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

Ideally, after a caesarean section, sutures are removed after 7-10 days, 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.

Seam separation is one of the most common problems during the rehabilitation period.

Doctors warn patients about possible complications even before the operation. With strict adherence to all recommendations and a well-performed operation, the likelihood of postoperative complications is very small. 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 seam has parted after a cesarean section? How to care for a wound so that it heals as soon as possible?

Postoperative period

As a result of a caesarean section, a woman has 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, medical treatment and a change of dressing are carried out. This allows you to identify possible problems in a timely manner and take appropriate measures.

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

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

Possible Complications

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

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

Early complications include inflammatory processes and suppuration, hematomas and light bleeding, a slight divergence of the seam.

If the dressing becomes wet, it should be treated with a peroxide solution or dimexide and immediately consult a doctor. The doctor examines the wound, determines the cause of the divergence of the seam, makes recommendations for further care.
If suppuration of the wound begins, the doctor installs a drain for quick cleaning. It is very important to remove pus, since overgrowth of inflamed tissues does not occur. In some cases, premature removal of surgical sutures may be required.
The seam can disperse within 1-2 days after removing the ligatures. In order to prevent this from happening, after their removal, physical activity should be limited. Usually, a torn suture is not sutured again, but a local treatment is prescribed, which helps the wound to heal as soon as possible. This process is also called secondary tension. In some cases, the doctor prescribes a second application of ligatures, but this happens very rarely.

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

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

Scar discrepancy prevention

In order to prevent the divergence of the seam, a woman should follow the following rules.

First of all, it should be remembered that a woman after a cesarean section is forbidden to lift weights for several months. In the first two or three days after the stitches are removed, it is not recommended to even pick up the baby. If possible, during this period, you should involve someone close to help in caring for the child. Overstraining the abdominal muscles leads to an increase in intrauterine pressure, which can cause the inner seam to open. To reduce stress before getting out of bed, a woman is advised to wear a postpartum bandage. It fixes the soft tissues of the abdomen and uterus, preventing them from moving, which reduces pain and muscle tension.
Antiseptic treatment of the wound will help to avoid the penetration of infections. It is recommended to treat the seam with a solution of brilliant green, iodinol, fucorcin. To prevent suppuration of the wound, the woman in labor after the operation is prescribed the intake of antibacterial drugs.
Depending on the physiology of the woman and the professionalism of the surgeon, the incision after the operation heals longer or faster. To speed up the process of regeneration and scar formation, the outer seam is treated with sea buckthorn oil, levomecol, panthenol ointments. It dissolves scar tissue very well and heals wounds with milk thistle oil. After the final formation of the scar, cosmetic surgery can be performed to correct it. In aesthetic surgery clinics, laser resurfacing or microdermabrasion can be performed. Quite often, scar tissue is polished with peels.

How many times can you give birth after a caesarean section

So, what to do if the seam still parted? First of all, stop panicking. Medicine knows many cases when a seam diverged in women. But not one of them was left with a through hole in the stomach. Consult 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 the attending physician.

The suture on the uterus after cesarean can disperse both shortly after the operation and during the next birth.

Types of stitches after cesarean

The "classic" option is considered a longitudinal or vertical incision. In modern practice, it is abandoned because it takes longer to heal and is more likely to rupture sutures in the future. Today, a vertical incision is resorted to in the most emergency case, if there is a threat to the life of the baby or mother, and childbirth should be carried out as quickly as possible. The longitudinal incision allows you to quickly remove the baby and avoid the threat.

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

How long does it take for a suture to heal after a caesarean section?

The timing of suture healing is mostly individual and depends on many factors: health status, hygiene and postoperative behavior, and so on.

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

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

Reasons why the sutures on the uterus can disperse

The stitches on the uterus can break even during postoperative recovery if the woman in labor does not follow the recommendations given by the doctor. In this case, the cause of the gap may be physical activity (sports), weight lifting (if the mother lifts the stroller alone, drags heavy packages 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 gestation, and in the very process of childbirth. In this case, the rupture of the suture is caused by an insufficiently long interval between childbirth (it is possible to give birth without the risk of rupture at least three years after the cesarean operation), the age of the woman (after 30, tissue elasticity is lost, the risk of rupture increases), vertical suture. In addition, the rupture can occur due to medical fault.

