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

An operative method of delivery becomes inevitable when the fetus occupies the wrong place in the uterus or there are complications in the form of placenta previa, cord entanglement. Sometimes there are no direct indications for a cesarean, just a woman, for example, no longer plans to have children and wants to perform surgical sterilization during the operation.

Regardless of the reasons for delivery by surgery, it should be remembered that caesarean is a major abdominal intervention. In the process of childbirth, in order to remove the baby from the uterus, doctors have to make several incisions in layers. 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 stitches after cesarean

Depending on the tissue incision technique, a woman can have different types of sutures:

vertical - superimposed when the incision is made vertically, from the navel to the pubic area;
transverse - the incision is made along the bikini line, referred to in medicine as the Joe-Kohen laparotomy;
in the form of an arc - an incision is made in the area of \u200b\u200bthe skin fold above the pubis (Pfannenstiel laparotomy).

Suture care after cesarean: treatment, ointments, creams

The 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 twice a day with a solution of brilliant green, after which it is covered with a sterile gauze bandage.

Approximately on the 7th day, the sutures are removed, however, the puerperal should 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 includes components that accelerate skin regeneration.

When suturing the wound surface with self-absorbable sutures, it is not necessary to remove the sutures, however, to speed up their resorption, the doctor may recommend the use of special ointments and creams. These drugs will serve as a prevention of the formation of seals and swelling in the seam area.

How long does a suture heal after a caesarean?

The formation of a scar at the site of the incision is observed by the end of the first week after delivery. From about this moment, a woman is allowed to take a shower and lather the area of \u200b\u200bthe seam, without making sudden movements and without pressing on the incision site with a bathing sponge.

Complications on the seam after caesarean section

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

The seam after cesarean hurts

Pain in the suture area can disturb a woman for several months. After complete healing of the wound surface, the suture may disturb the patient when the weather changes, loads, wear tight clothing. Such sensations are normal and do not require the use of drugs. The following symptoms should prompt immediate medical attention:

redness of the skin around the seam;
local increase in body temperature;
swelling and sharp soreness of the place of suturing;
discharge from the seam of liquid mixed with blood or pus;
a sudden increase in body temperature, accompanied by the above symptoms in the suture area.

Seam after cesarean: festering, oozing

In the first few days after the operation, the suture may ooze a clear liquid, but pus or scarlet blood should not stand out! Treatment with a solution of brilliant green will help prevent the development of complications.

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

Seam after cesarean: itchy

Itching in the suture area after operative delivery occurs as a result of the formation of a postoperative scar. This process is accompanied by increased dryness of the skin 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 seams with your hands; the use of special emollient anti-inflammatory creams and ointments will help reduce itching of the skin.

Hematoma, lump on the suture, induration of the suture after caesarean section

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

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

Can the seam on the uterus after cesarean disperse?

After a caesarean section, you should be extremely attentive to your health. Heavy lifting, strenuous physical activity, and early intimacy can lead to sutures coming apart. A new pregnancy is also dangerous: due to the insolvency of the scar and as the uterus grows, a strong tension of the tissues is observed, as a result of which the internal seams can disperse at the incision site. A new pregnancy after operative delivery can be planned no earlier than 3 years after cesarean.

Ligature fistula after cesarean

The formation of a ligature fistula occurs as a result of the use of poor quality suture material or the individual intolerance of the woman's body 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 the operation.

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

Adhesions after caesarean section

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

Aesthetic correction of the seam after caesarean section

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

How to remove the scar after caesarean?

First of all, in order to make the scar less noticeable, immediately after the healing of the wounds, cosmetic procedures should be started - the cream, which includes mumiyo, must be rubbed into the scar twice a day. According to patient reviews, over time, the scar becomes pale and not so conspicuous.

Suture plasty 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 go for such an intervention, soberly assess the possible risks, since like a cesarean section, plastic surgery has its drawbacks.

