehabilitation period and during a new pregnancy with the growth of the fetus in the uterine cavity.

Often, even a long break between pregnancies does not “save” from problems with the integrity of the uterine sutures. All this can be avoided if you carefully adhere to the rules of the rehabilitation period of cesarean section, which young mothers cannot stand when immersed in caring for the baby. The article will describe in detail the main problems after a cesarean section, as well as methods for preventing discrepancy.

A cesarean section is a surgical delivery procedure. As a result, the woman develops two sutures - an internal one on the uterus and an external one, which should be carefully looked after in the postoperative period according to the doctor’s recommendations. Due to the cut and rupture of blood vessels, the wound, both external and internal, will take a long time to heal. An internal wound requires a refusal to carry weights and other basics for a speedy recovery. At the same time, the external wound must constantly be subjected to antiseptic treatment.

With proper and timely care, the external scar is formed within a week - the doctor immediately removes the threads. The internal wound heals on its own and does not require repeated medical intervention.

This is important: Seam separation can occur both externally and internally. Moreover, the outer seam may remain intact, while a discrepancy will be diagnosed inside. Since the external scar immediately signals the development of problems, the internal one will only produce severe pain, which women usually endure for some time - this leads to serious internal bleeding and repeated surgery.

You should also be aware of the symptoms of internal and external seam separation. The external seam is covered with ichor - this indicates poor vascular restoration or divergence of the formed wound. An internal suture is a wound closed with self-absorbable materials. There is no need to remove such threads - they dissolve on their own within 80-90 days.

During the period of resorption of the threads, the wound provokes pain, which in the first days after a cesarean section is relieved by taking painkillers. Gradually, the intensity of the pain should decrease - if this does not happen, it means that complications have begun, for which you should immediately consult a doctor.

The table below identifies three types of scar integrity violations:

Violation	Description
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.

Often, suture dehiscence after surgery occurs in the first 3 months, so during this time a woman should take care of herself and follow all the doctor’s recommendations. In some cases, women in labor after surgery are prohibited from even picking up their baby - the ban is imposed in the first weeks of the postoperative period.

What a suture looks like after a caesarean section can be seen in this photo:

About problems in the postoperative period

Suture dehiscence after cesarean section is not the only complication in women. All possible problems are conventionally divided into 2 groups – early and late. Early complications are problems that developed during the postoperative period. Late - formed a month after surgery.

In addition to seam divergence, early problems include the following:

Light bleeding - If the bandage on the external seam becomes wet and bloody, you should treat it with hydrogen peroxide and consult a doctor.
Hematomas are compactions with symptoms such as increased body temperature, as well as severe pain, which can provoke inflammation.
Inflammation - this often happens due to stress, infection in the wound and other problems.
Suppuration - if the suture has rotted, the doctor installs drainage for the timely drainage of purulent masses. Rotting of the seam is possible due to infection in the absence of proper wound care.
Seam dehiscence occurs in most cases in the first 2 weeks after removing the threads. There can be many reasons for this - stress, poor vascular recovery process and other prerequisites.

Late problems include the formation of fistulas - cavity canals formed as a result of rejection of the threads with which the wound was sutured. A woman with diabetes mellitus should monitor the condition of the suture especially carefully. People with this disease are at risk of developing complications in the postoperative period due to constant changes in blood glucose levels, which reduces the connective function of cells.

Preventing discrepancies

Since the wound usually heals within the first few weeks after surgery, women in labor should follow these doctor's instructions to prevent problems. Namely:

In the first few days after surgery, a woman is contraindicated from picking up a newborn baby. The period of the ban may be increased by the doctor due to the examination and the presence of problems in the wound healing process.
For several months after delivery, the woman in labor is prohibited from lifting weights - muscle overstrain provokes an increase in intrauterine pressure, and this can lead to rupture of the internal suture.
To reduce stress on the new wound, women should wear a bandage after childbirth.
After surgery, a woman takes antibacterial drugs for a certain time. You should also treat the cut using iodine, brilliant green or another special solution. Now in the maternity hospital, immediately after surgery, a special plaster is glued to the woman in labor, which is not removed for a week - until the threads are removed.

Most women, after complete recovery, resort to plastic resection of the scar. Here you can use laser resurfacing or microdermabrasion, the results of which can be seen in the before and after format in the photo. These operations are minimally invasive and do not lead to pathological consequences.

If the suture heals slowly, which may be due to the individual characteristics of the body, the woman’s performance and the professionalism of the surgeon, it is recommended to treat the affected area with sea buckthorn or milk thistle oil, Levomekol or panthenol ointments.