Also, the risk of rupture of the suture on the uterus during childbirth increases if drugs were used to stimulate labor.

Symptoms of the divergence of the seam on the uterus

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

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

You can diagnose a rupture of the suture on the uterus using 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 terrible consequences - death for the baby or for the mother. But statistics say that this happens very rarely.

How to protect yourself from seam divergence

Follow all the recommendations of the doctor after the operation: during the recovery period, avoid physical exertion, do not lift weights.

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

In case of severe pain and vaginal bleeding, consult a doctor immediately.

If you are about 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. Today, such operations are performed without complications, but during the rehabilitation period, cases of pathological disorders are recorded. As a result of the presented fact, doctors explain to the woman in advance what to do if rupture after caesarean section, as well as methods to prevent the most common complication. The problem with scars is common and dangerous for a woman's health, and sometimes for her life. It is also noted that the divergence of the seams 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 caesarean section, which young mothers cannot stand, plunging into the care of the baby. The article will describe in detail the main problems after a cesarean section, as well as methods for preventing discrepancy.

A caesarean section is a surgical delivery. As a result, a woman has 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 the vessels, the wound, both external and internal, will heal for a long time. An internal wound requires the abandonment of heavy weights and other basics for a speedy recovery. At the same time, the external wound must be constantly subjected to antiseptic treatment.

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

This is important: The divergence of the seam can occur both outside and inside. Moreover, the outer seam can remain intact, while the discrepancy will be diagnosed inside. Since the outer scar immediately signals the development of problems, the inner one will give only severe pain, which women usually endure for some time - this leads to serious internal bleeding and a second operation.

You should also be aware of the symptoms of a divergence of the inner and outer seam. The outer seam is covered with ichor - this indicates a poor restoration of blood vessels or a divergence of the formed wound. An internal suture is a wound sutured with absorbable materials. Such threads do not need to be removed - they resolve themselves within 80-90 days.

During the period of resorption of the threads, the wound provokes pain, which in the first days after the cesarean section is removed by taking painkillers. Gradually, the intensity of the pain should decrease - if this does not happen, then complications have begun, with which they urgently go to the doctor.

In the table below, three types of scar integrity are distinguished:

Violation	Description
Threatened uterine rupture	Such a complication often does not manifest itself clinically and can only be detected during an ultrasound scan of the scar condition.
The beginning of the rupture of the old seam	It is usually characterized by severe pain in the area of the operation, signs of pain shock in a woman are possible: a drop in blood pressure, tachycardia, cold clammy sweat. On the part of the child's body, such a pathology may be accompanied by a decrease in the heart rate.
Complete uterine rupture	In addition to the symptoms already listed, it is characterized by a sharp pain in the abdomen in the interval between contractions, a change in the movement of the child's body in the birth canal, and the development of bleeding from the vagina.

Often, the divergence of the seams after the operation occurs in the first 3 months, so at this time a woman should take care of herself and follow all the doctor's recommendations. In some cases, after the operation, women in labor are forbidden to lift even their child in their arms - the ban is imposed on the first weeks of the postoperative period.

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

Problems in the postoperative period

The divergence of the seam after caesarean section is not the only complication in women. All possible problems are conditionally divided into 2 groups - early and late. Early complications are problems that develop in the postoperative period. Late - formed a month after the operation.

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

Light bleeding - if the bandage on the outer seam becomes wet and bloody, treat it with hydrogen peroxide and consult a doctor.
Hematomas - seals with symptoms in the form of fever, as well as severe pain, can provoke inflammation.
Inflammation - often this happens due to the load produced, infection in the wound and other problems.
Suppuration - if the seam is rotten, the doctor installs drainage for the timely departure of purulent masses. Rotting of the seam is possible due to infection in the absence of proper wound care.
The divergence of the seam - occurs in most cases in the first 2 weeks after removing the threads. There can be many reasons for this - load, poor vascular recovery process and other prerequisites.