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

Many women decide to correct the appearance of the anterior abdominal wall by tattooing in the seam area. This is not prohibited, but you should wait for the formation of a normal scar and complete healing of the tissues.

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

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

Causes of uterine rupture along the scar

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

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

Symptoms

When the uterus ruptures during childbirth, a woman:

blood may begin to flow from the vagina;
when touching the stomach, a woman experiences severe pain;
intense colic is felt in the area of \u200b\u200bthe peritoneum;
the baby's head stops moving towards the exit from the birth canal and, as it were, goes back;
there is severe pain in the area of the scar. Between individual fights, it is especially intense;
a bulge may appear in the region of the pubic bone, due to the fact that the head of the fetus “breaks through” the uterine suture;
the fetus begins anomalies with cardiac activity (very low pulse, a decrease in heart rate);
the uterus unnaturally often contracts. And it does it irregularly.

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

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

How often does this happen?

There is an erroneous opinion that women with a healed "post-caesarean" education can no longer give birth at all. This is not true. Numerous studies have shown that scarring problems in parturient women who have had a caesarean section occur relatively infrequently - approximately in one case in 100-150. True, the quality of medical care plays an important role here. If it is low, the probability of uterine rupture increases by 5-7 times.

How often uterine rupture occurs during pregnancy depends to a large extent on the location where the suture is located and what type it is:

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

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

An important role is played by the number of caesarean sections. Recent studies conducted in the United States show that the scar diverges during the following births:

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

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

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

What to do?

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

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

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

Why is a seam divergence dangerous for mother and child?

The divergence of the seam can destroy both the mother and the baby. To prevent this from happening, a woman expecting a baby should carefully listen to her feelings, be close to a medical institution and not be alone.

How to prevent a break?

A woman who is preparing to give birth after a caesarean cannot do without regular visits to the antenatal clinic. It is there that she will be helped to determine how high the risk of an unsuccessful outcome of the operation is.

It is especially important to regularly check:

whether the fetus has macrosomia (oversized), as this increases the risk of ruptures. To avoid macrosomia, you should not eat foods that are high in sugar;
whether the expectant mother has a narrowing of the bone pelvis and flattening in the area of the sacrum;
whether premature discharge of amniotic fluid has begun.

Women with a uterine scar are highly discouraged from giving birth outside the clinic. Recent studies by American and British experts have shown that "home" childbirth dramatically increases the likelihood of suture divergence. It is better for women with a scar to go to the hospital a week and a half before the possible onset of childbirth.

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

Although it used to be considered a rather dangerous operation, at present, caesarean section is often used during pregnancy and childbirth. Although the operation itself is safe because it is always performed only by qualified doctors, its consequences can harm the woman's health. Most often this happens due to the fact that the seam has parted after a cesarean section.

Types of stitches after caesarean section

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

Horizontal notch. Typically, this incision method is used for a planned operation. As a rule, self-absorbable threads called catgut are used to apply such sutures, and the scars after them heal quickly enough, with a minimum of traces.
Vertical cut. This type of incision is usually used when there are any complications during childbirth. It allows you to facilitate the passage of the child and ensure normal delivery. In terms of healing, such an incision is less comfortable due to the impossibility of using a self-absorbable thread, as well as the scar remaining after the operation.

Thus, after a caesarean section, a woman has two stitches: one on the uterus, and the second on the anterior abdominal wall. Both seams, if you do not follow the recommendations of the doctor during the rehabilitation period, may disperse. But the divergence of the internal is considered the most dangerous. At the same time, the risk that this will happen is quite small - only fifteen percent.

Rupture of threads in the abdomen

Another complication that women who have undergone caesarean section may encounter is the divergence of the threads in abdominal areas. The external seam after caesarean section heals quickly enough, but, despite this, it may have time to undergo damage. Most often this is caused by physical exertion or non-compliance with the sterility of thread processing. The edges of the wound should be cleaned regularly using sterile cotton swabs or sticks. It is important to be careful when doing this, as the wrong movement can result in a tear in the seams.

