Pregnancy after cesarean section after what time. When can you get pregnant after a cesarean section? Why does pregnancy not occur after a cesarean section?

02.05.2019

The priority for a woman in a position is for the pregnancy to end successfully and the baby is born healthy. Even if she did not manage to give birth herself, but everything went well, then the very fact of giving birth through Caesarean does not bother the happy mother. However, time passes, and most women again begin to think about replenishing their families. And then the question arises: "Pregnancy after cesarean section - what is it?" Is it easy to conceive, endure and give birth with a scar on the uterus? Is natural delivery possible?

Immediately after the baby is removed, the uterus is a bloody wound. The scar is fresh and fragile: any significant stress can lead to dehiscence of the suture with the development of complications. The first changes begin a month after the intervention, if there are no unforeseen situations. The mucous membrane of the uterus is restored, bloody postpartum discharge (lochia) stops. The wound is healed by the formation of connective tissue.

If the healing is successful, then in the future, vessels begin to grow into this area, and then muscle cells. A full-fledged muscle layer is detected in about 70% of women who give birth by surgery. The regeneration processes are influenced by the postoperative period and the individual characteristics of a woman. It is from the strength and elasticity of the formed scar that the peculiarities of pregnancy after a cesarean section depend.

Pregnancy after cesarean section: optimal timing

There are many rumors about when to plan a pregnancy after a cesarean section. Until recently, it was believed that conception earlier than three years after a cesarean section could end in disaster - a fresh scar would not withstand, and at a later date there would be a threat of violation of the integrity of the uterus. Therefore, early pregnancy after surgery was strictly prohibited. But not so long ago, data was received that cast doubt on such a time frame. Scientists have proven that the scar is most elastic approximately 2 years after the operation, and in the future its atrophy may occur. According to doctors, if a woman agrees to become a mother again so early, then the best time for preparation falls on this period.

But what happens if you get pregnant right after a cesarean section? Unfortunately, in this case, the prognosis is unfavorable. Gestation earlier than a year after the operative delivery endangers the woman's health and her ability to have children in the future. At this time, the scar is not yet formed enough to bear the additional load. This can lead to complications up to the divergence of the suture on the uterus and the death of the fetus and mother.

Termination of pregnancy during this period is also extremely risky. Medical abortion before six weeks of pregnancy is relatively safe. Any intrauterine intervention can lead to a violation of the integrity of the uterus in the area of \u200b\u200bthe scar and result in the woman's infertility.

There were cases when pregnancy occurred almost immediately after cesarean and ended well. This is rather a happy exception than the rule, so immediately after an abdominal birth, spouses must think about effective contraception.

What spouses should consider

When a woman with an operated uterus is planning to conceive, it is important to pay attention to several factors.

What kind of pregnancy is it after surgery?... Previously, it was believed that it was possible to give birth by surgery only twice, and the third pregnancy was extremely dangerous. Now doctors are not so categorical. Medicine is increasingly inclined to believe that even after a cesarean, the first birth can take place naturally. The operation itself is now not so traumatic, and, provided the scar is in good condition, a woman can give birth three to four times without a significant risk of serious complications. However, the fifth and subsequent births are associated with serious consequences. This is a huge disadvantage of a cesarean section for those who want a large family.
The reason for the caesarean section in a previous pregnancy... If there is an opportunity to eliminate the pathology, due to which the previous childbirth ended promptly, then there is a great chance to give birth on their own, even after a cesarean section. For example, if the cause of cesarean was gestosis, and this pregnancy is going well, then childbirth may well be natural, taking into account the state of the scar.
Examination of the organs of the reproductive system... At the stage of preparation for pregnancy with a scar on the uterus, careful monitoring of the state of the reproductive system is necessary, whether there is chronic inflammation of the organs of the genitourinary system. Even if the spouses are not yet ready for the birth of another baby, six months after the abdominal birth, a woman needs to undergo a full examination by a gynecologist in order to prevent secondary infertility in the future.

Contraindications

There are pathologies in which pregnancy after a cesarean section is dangerous. If the reason for the operation in the past was a serious somatic illness of a woman (diseases of the cardiovascular system, problems with the respiratory system, serious pathology of the urinary system, diabetes mellitus), then doctors warn of a high risk for repeated bearing of a child and suggest tubal ligation as an irreversible method contraception.

Pregnancy and the birth of a healthy baby after cesarean is quite possible if there are no contraindications. It is important to observe thorough preparation for pregnancy: the optimal period of conception is from two to four years, the woman must be fully examined (the gold standard is to examine the scar from the inside using hysteroscopy), the presence of serious diseases that can affect the course of a new pregnancy is excluded.

What are the risks

How does pregnancy go after a cesarean section? First of all, the expectant mother should be under the supervision of doctors from the first two strips on the test. The fact is that pregnancy after a cesarean section is often accompanied by various complications. Here are five main ones.