Late problems include the formation of fistulas - cavity channels that form as a result of rejection of the threads with which the wound was sewn up. A woman with diabetes should monitor the condition of the seam especially carefully. People with the presented 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.

Discrepancy Prevention

Since the wound in most cases diverges in the first few weeks after surgery, women in labor should resort to the following doctor's prescriptions to prevent problems. Namely:

In the first few days after the operation, it is contraindicated for a woman to lift a newborn baby in her arms. The term of the ban can be increased by the doctor due to the examination and the presence of problems in the wound healing process.
Within a few months after delivery, a woman in labor is forbidden to lift weights - muscle strain provokes an increase in intrauterine pressure, and this is fraught with a divergence of the inner seam.
In order to reduce the load on the new wound, a woman should wear a bandage after childbirth.
A woman after surgery for a certain time takes antibacterial drugs. You should also treat the cut using iodine, brilliant green or another special solution. Now in the maternity hospital, a special patch is glued to a woman in labor immediately after surgery, which is not removed for a week - until the threads are removed.

Most women after full recovery resort to plastic resection of the scar. Here you can use laser resurfacing or microdermabrasion, the results of which in the before and after format can be seen 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 oil or milk thistle, Levomekol or panthenol ointments.

It is only important to listen to the advice of a doctor who will tell you about contraindications to their implementation. The formation of a scar after a caesarean section is a long process and largely depends on the human factor. This can only be explained by the occurrence of recovery complications due to a violation of the care and rules of the postoperative period - the doctor did not advise the woman on processing issues and made inaccuracy during the surgical intervention. Often, the woman in labor 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 in 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 after a while the suture after a cesarean section will look (isn't it ugly?), how much will it be noticeable and how long will the healing process take. It depends on what kind of incision was made by the surgeon, whether there will be complications in the postpartum period, and how competently the woman takes care of the operated area of her body. The better a woman is aware, the less problems she will have in the future.

Kinds

The reasons why a doctor decides to do a caesarean section can be very different. Depending on the delivery process and the complications that have arisen in its course, incisions can be made in different ways, and as a result, unequal types of sutures are obtained that require special care.

vertical seam

If acute fetal hypoxia is diagnosed or the woman in labor begins to bleed profusely, a caesarean section is performed, which is called corporal. The result of such an operation is a vertical seam, starting from the navel and ending in the pubic area. It does not differ in beauty and in the future will spoil the appearance of the body quite strongly, since the scars are nodular in nature, very noticeable against the background of the abdomen, prone to thickening in the future. This type of operation is performed quite rarely, only in emergency cases.

Horizontal seam

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

Internal seams

The internal sutures on the wall of the uterus in both cases are varied in the way they are applied. The doctor is guided here by the fact that to achieve the best possible conditions for faster wound healing without complications, to reduce blood loss. Here you can not make mistakes, since the course of the next pregnancies depends on this. During a corporal operation, a longitudinal internal suture is made after a caesarean section, with a Pfannenstiel laparotomy - a transverse one:

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

The speed of healing, features of care, various complications - all these important points directly depend on which 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) - German gynecologist, first introduced the surgical transverse incision into practice, which received his name.

Features of the recovery period

It will depend on the type of incision made how long the suture heals after a cesarean section in terms of pain and other consequences of the operation. It will take longer to tinker with the longitudinal one, and the risk of complications will be much higher than with the 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 seam hurts (even severely) in the first weeks, or even months. This is a natural reaction of tissues to the incision made, so that the pain syndrome can be blocked with the most common painkillers:

immediately after the operation, analgesics (narcotic) are prescribed: morphine and its varieties, tramadol, omnopon; in the subsequent period, analgin supplemented with ketanovy, diphenhydramine and other anti-inflammatory nonsteroidal drugs can be used.

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 seam hurts after a cesarean section, it depends on its type. Longitudinal will disturb about 2 months, transverse - 6 weeks with proper care and without complications. However, even during the year, a woman may feel pulling, discomfort in the operated area.