Also, in the area of the incision, the divergence of the abdominal muscles after a cesarean section can occur due to the wearing of narrow pressure clothing. This is due to the fact that the muscle corset is not yet strong after the operation. The muscles cannot withstand the same tension as before the operation, so tight clothing causes the threads on the seams to break.

Divergence of the seam on the uterus after cesarean

The most severe complication that can occur after surgery is the divergence of the suture on the uterus or the internal suture. This most often happens to women during the second and subsequent pregnancies that end in a caesarean section. This is due to the fact that scar tissue is less well supplied with blood than normal. Therefore, in a place that has undergone repeated incision and healing, tissue density is lower, and ruptures occur more often. The most common causes are exercise and heavy lifting. Also, a gap can happen due to a short break between pregnancies. Doctors recommend taking a break for at least three years.

There are usually three types of violation of the integrity of the seam after the operation:

Threatened uterine rupture. Asymptomatic damage, usually detected only through.
The beginning of the rupture of the old seam. It is symptomatically expressed by pain in the suture area and symptoms inherent in pain shock: cold sweat, pressure drop, tachycardia.
Rupture of the uterus. Includes symptoms of a previous complication, as well as severe abdominal pain and bleeding.

Symptoms of Seam Divergence

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

You should also pay attention to vaginal discharge. They usually begin to appear immediately after surgery. In the event of any damage to the seam, their number quickly increases. They may also be red. This is a very dangerous signal indicating that the patient needs urgent medical attention. Also, the discharge consists of two parts - from the liquid and from goofy.

Do you have symptoms of seam rupture?

YesNot

They protect the mucous cavity from infection and viruses and are excreted regularly. If they have ceased to stand out, then this indicates that they have entered the abdominal cavity, which can lead to infection.

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

signs

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

With a rupture of the suture on the uterus after cesarean, three degrees of violation of the integrity of the scar are usually distinguished: threatening damage, the onset of divergence, and complete divergence of the sutures on the uterus. The main danger lies in the fact that the first stage of damage, threatening rupture of the uterus, does not particularly declare itself in any way, it can only be determined by ultrasound. That is why after the operation, the patient needs to undergo diagnostics for some time in order to be sure of the integrity of the suture, even if she is not disturbed by any pain symptoms.

The beginning of the discrepancy is usually characterized by an increase in pain in the area of the operation and symptoms similar to pain shock: cold sweat and tachycardia. The resulting rupture of the uterine wall is an extremely dangerous injury. Statistically, it is the most common cause of death for both mother and child. They can be saved only with urgent surgical intervention.

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

Scar discrepancy prevention

As with any surgical intervention, after a caesarean section, a postoperative recovery period is indicated. Although it is not very large for this particular operation, it is important to follow all the indications of the doctor, because neglecting them can lead to serious complications. The main points to keep in mind are:

Heavy lifting prohibited. Any physical activity after the operation can lead to the fact that the seam can simply disperse. It is not even recommended to pick up a child, which is usually forbidden by doctors in the first days after the operation.
It is important to treat the seams and take antibacterial drugs.

These rules should not be neglected in any case, because any violation threatens to lead to rupture of the walls of the uterus, which is an extremely serious and dangerous injury that can even lead to death.

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

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

Attention! Before using any ointments, consult your doctor!

Scar ointment

How long does a stitch take to heal?

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

After that, a week later, an extract usually occurs. As a rule, possible complications in the process of suture healing at this stage are prevented by carrying out normal hygiene measures. Usually, if the wound does not bleed, and no discharge comes out of it, then the procedures are limited to a simple change of a sterile dressing. The seam heals quickly enough, after complete healing, cosmetic surgeries can also be performed to give the scar a more attractive appearance. You can also do this, this is another good way to hide the traces of the operation.

What to do if the seam broke after cesarean

But what to do in a situation if the seam has parted or any other damage to the scar has formed?