The threat of termination of pregnancy... It occurs in a third of women operated on. Depends on the position of the ovum in the uterus. The closer the embryo attachment to the scar, the higher the risk of threat.
Placenta accreta... Pathology in which the tissues of the child's place grow into the muscular layer of the uterus. It is diagnosed in the third stage of labor, when the placenta cannot separate from the walls and leave the uterus, or it is not possible to separate it manually. In this case, it is very important to operate on the woman in time, otherwise the bleeding that opens can lead to death.
Insufficiency of a scar on the uterus... Diagnostic standard - ultrasound - signs of inferiority of scar tissue: lower uterine segment of 3 mm or less with a normal thickness of 4 mm. In this case, the pregnant woman may note soreness at the site of the scar, and the fetus on CTG shows signs of hypoxia. Suspicion of a threat of uterine rupture is a reason for immediate hospitalization. When the diagnosis is confirmed, urgent operative delivery is indicated.
Ectopic pregnancy... The sad consequence of adhesive processes in the pelvic cavity after undergoing cesarean. Also, the result of adhesions can be an acquired bend of the uterus. This leads to difficulties in conceiving.
Circulatory disorders in the mother-child system... In the early stages, insufficient blood supply can lead to a frozen pregnancy, at later stages, it threatens the development of fetoplacental insufficiency. In this condition, the development of the baby inside the uterus is slowed down due to lack of nutrition. If the treatment with a conservative method fails, then there is only one way out - an emergency cesarean and nursing the child in the pediatric intensive care unit.

The more abdominal births a woman has undergone, the higher the risk factor for complications.

A second pregnancy after a cesarean section is allowed, a third is also possible, but with each subsequent birth, the lower uterine segment becomes thinner, so the approach to planning in such a situation should be extremely responsible. There is also the question of the timing of hospitalization and the choice of a maternity hospital for delivery. After the fourth birth, it is worth thinking about surgical contraception so as not to endanger the life and health of the mother.

Chances to give birth "most"

Back in the middle of the last century, a single cesarean section was an unambiguous indication for further operative childbirth. With the development of medicine, the technique of surgery has improved, cesarean has become less traumatic. Now the prohibitions of doctors are not so categorical. The advantages of spontaneous childbirth are that the woman will not be re-dissected the uterus along the scar. This makes the next pregnancy more likely, and the reoperation is usually more difficult and the risk of bleeding is higher. There are chances of natural childbirth in such cases:

pregnant with one cesarean history - for non-recurring indications (improper location of the fetus, gestosis, fetal hypoxia, placental abnormalities);
favorable course of the current pregnancy - the presence of new indications for the operation is not allowed;
single fetus in cephalic presentation - multiple pregnancies create additional stress on the scar;
satisfactory ultrasound and clinical findings - a full-fledged wealthy muscle layer in the lower part of the uterus;
good condition of the pregnant woman and the fetus - according to the data of medical examinations and CTG;
informed consent of the woman - the woman in labor should be fully aware of the risks, projections and indications for natural childbirth.

The expectant mother with the appropriate psychological attitude will be able to successfully give birth after cesarean, fear and doubt serve as an obstacle to the spontaneous course of childbirth.

The terms for hospitalization and planned delivery in the absence of indications for independent childbirth have also changed. With a wealthy scar on the uterus, 39 weeks is considered the ideal time for abdominal birth. A second cesarean is performed with excision of the old scar and the formation of a new suture in the same place.

Natural obstetrics after cesarean section is possible only in large specialized maternity facilities. It is important to have modern equipment, good resuscitation and competent specialists capable of performing complex surgical interventions, up to the removal of the uterus. During childbirth, the postpartum woman and the fetus should be closely monitored.

It is very important not to miss the threatening rupture of the uterus, a symptom of which may be local soreness at the incision site. It is worth hoping for a favorable outcome of natural childbirth with a scar on the uterus in 50-90% of cases. In other cases, an emergency caesarean section is performed.

There is no question as to whether pregnancy is possible after a cesarean section. If a woman wants to become a mother again and dreams of a new pregnancy, everything is in her power. However, it must be remembered that bearing with a scar on the uterus requires more attention and responsibility from a woman. Lifting weights is strictly prohibited, you need to observe the mode of work and rest. It is important to choose "your" doctor and listen to his recommendations at the planning stage, not to neglect the indications for hospitalization and the method of delivery. Indeed, at the end of the journey, the best reward for all efforts will await - the health of the future baby.

Reviews: "It is important to meet deadlines"

I have a third pregnancy after 2 caesarean ... between 1 caesarean and the second pregnancy 4 years have passed, left without problems, the suture was excellent ... in our city after cesarean - only caesarean, so we operated on ... everything went fine ... the third got pregnant after 1 , 1 year after the last cesarean .... On the ultrasound they said that everything is fine, but the term is still small, how it will be further - time will tell ...

Kitty, http://forum.forumok.ru/index.php?showtopic\u003d36116

My pregnancy came 4 months after the COP, but froze. after another 8, I became pregnant with my daughter, that is, a year and a month after the COP. The adhesions were painful, from 32 weeks of bed rest, since the ultrasound specialist incorrectly planned the scar (he said 2 mm, but it was 8 mm). At 37, contractions began, I was well in the hospital. EX and everything ended well this time

Irishka Kulikova, https://www.baby.ru/community/view/77360945/forum/post/77411869/

When I was in storage in 1B, there was a woman with me in the ward, who also became pregnant after the COP, but six months have passed already there .. So, she was in the maternity hospital from the 20th week until the very birth (she was cut again at 6 months - since it was impossible to wait any longer, the seam was overstretched)! They were not even allowed to go to the toilet! And then in the children's hospital, while the baby got stronger ... HORROR! And the first child was wandering around his grandmothers ...