Hardness

Many are concerned about the fact that after a cesarean section, the seam is hard and hurts: 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, the tissues will gradually begin to soften. The horizontal (transverse) cosmetic heals faster, so hardness and thickening over the seam (adhesions, scarring of tissues) should go away within a year. Many people notice that over time a characteristic fold forms over the seam, which, in the absence of pain and suppuration, does not present a problem. This is how scarring of nearby tissues occurs. To avoid unpleasant consequences, it is recommended to do an ultrasound. It is much more serious if, after a cesarean section, a bump appears above the seam. Someone notices it already in the first year, for some it manifests itself much later. Sizes can be completely different: from a small pea to a walnut. Most often it is purple or purple. In this case, a visit to the doctor and ultrasound are required. It can be either harmless scarring of tissues, or fistula, inflammation, suppuration, and even cancer formation.

The hardness of the scar, all kinds of folds and seals around it in the first year after the operation is a fairly common phenomenon. If all this is not accompanied by severe pain and suppuration, you should not worry. But as soon as a bump appears on the seam and the above symptoms, consultation with a specialist and treatment are inevitable.

Allocations

If the suture after a caesarean section oozes ichor (clear liquid) in the first week, no need to worry. This is how healing happens, it's 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 scares some. In fact, this indicates wound healing and nothing more. This is an indicator that everything is going its own way. However, touching and combing the stomach is strictly prohibited. Now, if the scar does not just itch, 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.

Read more about recovery after caesarean section in our separate article.

through the pages of history. The name of the caesarean section goes back to the Latin language and literally translates as "royal incision" (caesarea sectio).

In the hospital

The first suture treatment after a caesarean section is done in the hospital.

After the examination, the doctor decides how to treat the seam: in order to avoid infection, antiseptic solutions are prescribed (the same green stuff belongs to them). All procedures are performed by a nurse. The dressing is changed daily after the caesarean. All of this takes place 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 from the edge with a special tool, and then the thread is pulled out. As for the question of whether it hurts to remove stitches after a caesarean section, the answer is unlikely to be unambiguous. It depends on the level of pain threshold. But in most cases, the procedure is comparable to plucking the eyebrows: at least the sensations are very similar. In some cases, an ultrasound scan of the suture is prescribed after the operation in order to understand how the healing is going, whether there are any deviations.

But even in the hospital, before discharge, no one can tell you exactly how long the suture heals after a cesarean 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 learn 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 things (anything that exceeds the weight of the newborn). Avoid strenuous exercise. Do not lie down after a cesarean all the time, walk as much and as often as possible. If there are any complications, it will be necessary to treat the seam at home with brilliant green, iodine, but this can only be done with the permission of the doctor 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 process a stitch at home. At first, it is not the scar itself that is wetted, but only the area of the skin around it, so as not to burn a fresh wound. As for the timing, how much the suture needs to be processed after a cesarean section, this is determined by the nature of the discharge and other features of the healing of the scar. If everything is in order, a week after discharge will be enough. In other cases, the time is determined by the doctor. To prevent the divergence of the seam, wear a bandage that fixes the stomach. Avoid mechanical damage after cesarean: so that the scar is not subjected to pressure and rubbing. Many doubt whether it is possible to wet the seam: after discharge from the hospital, you can take a shower at home without a doubt. However, you do not need to rub it with a washcloth. Eat right for faster tissue repair and faster healing of scars. By the end of the 1st month, when the wound heals and the scar forms, you can ask the doctor how to smear the seam 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 recovery. Ampoule vitamin E can be safely applied directly to the scar: it will speed up healing. A good suture ointment that is often recommended for use after a caesarean is Contratubex. Several times a day (2-3) for at least half an hour, expose the stomach: air baths are very useful. Constantly see a doctor. It is he who will tell you how to avoid complications, what can and cannot be done, when to do an ultrasound of the seam and whether there is a need for this.

So caring for a suture after a cesarean section at home does not require any special efforts and 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. They should be reported to the doctor immediately: only he can prevent complications.

It is interesting! Not so long ago, scientists concluded that if the peritoneum is not sutured during cesarean delivery, then the risk of speck formation is reduced to almost zero.

Complications

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

Early Complications

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

A fairly rare complication is the divergence of the seam, when the incision begins to creep in different directions. This can happen after a cesarean on days 6-11, since the threads are removed within this period. The reasons for the seam to open may be an infection that prevents the full fusion of tissues, or the weight of over 4 kg that the woman lifted during this period.