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

Bleeding. If bloody discharge begins to ooze from the wound, then it must be treated, and then consult a doctor.
Inflammation. If the wound begins to become inflamed, then this may indicate an infection.
Suppuration. The accumulation of pus in the wound may indicate an infection in a vulnerable place. To avoid spreading it, the doctor installs a drain to get rid of the pus.
Discrepancy. After the muscles are moved apart during the operation, they are held together with sutures. One of the most common complications is their discrepancy from loads.

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

The opinion of doctors in emergency situations

Due to the fact that caesarean section is a very common operation, the greatest risk appears not during it, but during postoperative recovery. This is due to the existing risk of complications that occur under a variety of circumstances. The problem is that almost all injuries that appear after surgery require medical attention. That is why doctors are urged to follow the doctor's recommendations after discharge in order to avoid possible complications.

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

At the first sign of infection in the wound, you should also immediately go to the doctor. Inflammation or suppuration can be fraught with infection of the whole organism, which is dangerous for the life of the woman in labor. In most cases, you should not try to help yourself on your own - due to the lack of the necessary stock of knowledge and skills, you can not only not help, but also harm yourself.

Conclusion

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

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

There are a number of major pathological changes in the uterus, in which a planned caesarean section is recommended:

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

Types of sutures on the uterus

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

Vertical

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

Horizontal

Produced in regular situations. An incision is made in the suprapubic region, in the lower part of the body of the uterus. Blood loss is minimal (in the absence of complications), the wound heals quickly enough. In the future, there is a high probability of independent childbirth.

All sutures are applied with absorbable materials. Healing and scar formation occurs within six months.

The control over the scar is carried out by means of ultrasound diagnostics. Doctors recommend planning the next pregnancy 1-2 years after the caesarean section.

In the process of bearing a fetus, the uterus is strongly stretched due to the elasticity of its walls. Therefore, after childbirth, it should return to its original state - to shrink. Full recovery can take up to 2 months.

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

The presence of adhesions can prevent the timely contraction of the uterus to normal sizes, since the organ can be displaced due to them. With abundant blood loss, the uterus is prone to hypotension, which affects its contractility. Infections in the uterine cavity pose a danger to its normal recovery.

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

Common drugs:

Ergotal;
Hyphotocin;
Deaminooxytocin;
Pituitrin;
Oxytocin etc.

After childbirth, the inner surface of the uterus is a continuous wound, as the mucosa is injured. An indicator of the normal recovery process will be uterine bloody discharge and clots, which are called "lochia". Such secretions are a wound secret that is separated from the inner layer of the uterus. The first few days, lochia may be bright red due to the large accumulation of red blood cells, then they become pale.

Important! Normal lochia do not have a pronounced odor. If there is a putrid odor, you should immediately inform the doctor about it. This indicates their stagnation or process.

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

External seam and internal seams on the uterus are painful. Nevertheless, it is important for a woman to move a lot within a few hours after the operation. Painkillers will be prescribed for a few days. Due to prolonged lying or sitting in a sitting position, the uterus, which is already poorly contracted, may acquire an anterior inflection. This will lead to a narrowing of the birth canal at the point of inflection and will prevent the removal of lochia. The rejected material is an excellent medium for pathogens, such as saprophytes. The accumulated blood decomposes, toxins and decay products enter the general circulation, which leads to infection.

Regular emptying of the bowels will also help to avoid an anterior inflection of the uterus. If stool disorders such as constipation are detected, mild laxatives and a revision of the postpartum diet are necessary.

The formation of a scar on the uterus in the postpartum period is important. The connective tissue that is formed at the site of the incision does not have sufficient elasticity, which may prevent subsequent independent childbirth. It is necessary that the scar be as thin as possible, and contractions of the uterus, although a little, still deform it, causing pain. In some cases, a woman in labor may be prescribed physiotherapy for better formation of a postoperative scar.

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

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

Oxytocin, obtained synthetically, is prescribed intravenously after a caesarean section with a weak uterine contraction.