Elleonbry, http://forum.forumok.ru/index. php? showtopic \u003d 36116

The desire to have a baby after a cesarean section occurs in women for various reasons. Who got into the taste of motherhood, others want the children to be almost the same age. Others were unlucky due to the sudden loss of a child.

Another reason such as age - approaching 40 also urges a married couple to give birth to a second baby, or maybe a third baby. And then the question arises, when does the doctor give the go-ahead for pregnancy?

Cesarean section - what is it?

First you need to understand the designation of a cesarean section. In simple terms, a cesarean section is an operation whereby a baby is removed through an incision in the uterine cavity. This operation is used in cases where mother and child are at risk from natural delivery. Distinguish between planned and emergency caesarean sections.

The indications for a planned cesarean section are as follows:

violation of the placenta;
changes in the wall of the uterus;
obstacles to a child being born;
improper location of the fetus;
extragenital diseases;
the age of the pregnant woman is more than 30 years;
Diseases that are not related to pregnancy and are a threat with natural delivery.
in vitro fertilization;
multiple pregnancy;
the condition of the child.

Indications for emergency caesarean section:

bleeding;
premature placental abruption;
fetal hypoxia;
suspicion of an incipient or already completed rupture of the uterine scar;
sluggish labor activity;
complicated pregnancy, severe forms of preeclampsia.

The very caesarean section for a woman's body is a great stress, because it is still an operation. In the process of carrying out it, a woman loses much more blood than during natural childbirth.

The healing process also takes much longer. After carrying out such a manipulation, a woman should be monitored by a doctor constantly, until complete recovery. The gynecologist, during the examination, will give complete information about the condition of the scar on the uterus. It is from its elasticity and the speed of healing that we can talk about the next pregnancy.

When can you get pregnant after a cesarean?

In fact, you can get pregnant as soon as the woman stops breastfeeding. The process of restoring the menstrual cycle is the same as for women who have given birth naturally. It's just better to listen to the doctor's opinion and not rush to conception for at least two years.

After a cesarean section, a woman's body undergoes rehabilitation for at least a year and a half. Usually, doctors do not prohibit giving birth to a child if the pregnancy occurs after a cesarean after two years, but ideally, it is best - it will be three years. The risk of complications is very high if the pregnancy occurs earlier.

During this period, it is very important to observe contraception. An abortion between the cesarean section and the next expected pregnancy is highly undesirable. When scraping, the scar is injured, which leads to its thinning. In the future, this fact can cause problems during the next pregnancy and childbirth.

If conception occurred earlier than doctors advise, do not panic ahead of time. There are many cases of women becoming pregnant six months later and earlier after a cesarean section. Sometimes the success of a successful bearing and childbirth is envy not only on the woman's body, but also on the professionalism of the gynecologist.

After a while, after consulting a doctor, you can plan your next pregnancy. Depending on the condition of the scar on the uterus, the doctor's verdict depends. The scar must be formed by muscle tissue so that it cannot even be seen.

Thanks to modern technology, the condition of the scar can be assessed using such examination methods as:

Hysterography - This is an x-ray of the uterus in different protections: lateral and straight. For this study, a contrast agent is injected into the uterine cavity. This procedure is carried out only six months after the cesarean section.
Hysteroscopy - This is an examination of the uterine cavity and the scar on it using a special device - an endoscope. This examination is carried out from 8 to 12 months after the cesarean section.

And only after such a thorough examination, the gynecologist can tell you the state of your health and the possibility of already conceiving a child.

Contraindication of pregnancy after cesarean section

Caesarean section can cause serious "taboos" and doctors strongly recommend giving up the desire to give birth to another child. Such cases are quite rare, but they do occur.

First, if a longitudinal scar was made in the uterine cavity during the operation, there may be serious problems. The risk of rupture of the uterus along the scar increases significantly with subsequent pregnancy.
Secondly, such a scar is often formed by connective tissue. In this case, you should no longer think about the next pregnancy.

But if conception has occurred and there is a desire to give life to a small creature that will bring a lot of joy, consult a gynecologist. In some cases, the doctor will allow childbirth, but this depends to a greater extent on the qualifications of the doctor and your willingness to take risks.

Any woman who is expecting a baby wants her pregnancy and childbirth to be as easy and natural as possible. Unfortunately, there are situations when it is extremely dangerous for the expectant mother to give birth on her own. Then the doctors decide to perform a caesarean section (childbirth with an operation). It is not an obstacle to the desire to have more children, and pregnancy one year after cesarean section has every chance of ending with the birth of a healthy baby.

Pregnancy one year after cesarean section

Intervention in the birth process can be both planned and emergency. The latter is carried out when the usual childbirth was planned, but something went wrong in their process. There are absolute indications (most often these are health problems in a woman in labor) and relative (when the doctor decides on the operation individually).