It is only important to listen to the advice of a doctor who will tell you about contraindications for their implementation. The formation of a scar after a cesarean section is a long process and largely depends on the human factor. This can only be explained by the occurrence of complications in recovery due to violation of care and rules of the postoperative period - the doctor did not consult the woman on treatment issues and was careless during surgery. Often the mother herself is to blame for the discrepancy - even one awkward movement can provoke serious complications with a new surgical intervention.

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 done over the course of 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 seam: 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.

One of the complications after a cesarean section is suture dehiscence. The external seam may come apart, and this will immediately become obvious, or the integrity of the internal seam may be compromised, and this can only be seen with the help of diagnosticians. A discrepancy can occur after the operation and years later, when the woman wants to feel the joy of motherhood again. In this article we will talk about why seams come apart, what to do if this happens, and how to prevent such a situation.

Inner and outer seams

During surgical delivery, the surgeon cuts not only the abdominal wall, but also the anterior wall of the uterus. Immediately after the birth of the fetus and removal of the placenta, each incision is stitched with its own stitches. For the seams inside and outside, various suturing techniques are used, as well as special materials.

When the operation is planned, most often a horizontal section is made just above the pubis (in the lower segment of the uterus). An emergency caesarean section can be performed by cutting the abdominal wall either horizontally or vertically, depending on how urgently the baby needs to be removed.

When forming an internal suture, the surgeon has no room for error - the edges of the wound must match as accurately as possible. Even a slight displacement can lead to the formation of a rough and incompetent scar. Threads for suturing the uterus are usually self-absorbing; these sutures do not need to be removed or processed later. Most often, the uterus is sewn with a single-row continuous seam.

External seams can be stitched. Materials for the external suture can be different - silk surgical threads, self-absorbing threads, medical alloy staples. Recently, a number of clinics have been practicing a new method of soldering the seam with liquid nitrogen, that is, without the use of threads at all.

External stitches can be cosmetic or regular. The first ones then look more aesthetically pleasing. If we talk about external sutures, then the horizontal section according to Pfannenstiel is always more preferable, since the likelihood of its divergence is much lower than with the corporal section (vertically from the navel to the pubic area). Horizontal external sutures heal better than vertical ones.

The healing process takes place in different ways. Internal sutures on the uterus take about 8 weeks to heal. After this time, the long, almost two-year formation of a strong and reliable scar begins. If negative factors do not interfere with this process, it will be quite strong and can easily withstand bearing the next child and even in some cases physiological childbirth in the most natural way.

If more coarse connective tissue is formed during formation, the scar may fail. This will pose a risk of divergence in the future if the woman becomes pregnant.

The external suture takes a little over a week to heal, after which the sutures are removed if they are not self-absorbing. A vertical suture after a corporal cesarean section takes about 2 months to heal and requires more careful care.

Types of violation

All problems with the condition of the seam can be divided into early and late. Early ones are those that make themselves felt in the coming days or weeks after surgery. Late problems include problems that are significantly distant in time from the moment of surgical intervention.

Early complications may be:

bleeding from the external suture area;
internal bleeding;
formation of hematomas in the area of scars;
inflammatory process (both internal and external);
divergence of the internal or external seam.

Late complications are the formation of fistulas, hernias and divergence of the uterus along the scar during the next pregnancy or childbirth.

Reasons for the discrepancy

There are many reasons that can lead to sutures coming apart both internally and externally, but the leading place is given to violation of the regime recommended during the rehabilitation period. So, both external and especially internal seams can be damaged due to improper motor activity of the postpartum woman.

It is recommended to get up after surgery only after 8-10 hours, but some try to do this earlier, which leads to early injury to the sutured areas. Careless attempts to stand up and sit down after surgery, and subsequently ignoring the requirement to limit lifting weights to 3-4 kilograms are the main reason why the seam came apart.

Infection may also be the cause of postoperative suture separation. Both the internal and external wound surfaces may become infected. In general, infectious complications after cesarean section are among the most dangerous and most likely, despite the sterility in the operating room and technological progress. Inflammation or suppuration disrupts the process of fusion of the wound edges, which may well result in a violation of the integrity of the suture.

Another reason, not the most common, but very likely, is the woman’s body’s immune reaction to the surgical material used for sutures. It is generally quite difficult to understand immunity, and therefore you can never say in advance whether sutures, especially internal self-absorbable ones, will take root. If the immune system begins to reject them, an inflammatory process will inevitably begin, which will lead to a violation of the integrity of the scar. A certain negative immune reaction may also occur to external suture material.