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

elevated temperature; if the seam is festering or bleeding; his swelling; redness.

So what to do if the seam after a cesarean section is inflamed and festering? Self-medication is not only useless, but also dangerous. In this case, it is necessary to consult a doctor in a timely manner. In this case, antibiotic therapy (ointments and tablets) is prescribed. Advanced forms of the disease are eliminated only with the help of surgical intervention.

Late Complications

Ligature fistulas are diagnosed when inflammation begins around the thread, which is used to sew blood vessels during cesarean section. They form if the body rejects the suture material or the ligature is infected. Such inflammation appears months later as a hot, reddened, painful lump, from a small hole in which pus may flow. Local processing in this case will be ineffective. The ligature can only be removed by a doctor.

Hernia is a rare complication after cesarean. 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 the uneven growth of tissue 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: excision of the scar.

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

Blimey! 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. However, there are certain nuances regarding the seam that you will have to face when carrying subsequent children.

The most common problem - the seam 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 it is about to disperse. For many young mothers, this causes panic. If you know what this pain syndrome is dictated by, fears will go away. If a period of 2 years was maintained between caesarean and subsequent conception, the discrepancy is excluded. It's all about the adhesions that form during the restoration of wounded tissues. They are stretched by an enlarged belly - hence the unpleasant, pulling pain sensations. You will need to inform your gynecologist about this so that he can examine the condition of the scar on an ultrasound scan. He can advise some pain-relieving and softening ointment.

You need to understand: the healing of the 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 in mind all these nuances, 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 giving birth by caesarean section, a scar remains on the abdomen, because 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 and not injure him.

Types of incisions for caesarean section directly depend on the course of childbirth, for example, in case of acute fetal hypoxia or heavy bleeding in a future mother, the doctor may decide to conduct corporal caesarean section. This means that the incision on the abdomen will pass vertically from the navel to the pubic area.

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

Usually, caesarean section is performed laparotomy according to Pfannenstiel. This is an incision in the skin and subcutaneous fat transversely passing through the suprapubic fold. In this case, there is no opening of the abdominal cavity, and due to the transverse direction of the incision and the fact that it is located inside the natural skin fold, the scar from the caesarean section will subsequently become almost invisible.

cosmetic seam after a caesarean section, they are usually applied precisely with a Pfannenstiel incision. With a corporal incision, the strength of the tissue connection must be very high, which requires interrupted sutures, and a cosmetic suture after such a caesarean section is categorically not suitable.

Internal seams, which are superimposed on the wall of the uterus, have a large number of options, for example, you can use the hardware technique for 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 seam after a cesarean section does not hurt 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 the infection.

Also, after a cesarean, they can not do without drugs that will help reduce 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 the cesarean section, the stitches are removed, unless, of course, they are self-absorbable.

After the suture has healed, it will become almost invisible, and will not cause unnecessary trouble for the mother. Of course, if she follows the recommendations of the doctor and properly care for him.

How to care for caesarean section stitches?

While you are in the hospital, daily dressings and antiseptic treatment of the suture after cesarean 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 to remember is that doctors will allow you to pamper yourself with a shower only a day after the stitches are removed, and rub the stitch with a washcloth a week later. If the postoperative period will pass with complications, then the doctor may prescribe you special ointments that will help the suture heal as soon as possible.

What complications can occur 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 after caesarean section - in the hospital. These include small hematomas and bleeding. You will easily notice them - the bandage on the seam will get wet with blood. If this happens, inform the medical staff immediately so that the wound does not fester.

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

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

First, swelling and redness appear, pain is possible, and the skin around the seam left after the caesarean section is tense, then the medical staff makes dressings with a special antibacterial solution, and if the condition of the woman in labor 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. Among them, the most common complication is ligature fistulas. This complication after caesarean section occurs in many women in labor. It occurs due to the rejection of the suture material by the body.