Absolute indications for surgical delivery are clinically narrow bones of the woman's pelvis, organ tumors, severe varicose veins in the genital area and vagina, serious diseases - retinal detachment, myopia, problems with the cardiovascular system, diabetes and others.

Relative indications include the abnormal course of labor, presentation of the fetus, its large size, the age of the woman in labor over 30 years, preeclampsia of mild or moderate severity, IVF, as well as obstetric pathology. Often, a cesarean section is prescribed for patients who are pregnant with twins or a large number of children. This significantly reduces the risk of complications for the mother and children.

Natural childbirth after surgery - a reality or an unjustified risk?

Often, patients are sure that after the operation, they can forget about the desire to give birth on their own. However, experts say that this is a delusion. The muscle tissue at the site of the surgical scar is restored in a year or two. It is best to wait a few years before getting pregnant again. Although second pregnancy one year after cesarean also has a chance of ending in natural childbirth. True, only if there are no absolute indications for the COP.

If the first time the operation was performed due to a narrow pelvis, the woman has a very large the likelihood of giving birth again on their own. Often such a diagnosis is made due to insufficiently active labor. During the next birth, this problem may not arise.

European and American experts insist that giving birth after cesarean, without resorting to surgery, is more desirable and safe. The natural course of childbirth significantly reduces the risk of infection, favors the development of the child and his adaptation, allows immediately after his birth to establish and maintain breastfeeding, contribute to a closer psychological connection between the mother and her baby.

The modern level of medicine makes independent childbirth real even for those who have undergone not one, but two surgical interventions. In Europe and the United States, about 70% of women successfully give birth on their own, even when they have pregnancy after the second cesarean a year later... In our country, the number of such cases does not yet exceed 30%. The main factor in successful spontaneous childbirth is the condition of the uterine scar. It is determined by examining it before and during pregnancy.

Pregnancy after cesarean, precautions

Doctors insist that the time interval between operative delivery and the next pregnancy should be at least 18 months, ideally from two to three years. During this entire period, special attention should be paid to protection, since having an abortion after surgery on the uterus is a big risk.

The termination of pregnancy always damages the health of the woman, and if the patient has recently undergone a cesarean, it increases many times. If the abortion is performed surgically, the suture on the uterus may become damaged and become thinner. Also, the risk of possible complications, including infertility, increases significantly.

Of course, modern operative childbirth is carried out using a technology that helps to quickly and efficiently heal the suture. In medical practice, effective measures are used to protect against infections - effective new antibiotics, strong material for sutures, modern methods of making incisions.

But all of the above does not negate the fact that repeated caesarean is much more dangerous than the first. Therefore, it is better to do it after a certain time, for example, when it was diagnosed pregnancy 2 years after cesarean... If the patient has already had two such operations in the past, it is better for her not to risk it.

The tissue at the site of the scar is transformed, adhesions are formed, and the risk of endometritis increases. In addition, two transferred caesarean ones have a bad effect on the general condition of the body, and he may simply not be able to cope with the bearing of a third child. It is for these reasons that in the process of the second cesarean, doctors often suggest that a woman be sterilized.

Recovery before the next pregnancy

Often, pregnancy after cesarean in women occurs earlier than the time recommended by doctors. The reason may be her desire to have children with a short break in age, or she wants to have time to give birth again before she turns 40 to reduce the likelihood of complications.

If a woman wants to give birth on her own after a cesarean, she needs to prepare for this immediately after the operation. Proper care of the seam is important. Without the formation of a strong and full-fledged scar, problems may arise not only with the birth of the next baby, but also with its bearing.

As a rule, a gynecologist gives the go-ahead for pregnancy only if the scar is completely formed by muscle tissue and is practically invisible. In this case, the possibility of a favorable outcome is very high. Especially if enough time has passed and it has come pregnancy after cesarean after 5 years or more. If the scar is formed from mixed fibers, or to a greater extent consists of connective tissue, repeated pregnancy is strictly prohibited.

https://youtu.be/Va78_cAkrZA

Body diagnostics

Usually, the doctor prescribes an examination of the postoperative scar six months or a year after the operation. For research in modern medicine, methods such as hysteroscopy, ultrasound of the uterus with a vaginal probe and hysterography are used.

Hysteroscopy is an examination of the uterus using a special apparatus - an endoscope, which is inserted into its cavity. This procedure is equivalent to surgery, so only a specialist with the necessary qualifications should carry it out. Many women experience pain during the procedure, so it is done with local or general anesthesia.

Hysterography is a diagnostic method in which the doctor injects a small amount of contrast agent into the uterus. Then the patient is given an x-ray of the uterus and fallopian tubes. The injected substance does not transmit X-rays and allows you to get a clear picture of its cavity and outlines.

If an unscheduled pregnancy 1.5 years after cesarean, and the necessary research has not been done, this is not yet a reason for panic. Hysteroscopy is no longer possible, but an ultrasound of the uterus with a sensor can be done. It shows not only the scar, but also the placenta attachment site. It is good when they are at a considerable distance from each other.