Endometritis as a complication after caesarean section

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

Postpartum endometritis is a common complication after caesarean section. During an emergency operation, it develops much more often than after a planned one.

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

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

Diagnosis of postoperative endometritis

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

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

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

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

Treatment

At the beginning of treatment, it is necessary to take material (sowing) from the vagina and uterine cavity in order to identify infectious agents and select the right antibiotic.

In the treatment of postpartum endometritis, doctors prefer an integrated approach. If conservative treatment is possible, the patient is prescribed drugs that promote the contractile function of the uterus, antibiotic therapy will be mandatory. It is important to accompany antibiotic treatment with detoxification and infusion therapy, as well as various vitamin complexes aimed at general strengthening of the body. You should also take care of nutrition. The food should contain a lot of protein.

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

The standard treatment regimen for endometritis after caesarean section consists of an antibiotic of the lincomycetin group. With a milder course of the disease, such groups as macrolides, cephalosporins, fluoroquinolones can be used. Drugs can be administered intravenously, as an infusion or orally.

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

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

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

How is the procedure?

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

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

In the case when washing the uterine cavity is not possible, doctors perform hysteroscopy under general anesthesia, removing blood clots and afterbirth. In the absence of large volumes of fluid accumulation and clots in the uterus, doctors expand the patient's cervical canal so that their rejection occurs faster.

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

Video: Suture after caesarean section of the uterus

Video: Consequence of caesarean section

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

Scars on the uterus after cesarean section: types and features

The caesarean section has long been used in gynecology as a way to help a baby come into the world. In many cases, only thanks to surgical intervention, doctors save the life of not only the baby, but also the mother. After all, childbirth is a complex and unpredictable process, when at any time you may need emergency assistance and a quick extraction of the fetus.

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

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

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

Recently, more and more expectant mothers independently ask doctors to prescribe a CS, although they have no indications for delivery by surgical intervention. It's just that women don't want to experience pain during labor and natural childbirth. However, doctors warn that natural childbirth is much preferable for the health of the mother and baby, so if there is a chance to give birth to a baby on your own, you should not refuse it.

Doctors use different techniques during operative delivery. First of all, this concerns the type of incision of the skin of the abdominal cavity and the tissues of the wall of the reproductive organ, through which the baby is removed. The type of incision largely determines the rate of recovery of the body after CS, as well as the possibility for a woman to give birth to another baby on her own or she will again have to undergo surgical delivery.

Longitudinal (corporal) scar

The vertical incision is considered classic: it was performed earlier during the CS operation. Modern doctors try to avoid a longitudinal incision of the uterus and abdominal cavity. Today, this type of incision is made only when minutes are counted and it is urgent to remove the fetus from the body of the woman in labor. It is the corporal incision that gives good access to the organs, so the surgeon can act quickly, which is very important during emergency delivery by surgical intervention.

The longitudinal incision on the abdominal wall is about fifteen centimeters long, and in the area of the uterus, the doctor performs a vertical dissection throughout the body of the reproductive organ.

A vertical incision in the uterus is done in an emergency

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

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

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

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

transverse scar

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

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

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

Modern specialists prefer to perform exactly a horizontal incision on the body of the reproductive organ, because. this has a lot of advantages:

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

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

The horizontal scar on the uterus is more durable, so the risk of rupture of the suture is reduced in subsequent pregnancies

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

The scar after caesarean section on the reproductive organ of a woman is formed four months after the surgical intervention. However, doctors do not recommend planning the next pregnancy earlier than two years after birth. That is how long it takes for the seam to completely heal and heal.

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

A young mother should not forget about planned visits to a female doctor. The fact is that the excellent and rapid healing of the skin of the abdominal cavity does not guarantee that the tissues of the uterus are also well restored, and the suture does not cause concern. Therefore, when discharged from the maternity hospital, obstetricians-gynecologists necessarily conduct a conversation with a woman, in which they mention that two, six and twelve months after a cesarean section, she should sign up for an examination at a antenatal clinic.