The process of occurrence of ligature fistulas is quite long: first there is swelling, then redness, pain, and then pus erupts. If you carefully consider the wound, then in it you can consider the culprit of all troubles - the remaining ligature. Treating yourself - smearing with antiseptic solutions and creams - is useless, the fistula will then close, then boil again. Therefore, you need to contact a specialist to remove the thread.

Scar correction methods after caesarean section

Usually, when performing a caesarean section, doctors try to make the seam as neat 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, a scar will remain for someone less, for someone more noticeable. Therefore, a few months after the operation, you will begin to think about how to remove a scar remaining after caesarean section.

Today, special clinics of aesthetic surgery cope with such a problem very effectively, where in a few sessions with the help of a laser you will be relieved of scar tissue. Before you go for laser correction, you should consult with your doctor so that he can determine the best time for the procedure based on the condition of the suture.

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

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

An absorbable synthetic suture material is used to suture the edges of the wound, which holds the edges tightly in position for several months. Such material is convenient in that it dissolves gradually, and by the time it completely disappears, a strong suture will form on the uterus, which is able to withstand a new pregnancy, and in some cases even provide independent childbirth.

Provided that the healing process proceeded without complications, complete recovery of the uterine wall occurs after 6-8 weeks from the date of surgery. If the recovery period was accompanied by inflammatory reactions or there was a divergence of the seams, the time for the final restoration of all layers of the uterus is lengthened and can reach 10 weeks.

If the first birth of a woman, for various reasons, ended with an operation, then the second and subsequent births require the inclusion of this pregnant woman in the risk group. The divergence of the suture after cesarean is a rather serious problem of 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 for such women was unequivocal: if there is such a type of delivery in the anamnesis, then all subsequent births should be carried out only by surgery. This was associated with a high risk of uterine rupture along the old scar during the natural process. What are the reasons for this complication?

The probability of uterine rupture depending on the scar

For a long time, many obstetrician-gynecologists used the classic vertical suture, which was used to suture the muscular wall of the uterus in its upper third. A similar tactic in the operation of caesarean section was 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 delivery through the natural birth canal.

The divergence of the suture on the uterus after cesarean in this case was, according to different authors, from 4 to 12%. This forced the experts to recommend that the woman re-lie down on 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 practically does not affect the frequency of postoperative complications.

The anatomical structure of the female uterus is such that muscle incisions in this area heal much faster and less often create prerequisites for tissue damage. When carrying out such operations, the probability of divergence of the seam on the uterine wall is sharply reduced and is no more than 1 - 6%. It is these figures that allow modern specialists to allow up to 80% of women who have undergone operative delivery to go into natural vaginal delivery.

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

Types of suture after caesarean section

Who is at risk for uterine rupture during childbirth?

As mentioned above, about 4 - 5% of women in labor are at risk of experiencing a possible divergence of the old scar during vaginal delivery. 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 an excessive load on the old scar during pregnancy and childbirth can be fatal.

It is also very important to observe the necessary intervals between births. For the formation of a full-fledged dense seam, the female body takes from 12 to 18 months, therefore, a second pregnancy in a woman who has undergone a caesarean section is recommended no earlier than 2 years after the operation.

Pregnant women who do not have a history of operative delivery may be at risk of uterine rupture. Quite often, such complications occur when a woman in labor enters the delivery room for 5, 6 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 tactics for conducting childbirth.

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

Signs of violation of the integrity of the scar on the uterus

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 divergence of the seam after cesarean 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 during an ultrasound scan of the scar condition.
The beginning of the rupture of the old seam	It is usually characterized by severe pain in the area of the operation, signs of pain shock in a woman are possible: a drop in blood pressure, tachycardia, cold clammy sweat. On the part of the child's body, such a pathology may be accompanied by a decrease in the heart rate.
Complete uterine rupture	In addition to the symptoms already listed, it is characterized by a sharp pain in the abdomen in the interval between contractions, a change in the movement of the child's body in the birth canal, and the development of bleeding from the vagina.

In addition to monitoring a woman, during vaginal delivery in a pregnant woman with a scar on the uterus, it is necessary to monitor the condition of the fetus. For this, modern medical institutions are equipped with appropriate equipment. This may include the use of dopplerography or a fetoscope.