The specifics of pregnancy

In general, the interesting position of a woman after an operative delivery does not have any pronounced features. The main thing is to carefully approach the choice of a gynecologist who will conduct such a pregnancy. Long before the birth, you should choose a clinic and a doctor who will take over the birth. With him follows all the nuances of his situation. Pregnancy after a cesarean section, of course, implies more careful control, but still you should not think about it all the time, everything will be fine with you.

Of course, second pregnancy after cesarean section a year later is fraught with risk. At the same time, it has more chances to end with a natural childbirth than the one that came after a long period of time (from 10 years). It's all about the age of the expectant mother: the younger a woman, the easier it is for her to give birth without complications.

During each visit to the gynecologist, he without fail controls the suture on the uterus and palpates (palpates) it. When the expectant mother registers with the antenatal clinic, it is very important that she has a detailed statement from the hospital where the operation was performed. This document indicates the type of sutures imposed, features of the postoperative period, the results of ultrasound. If a woman does not have such an extract, it is worth going to the hospital and asking its employees to raise the archive.

After the 35th week of an interesting situation, you can decide with a gynecologist about the admissibility of independent childbirth. At this time, the doctor conducts an ultrasound examination and assesses the size of the future baby, his presentation, the reliability of the suture on the uterus and the features of the placenta placement.

Second pregnancy one year after cesarean

If a woman wants to try to give birth herself, has no contraindications to this, and the ultrasound results are good, she should take care of finding a good clinic and a doctor. The local gynecologist can only recommend this or that method of delivery, but in general, the hospital doctor is responsible for this.

The woman who had pregnancy after the second caesarean section a year later, most often referred to planned childbirth. The expectant mother goes to the clinic a little earlier than the expected date of birth of the baby, and at 40 weeks she is punctured by the fetal bladder and provoked labor.

This practice is carried out for the sake of complete safety. The patient's childbirth is called in the daytime under the maximum supervision of doctors. They are ready to carry out emergency operational childbirth at the slightest threat. The worst thing that can happen during labor is the divergence of the suture on the uterus. It happens very rarely, but an experienced doctor must be present during childbirth. If he notices the beginning of a gap, he will immediately take emergency measures.

Stimulation of labor - to carry out or not?

The woman who pregnancy came after cesarean after 1 year, it is customary to be hospitalized in advance and to medically cause childbirth. However, there are doctors who do not share this approach. They argue that since rupture along the scar is deadly, it must be prevented as much as possible.

If the cervix opens smoothly, independently and without medical stimulation, the risk of rupture is almost zero. Of course, such a generic process lasts longer than usual, but the case is also not easy, which means that it requires the most careful management. After the baby and the placenta are born, you need to examine the scar from the inside under general anesthetic.

It may be worth looking for a good paid clinic, where the wishes of patients are treated more attentively than in public institutions. Before the very birth of the baby, doctors conduct a decisive examination of the expectant mother. The size of the fetus is important here: if it is large enough, it is better to agree to a repeated cesarean.

Most pregnancies and childbirth after a caesarean section go well. Regardless of what type of childbirth a woman chooses, she has every chance of giving birth to a wonderful healthy baby. The main thing is to be examined on time, follow the doctor's recommendations, monitor your condition and tune in only to the good.

Pregnancy after the second cesarean is most often regarded by gynecologists as a risk. But there are many women who decide on, despite the warnings of doctors.

Complications of the third pregnancy after cesarean sections

It is generally accepted that the most alarming pregnancy in psychological terms is the first one, because there is uncertainty ahead, and even the body itself does not yet know how it will behave in childbirth. However, when the first pregnancy ends with surgery, the second and subsequent ones become alarming for other reasons related to medical issues.

Pregnancy that occurs after the second cesarean is most often complicated. How serious the risk of these complications is, only a doctor can say, assessing in aggregate many factors: age, a history of genitourinary diseases, scarring, etc.

Unfortunately, no matter how skillfully the seam is made, there is always a risk of scar dehiscence, and the more scars, the higher it is. The divergence of the suture is fraught with internal bleeding, which is dangerous not only for the fetus, but also for the life of the mother. That is why, after the third cesarean, experts recommend a woman to undergo sterilization.

Other dangers of a third pregnancy after surgery are as follows:

anemia;
endometritis;
bowel and bladder trauma;
which can provoke bleeding early in pregnancy;
fusion of the placenta with a scar, which will not allow it to separate after a cesarean.

The latter complication leads to subsequent removal of the uterus. The attachment of the placenta next to the scars is dangerous not only for the mother, but also for the child: this can lead to delays in the development of the fetus.

The weight of the child in the third pregnancy is usually higher than in the previous ones. A large fetus can provoke labor pains ahead of schedule. Therefore, doctors recommend carrying out the third operation no later than the 38th week.

How to mitigate risks?

No woman is immune from the dangers of carrying a child after, therefore, when deciding on pregnancy in this case, the following questions should be answered:

How old is the woman?
Have there been abortions?
Did the woman have inflammatory diseases of the uterus?
How was the rehabilitation period after the second cesarean?
How long has it been since the second surgery?