It is very important that before the couple starts planning the conception, they should also see a doctor who will assess the condition of the suture and give recommendations: is it a favorable time for pregnancy or is it worth waiting a little longer.

First of all, the gynecologist will assess the thickness of the suture using ultrasound. Normally, it should be 5 mm. Some women are frightened when during pregnancy, as the fetus grows, the seam becomes thinner. This is normal: after all, the uterus is stretched, so it is considered a normal option if by the thirty-fifth week the thickness of the suture is 3.5 mm. The gynecologist also determines the structure of the scar. Ideally, the suture should consist of muscle tissue: it is very elastic, therefore, with an increase in the uterus, it stretches perfectly and this reduces the risk of scar divergence. But the body of each woman is individual, therefore, in some young mothers, connective tissue may predominate in the scar area: it breaks much more often, because. simply can not withstand the load as the fetus grows.

What is an inconsistent scar

Unfortunately, the suture on the uterus is not always scarred as doctors and the youngest mother would like. There are situations when, based on the results of the examination, a woman finds out that the scar on the uterus is insolvent - an incorrectly formed scar tissue in the area of the incision on the wall of the woman's reproductive organ. Gynecologists identify factors that signal the insolvency of the scar on the uterus:

the thickness of the seam is 1 mm;
the seam consists only of connective tissue or of mixed, but very little muscle;
in the area of the scar there are non-united areas, irregularities. This increases the risk of rupture of the uterine wall during stretching of the organ.

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

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

A scar is considered insolvent, in the area of \u200b\u200bwhich there are non-fused areas or cavities: in this case, there is a high probability of a rupture of the seam during gestation

The whole danger of the situation: the consequences of the insolvency of the scar

It should be understood that doctors do not just strongly recommend carefully planning the next pregnancy if the previous birth ended with an operation. The fact is that the main danger of insolvency of the scar is uterine rupture during the period of bearing a baby. As the fetus grows, the uterus also grows. It does this by stretching the muscle tissue. But if the seam is thin and consists of connective tissue, it cannot withstand the load and it diverges. The consequences of this are very dangerous:

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

Video: what an inconsistent scar looks like on ultrasound

Symptoms of the divergence of the seam on the uterus

Before discharge from the maternity hospital, a young mother is given a list of recommendations that she must follow in order to avoid postoperative complications. Of course, with the return home, most of the care of the baby will go to the mother, but you should think about your own health and for at least two months after giving birth, provide yourself with help in the person of a husband, grandmother or nanny.

Some young mothers think that the rupture of the seam can only occur during the next pregnancy. However, if the recommendations of the gynecologist are not followed, the suture may break even in the first weeks after delivery with the help of a CS.

If during the period of bearing a baby, the divergence of the scar occurs due to excessive tension of the tissues of the reproductive organ, then during the recovery period after the operation, the cause of the rupture of the seam is most often excessive physical activity: lifting weights, for example, a baby carriage, carrying the baby for a long time, etc. d. A young mother should be alert and urgently call an ambulance with the following symptoms:

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

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

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

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

Despite the fact that the seam in the abdomen has healed well, the scar on the uterus may not be in such good condition, so you should not neglect the supervision of a doctor so that if there is a risk of rupture of the uterine wall, take timely action

Treatment of the divergence of the scar on the uterus

Before making a decision and making a diagnosis, a woman undergoes an ultrasound scan. During the examination, the doctor can confidently say in what condition the suture is after the CS. If there is a discrepancy between the tissues of the scar on the uterus, urgent surgical intervention is necessary. An abdominal operation will be required so that doctors can assess the extent of the rupture, stop the bleeding, and reseat the suture.

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

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

After discharge, a woman must definitely come for scheduled examinations to a gynecologist. At each appointment, the doctor will definitely conduct an ultrasound scan to monitor the healing of the scar on the uterus.

Scar discrepancy prevention

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

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

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