The medical literature describes situations where there are practically no symptoms of suture divergence after cesarean. 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 a doctor who delivers a woman with a similar pathology can play a big role.

Uterine rupture is considered the most severe complication, occupying one of the first places among the 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 seam can open after a cesarean. 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 the 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 is overgrown mainly with connective tissue, then the structure of the muscular layer of the uterine wall is disturbed. 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 basic recommendations of the doctor, physical activity on the abdominal wall exceeded the permissible norms, there were certain errors and shortcomings in diet and lifestyle. Finally, various chronic diseases, a decrease in the body's immune forces can cause a weak scar on the uterus.

A similar problem is usually detected by a specialist during an ultrasound scan of the uterus and the suture on it. It is he who gives the conclusion about possible independent childbirth after a caesarean section.

We recommend reading the article about complications with a suture after a caesarean section. From it you will learn about the types of sutures during surgery, how to care for the scar, possible complications, the use of healing agents, the need to correct the suture.

Uterine scar and second pregnancy

When there are no problems with a scar on the uterus, pregnancy does not affect the woman's condition in any way. Up to 32 - 33 weeks, the pregnant woman generally does not have any clinical manifestations of the existing pathology. Only in the later stages of pregnancy can there be mild pain 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, they are 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 term.

According to modern canons, ultrasound for a woman who had a history of caesarean section is mandatory throughout pregnancy. It is this method of examination that allows obstetrician-gynecologists to decide on the need for a second operation. Even at 28-29 weeks, the location and size of the child, the place of attachment of the placenta in the uterine cavity are determined, which is necessary to avoid the risk of rupture of the muscle wall scar.

From the 31st week, the ultrasound doctor constantly monitors the condition of the scar, and if there is a suspicion of its failure, it immediately raises the question of conducting a new operation. For the same period, there is a period of hospitalization of a similar pregnant woman in the pathology department.

In modern protocols, the time from diagnosing uterine rupture to performing an emergency caesarean 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 into natural childbirth, the woman should be informed about a possible emergency operation and about the certain risks of such tactics. In addition, in such a contingent of women in labor, it is impossible to carry out analgesic therapy and artificial stimulation of labor. The doctor simply does not interfere in the course of childbirth, his task is to recognize possible complications and take appropriate measures.

It is up to every pregnant woman who has a scar on the uterus to give birth herself or go for a second operation. There are situations when specialists make a decision for her, but in 70% of cases it is the choice of the woman herself. The task of the doctor in this situation is to give her the full amount of information and support any decision she makes.

One of the complications after caesarean section is the divergence of the seam. The outer seam may separate, and this will immediately become obvious, or the integrity of the internal may be violated, and this can only be seen with the help of diagnosticians. The discrepancy can happen after the operation, and years later, when a woman wants to feel the joy of motherhood again. In this article, we will talk about why the seams diverge, what to do if this happens, and how to prevent such a situation.

Inner and outer seams

During operative delivery, the surgeon dissects 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 sutured. For seams inside and outside, different 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 with a dissection of the abdominal wall either horizontally or vertically, depending on how urgently the child needs to be removed.

When forming the internal suture, the surgeon has no right to make a mistake - the edges of the wound should match as accurately as possible. Even a slight displacement can lead to the formation of a rough and inconsistent scar. Uterine sutures are usually self-absorbable, and these sutures do not need to be removed or processed afterwards. Most often, the uterus is sewn with a single-row continuous suture.

External seams can be applied with stitches. The materials for the external suture can be different - silk surgical threads, absorbable threads, medical alloy staples. Recently, a new method of soldering the seam with liquid nitrogen has been practiced in a number of clinics, that is, without the use of threads at all.

External seams may be cosmetic or conventional. The first then look more aesthetically pleasing. When it comes to external sutures, the horizontal Pfannenstiel section is always preferable, since the probability of its divergence is much lower than with the corporal section (vertically from the navel to the pubic zone). Horizontal external seams heal better than vertical ones.

The healing process is different. Internal sutures on the uterus heal for about 8 weeks. After this time, a 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 will be able to withstand the bearing of the next child without any problems and even in some cases, physiological childbirth in the most natural way.