Women 35 and older come under the close supervision of doctors. At the same time, today women and older than forty decide to have a third child. Of course, health is no less important here than age.

An important factor is how much time has passed since the second operation. This period should be from 2 to 5 years. Before a year, the scar has not yet healed and formed enough. This means that during the period of carrying a baby, he may become thinner and disperse.

And after 5 years, calcium salts are deposited in the formed scar, which leads to its compaction, as a result of which the tissues lose elasticity, it is more difficult for them to stretch with the growth of the fetus.

During pregnancy, a woman should follow these guidelines in order to minimize the risks of possible complications.

Regular scars check. Scheduled ultrasounds should be carried out without delay, because monitoring the condition of the seam is mandatory at all stages of bearing a baby.
It is forbidden to lift heavy objects, do housework, exercise, or any kind of stress.
Intimate relationships are prohibited.
It is strictly not recommended to be nervous, upset, worried for any reason.

At any stage of pregnancy, even minimal bleeding should be the reason for immediate medical attention. If they are accompanied by abdominal pain, weakness, dizziness or nausea, an ambulance should be called in the very first minutes of the onset of symptoms!

Even if the pregnancy is proceeding well, nevertheless, the woman should be hospitalized at 36-37 weeks.

Why is the third caesarean section dangerous?

The presence in the past of two caesarean is a categorical contraindication to natural childbirth, therefore, the only option for delivery in the case of a third pregnancy is another operation.

Any abdominal operation causes some damage to the body, and in particular to the organ that undergoes surgery.

Complications during the third cesarean are associated with the following factors:

Adhesions left over from previous surgeries can make it difficult to remove the baby. To get the fetus, doctors may cut the fetus, which will lengthen both the operation time and the recovery period after it.
If the adhesions break on their own, they can damage other organs in the abdomen. This is fraught with bleeding and a long rehabilitation period.
The presence of scars on the uterus will prevent it from contracting well. Bleeding from the uterus, which can occur in this case, will cause it to be removed.

Despite these risks, today they carry out operations of both the third cesarean section and the fourth, and fifth, and even the sixth.

Preparing for the third pregnancy

Pregnancy after the second operation must be planned. And not only parents, but also doctors should take part in its planning. A woman should undergo a comprehensive examination. The most important thing that is taken into account is the condition of the seam.

The scar is examined using hysteroscopy. During this procedure, the uterus is examined using special optical equipment. Another way to evaluate a scar is hysterography, which is an X-ray examination.

Planning should start no earlier than 2 years after the second pregnancy. During the first year after the operation, not only pregnancy, but also abortion is undesirable, so a woman should be very responsible about contraception. Ideally, you should wait 3 years and then examine the seam.

To make pregnancy and the postoperative period easier, you should monitor your health immediately after the second cesarean. Regular examination by a gynecologist, especially during the first year after the second pregnancy, will immediately eliminate all gynecological diseases, and a healthy lifestyle, proper nutrition and reasonable physical activity will help your body pass all the upcoming tests.

Features of the postpartum period

The main difficulties of the third postoperative period are associated with hypotonia of the uterus, characterized by a decrease in its contractility. Therefore, there is a risk of bleeding even after surgery. - lochia - can linger in the uterine cavity, which is fraught with infectious processes. To avoid these problems, women are prescribed drugs to contract the uterus.

The recovery period will increase, and the pain may be more intense than after previous operations.

At the same time, psychologically, the third caesarean is better tolerated, unless, of course, the woman is mentally preparing for the fourth.

Any pain can be endured when the desired baby, with whom you have gone through such an exciting and unsafe journey, is in your arms.

Why can't you give birth right away?
Pregnancy planning
The course of pregnancy
Special cases

Every repeated (planned or unexpected) pregnancy after a cesarean section invariably carries a certain amount of risk. However, this does not mean at all that after such a serious and important operation, it is forbidden to give birth at all. Some babies even manage to be born on their own, without surgery.

According to statistics, today a large number of women are successfully carrying and giving birth to babies some time after the COP. However, in many respects, the successful outcome of the case depends on how healthy the young mother is and whether she listened to the opinion of doctors when planning pregnancy and during the cherished 9 months.

Re-pregnancy bans

In certain cases, a second pregnancy after a cesarean section is strictly prohibited by doctors. These are exceptional situations when there are significant problems with a woman's health that directly threaten her life. If the operation had to be performed for the following medical reasons, it is unlikely that she will be allowed to give birth in the future:

heart disease: arterial hypertension, defects, rheumatism - lead to intrauterine fetal growth retardation, placental abruption, premature delivery;
diseases of the genitourinary system: chronic pyelonephritis, stones in the bladder, cystitis - they threaten with premature birth, intrauterine infection of the baby, gestosis;
problems with the respiratory system: asthma, chronic bronchitis - provoke oxygen starvation of the fetus, delay in its development, intrauterine infection;
diabetes mellitus is fraught with malformations of a different nature in the fetus;
diseases of the thyroid gland threaten with miscarriages, a decrease in the intelligence of the baby, and fetal malformations.