The reason for the violation of the condition of the internal sutures may be too active contractions of the uterus after surgery. But hypertonicity of the reproductive organ after surgery is quite rare.

Signs and symptoms

There are usually no issues with identifying problems in the condition of an external seam. The area where the threads are applied is red, hematomas may be observed, ichor or blood oozes from the wound, and pus may be discharged. In this case, the body temperature usually rises. The suturing area hurts, the seam “burns”, it pulls, it bothers you even in a lying position. The discrepancy itself is manifested by the formation of a hole of a certain size (depending on how many stitches did not take root or were torn off as a result of inflammation or mechanical trauma).

It is more difficult to understand that there are problems with the inner seam. In this case, the picture will be somewhat blurry and similar to a number of other complications after surgery. But an experienced doctor will first of all suspect the discrepancy of the scars and check these suspicions using certain diagnostic methods.

If there are problems with the healing of the suture on the uterus, the woman will have a high temperature. Discharge from the genitals will be much more abundant than after a normal uncomplicated operation; large fragments of suture material may be present in it. The general condition of the pregnant woman will rapidly deteriorate. Blood pressure decreases, episodes of loss of consciousness and rapid heartbeat may occur. The skin becomes pale and sweating increases.

The appearance of bumps on the external scar area cannot be ignored. This can be either a hernia or a fistula, if the bumps themselves are filled with pus and ichor.

Divergence during re-pregnancy

The danger of a suture after a cesarean section on the uterus lies in the fact that it may not withstand the next pregnancy and will separate. The risks of discrepancy especially increase when:

pregnancy that occurred too quickly after the first operation (less than 2 years have passed);
incompetent heterogeneous internal scar;
large fruit.

To monitor the stretching of the internal scar on the uterus during pregnancy, a woman repeatedly undergoes an ultrasound to determine the thickness and areas of thinning of the internal suture. But, alas, it is impossible to stop the uterine rupture that has begun.

The danger of such a discrepancy is quite obvious - the death of the fetus and its mother. Moreover, the woman dies from massive bleeding into the abdominal cavity, and the fetus dies from acute sudden hypoxia, which occurs due to disruption of the uteroplacental blood flow at the time of uterine rupture.

The first stage, the stage of a threatening rupture, cannot be felt in any way. It has no symptoms, and only an ultrasound specialist is able to determine this condition. In this case, the woman undergoes an emergency caesarean section.

The onset of rupture of the suture on the uterus is characterized by sharp abdominal pain, and the development of painful shock is possible. Blood pressure drops, tachycardia appears. The baby's normal heart rate suddenly slows down.

The completed rupture may be accompanied by the development of severe, profuse bleeding. If this happens during childbirth, if a woman decides to give birth with a uterine scar on her own, then an emergency caesarean section is also performed. In most cases the uterus is removed.

How to behave in such cases?

Considering the seriousness of the situation, if any problems with the stitches are detected, the woman should immediately report them to the doctor. If problems are discovered in the maternity hospital, a woman’s temperature rises, postpartum discharge becomes more abundant, there are signs of trouble with the external scar, then this cannot be hidden from the medical staff. The woman will be helped. If the problem is discovered at home, after discharge, the woman needs to take a horizontal position, call an ambulance and wait for the team to arrive. You should not go to clinics and antenatal clinics on your own, as the discrepancy may increase, and if we are talking about an internal seam, the hours count.

When calling the ambulance, you need to inform that that you suspect scar divergence and describe in detail your current state of health. This is important, because in this case, an obstetrician on duty will definitely be included in the medical team.

Suture infections are usually treated with antibiotics, both systemically and locally. If there is an internal dehiscence, the woman undergoes surgery to place new stitches or remove the uterus if it is not possible to close the tear.

If a rupture of the internal scar is detected at any stage during a subsequent pregnancy, it cannot be prolonged. A delivery operation is performed. If a child is very premature, he, alas, may not survive. If a woman is brought to a medical facility late, she, unfortunately, may also not survive.

Prevention

Stitch problems are easier to prevent than to treat. Considering the seriousness of the consequences of postoperative suture dehiscence, a woman must strictly follow the recommendations after a cesarean section:

lifting weights is strictly prohibited, the limit is 3-4 kg for at least six months;
you cannot squat, fall, or jump sharply, you should not pump your abs until six months after the operation;
after discharge, the external seam must be treated every day - dried with hydrogen peroxide, the area around it should be lubricated with brilliant green;
Before removing the sutures, it is imperative to wear a surgical bandage on the wound; after removal, the decision to wear it is made individually, depending on the condition of the suture;

To learn how to care for a suture after a caesarean section, watch the following video.