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

The external suture heals in just over a week, after which the sutures are removed if they are not self-absorbable. A vertical suture after a corporal caesarean section heals for about 2 months and requires more careful care.

Types of violation

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

Early complications may include:

bleeding from the area of the external seam;
internal bleeding;
formation of hematomas in the area of scars;
inflammatory process (both internal and external);
divergence of the inner or outer 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 a lot of reasons that can lead to divergence of seams both inside and outside, but the leading place is given to a violation of the regimen recommended during the rehabilitation period. So, both external and especially internal seams can suffer due to improper motor activity of the puerperal.

It is recommended to get up after the operation only after 8-10 hours, but some try to do it earlier, which leads to early injury to the sewn areas. Inaccurate attempts to stand up, sit down after the operation, and subsequently ignoring the requirement to limit weight lifting to 3-4 kilograms are the main reason why the seam has come apart.

The reason for the divergence of postoperative sutures may be an infection. Both internal and external wound surfaces can be infected. In general, infectious complications after caesarean section are one of the most formidable and most likely, despite the sterility in the operating room and technical progress. Inflammation or suppuration disrupts the process of fusion of the edges of the wound, which may well result in a violation of the integrity of the suture.

Another reason, not the most common, but very likely, is the immune reaction of the woman's body to the surgical material with sutures. Immunity is generally quite difficult to understand, and therefore it is never possible to say in advance whether the sutures will take root, especially internal self-absorbable ones. 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 can also occur on the external suture material.

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

Signs and symptoms

With the definition of problems in the state of the external seam, there are usually no questions. The area where the threads are applied is reddened, hematomas may be observed, ichor or blood oozes from the wound, pus may be discharged. In this case, the body temperature usually rises. The suturing area hurts, the seam “burns”, pulls, worries even in the prone 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 rejected as a result of inflammation or mechanical injury).

It is more difficult to understand that there are problems with the inner seam. In this case, the picture will be somewhat blurred and similar to a number of other complications after surgery. But an experienced doctor will first of all suspect the divergence of 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. The discharge from the genitals will be much more copious than after a normal uncomplicated operation, and may contain large fragments of suture material. The general condition of the pregnant woman will rapidly deteriorate. Arterial pressure decreases, episodes of loss of consciousness, palpitations can be observed. The skin becomes pale, sweating increases.

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

Divergence in re-pregnancy

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

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

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

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 from acute sudden hypoxia, which occurs due to a violation 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. She has no symptoms, and only a specialist in ultrasound diagnostics is able to determine this condition. In this case, the woman undergoes an emergency caesarean section.

The beginning of the rupture of the suture on the uterus is characterized by sharp abdominal pain, the development of pain shock is not excluded. Blood pressure drops, tachycardia appears. The baby's normal heart rate slows down sharply.

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

How to behave in such cases?

Given the seriousness of the situation, if any problems with the stitches are found, the woman should immediately report them to the doctor. If problems are found in the maternity hospital, a woman's temperature rises, postpartum discharge becomes more abundant, there are signs of an unfavorable external scar, then this cannot be hidden from the medical staff. The woman will be helped. If the problem is found already at home, after discharge, the woman needs to take a horizontal position, call an ambulance and wait for the brigade to arrive. You should not go to clinics and antenatal clinics on your own, as the discrepancy may increase, and when it comes to the inner seam, the clock counts.

When calling an ambulance, you need to report that that you suspect a scar dehiscence and describe in detail how you feel at the moment. This is important, because in this case, the obstetrician on duty will be included in the team of doctors.

Infectious lesions of the sutures are usually treated with antibiotics, both systemically and locally. With an internal discrepancy, a woman undergoes surgery to apply new sutures or remove the uterus if it is not possible to suture the gap.

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

Prevention

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

it is strictly forbidden to lift weights, the restriction is 3-4 kg for at least six months;
you can’t squat, fall, jump sharply, the press should not be pumped up to six months after the operation;
after discharge, the outer 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 necessary to wear a surgical bandage on the wound; after removal, the decision to wear it is made individually, depending on the state of the suture;

For information on how to care for a suture after a cesarean section, see the following video.