If the section was performed for one of these medical indications, doctors give the young mother recommendations for future plans. They explain that childbirth is contraindicated in such diseases. In some cases, right there, in the hospital, even before the operation, they can offer a radical method of preventing a new pregnancy - sterilization. If consent is given by the couple, the tubes are tied during the COP so that an unexpected unwanted pregnancy, fraught with complications and consequences, does not occur.

Statistics... Caesarean section is no longer a rare, frightening operation. It is used in 20% of cases.

Why can't you give birth right away?

If the reasons for surgical intervention in the natural process of delivery are associated with complications of this particular pregnancy (abnormal presentation of the fetus, herpes, etc.), in the future a woman is not prohibited from having children yet. However, after the operation, the doctor warns the young mother about compulsory contraception in the next few years. This is due to the fact that an early pregnancy immediately after a cesarean section will entail irreversible consequences. Complications can even be unpredictable.

After a cesarean, there is a scar on the uterus, the complete healing of which requires exactly such a period of time: at least 1.5 years, and even better - 2 years or more. If conception occurs earlier (for example, already 3 months after the operation), the scar will not be able to resist the load that has fallen on it. Pregnancy will stretch the walls of the uterus, causing it to rupture.
After surgery, the body experiences stress, so it needs a rehabilitation period. If it is complicated by a new pregnancy, there may simply not be enough strength to carry the baby. In this case, everything will end in miscarriage.
Serious problems with the placenta may begin, which turns out to be completely unprepared. Often in such cases, its detachment is diagnosed, which entails the death of the fetus.

This is why pregnancy after a cesarean section is dangerous if it is not planned in advance. If you do not take into account the recommendations of doctors, do not use contraception immediately after childbirth, you will have to terminate the pregnancy in order to avoid serious complications. Of course, there are cases of successful bearing of a second baby if he was conceived immediately after an operative birth (after 4-5 months, or even earlier). But you need to understand that these are exceptions, not rules, and you need to keep in mind all the consequences to which you expose yourself and the unborn baby.

For your information... If, after a cesarean, a woman has passed the recommended terms, the risk of scar rupture is only 0.5%.

Pregnancy planning

Avoiding all these complications is possible thanks to careful and reasonable planning of pregnancy in 2 years, which will pass after the cesarean section. If there are no medical contraindications for childbirth, after such a period of time, if you want to become a happy mother again, you need to consult a doctor, but even before conceiving a child. Preparation will include several necessary activities at once.

If you want to safely give birth to a baby, you will have to carefully protect yourself for the next two years.
After this probationary period, you need to visit a gynecologist. He examines the condition of the scar and connective tissue on the uterus, makes sure that he healed and is ready for new tests, and only then will he allow you to conceive again.
Since you will know why the first time you had a cesarean, you need to try to exclude this cause, that is, to engage in prevention, and, if necessary, treatment of all your ailments, before you conceive again.

Competent, mandatory planning of pregnancy after a cesarean section will prevent risks and complications, and will allow you to experience the happiness of motherhood once again. Any initiative in this matter, failure to comply with the recommended deadlines threatens with sad consequences.

The course of pregnancy

If you feel that you have conceived a baby and unexpectedly a pregnancy has come a month after a cesarean section, try not to hesitate to visit the appropriate doctor. In this case, her immediate medical interruption will be required in order to avoid complications, if the time permits (5-6 weeks). Otherwise, it is necessary to resort to instrumental termination of pregnancy, and this jeopardizes the woman's ability to have children in the future. If more than a year has passed since the operation, the significant 9 months will differ only slightly from the usual course of pregnancy. Here you have to adhere to the following rules:

Get registered with a gynecologist as soon as possible.
During the onset of pregnancy after cesarean, excessive, unbearable physical (and any other) loads are contraindicated, even despite a healed and seemingly strong scar.
You will have to visit the gynecologist more often and follow all his prescriptions.
As for the general condition of a woman, the sensations during such a pregnancy are no different from ordinary ones, if everything is in order. In case of inconsistency of the scar (if conception occurred after 6-7 months, or even earlier), if the child was left at his own peril and risk, pulling, sometimes even unbearable pains in the back and lower abdomen are not excluded.
Ultrasound is performed much more often.
Home birth in this case is categorically contraindicated.

The later conception occurs after such an operation, the more successful and safe both the bearing of the baby and the delivery itself will be. You need to understand that it is better in this case to become pregnant after 5 years (if age allows), so that the scar will finally heal and the uterus will be able to withstand all the load that it will have to experience.

Special cases

Life is so unpredictable that even the most prudent and prudent cannot foresee everything. Especially when it comes to the female body. Often, special cases of pregnancy after CS are diagnosed, which require a professional medical approach and the vigilant attention of the woman herself.

Two cops in a row

If you become pregnant after the second caesarean section, get ready for surgery again. There are very few of those who give birth in such cases naturally, and it is almost never possible to avoid complications. The connective tissue at the site of the scar loses its elasticity, which does not allow the uterus to withstand the load during delivery. In this case, the operation can be performed earlier.

Three cops in a row

If you have a pregnancy after 3 cesarean sections, don't even count on a natural birth. In addition, in the last weeks, given the repeated recurrence of scars, the doctor will suggest that you go to save. The risk is too great that the uterus will not withstand such a burden for the fourth time and may rupture when the baby's weight increases. Observing the condition of the fetus, mother and scar, the gynecologist may decide to perform the operation a little earlier. The modern level of medicine allows at the same time to reduce risks to a minimum.

Multiplicity

There are often cases when a pregnancy with twins is diagnosed after a cesarean section, and in this difficult case, the young mother will also not be allowed to give birth herself, since the uterus will not bear such severity. Moreover, if there are three (four, five, etc.) fetuses in the womb. Throughout pregnancy, you will have to be under the vigilant supervision of doctors, do constant ultrasound, and in the last stages you must go to the hospital.

Caesarean section is a serious abdominal operation that disrupts the course of natural childbirth, so it cannot but have consequences. If the pregnancy then came too early or complicated by some processes, repeated surgical intervention cannot be avoided. At least in most cases, it saves lives. Although with normal bearing of a baby, a woman can give birth herself, that is, in a natural way.

Legend or fact? There is an opinion that after a CS, a repeated pregnancy is often multiple. However, there are no exact statistical data on this, and this fact is not scientifically confirmed or explained.

Childbirth: natural or surgery again?

The debate about whether the next pregnancy after a cesarean section is sure to end in an operative way does not subside. Or is normal, natural childbirth possible? Everything will depend on the state of health of the young mother, the course of pregnancy and how much time (months, years) has passed after the surgery.

Natural childbirth is allowed:

when at least (even more) 2 years have passed after cesarean;
in the absence of serious diseases in the mother;
if the course of pregnancy has passed without complications and pathologies;
fleeting pregnancy after the second caesarean section, when they did not have time to prepare the woman in labor for the operation;
with correct presentation of the fetus;
if pregnancy occurs a year after the cesarean section, but the condition of the scar does not raise doubts among doctors (everyone has different healing rates), a woman may be allowed to give birth on her own, but this happens only in 30% of cases; so if you find the first signs that you are having a baby within 8-9 months after surgery, you will most likely be offered an abortion.

The operation is again inevitable if:

an early pregnancy occurred after a cesarean section (approximately after 1-11 months), in which the scar has not yet healed - in this case, you will have an abortion (medication or instrumental) or, if you want to leave the baby at all costs, repeated caesarean, if you bring it before the due date;
the mother has chronic, serious, untreated diseases that are medical indications for the operation;
pathology of pregnancy (abnormal presentation of the fetus, placenta, etc.);
age after 30 years;
the third pregnancy after two cesarean sections will definitely end exclusively with an operation, since in this case the risk of rupture of the uterine walls is maximum;
pathologically long scar healing under the influence of certain factors (genital infections, unhealthy lifestyle, physical activity);
if a longitudinal incision of the uterine wall was made during the previous CS;
several babies are expected at once.

If there are fears for the life of a mother or child, the opinions of doctors are almost always unambiguous: a planned operation is being performed. If no complications are foreseen, pathologies are absent, gynecologists, obstetricians, neonatologists only welcome the natural outcome of events and will provide all the necessary assistance.

Today, a repeated pregnancy after a cesarean section is not surprising to anyone if it was planned according to the recommendations of doctors. Only in this case can any complications be guaranteed to be avoided. In other situations, a woman should understand all the responsibility that she takes upon herself, unable to withstand a time interval of several years after the COP. There are chances for a successful outcome in this situation, but they are minimal. Happy delivery is very rare and is the exception, not the rule.

In recent decades, there has been a tendency to expand the indications for operative delivery.

Moreover, more than half of women who underwent surgery to remove myomatous nodes are planning pregnancy in the future.

In this regard, questions about the management of pregnant women in this risk group are becoming more and more relevant.

How is a caesarean section performed?

In order to understand the features and risks of managing pregnant women after a cesarean section, it is necessary to understand the course of the operation.

The first stage is the dissection of the anterior abdominal wall.

Layers: skin, subcutaneous tissue, aponeurosis, muscle stratification, parietal peritoneum. And only after all these layers is access to the abdominal cavity.

The most critical step is making an incision in the uterus.

It is usually performed as follows: the uterine wall in the lower segment is incised with a scalpel, after which the surgeon continues the incision with his index fingers.

This access is justified by the fact that the risk of damage to the vascular bundles located along the edge of the uterus is minimal. With a corporal incision, the uterus is cut longitudinally.

Then the fetus is carefully removed from the uterine cavity.

After that, manual separation of the placenta is performed. Remnants of placental tissue are removed with a curette.

Before suturing the uterine wall, you need to make sure that the outflow of bloody discharge will be complete - for this you need to check the opening of the cervical canal.
Suturing the uterus.

The correct technical implementation of this stage of the operation largely affects the further forecast. At the moment, preference is given to suture material - vicryl. It is quite durable due to the fact that it consists of several woven threads, and is also an absorbable material. The time of its complete resorption ranges from 60-90 days, which is enough for the fusion of the walls of the uterus.

After the revision of the abdominal organs, sequential suturing of all layers is carried out in the reverse order.

When do the seams heal after a cesarean section?

The healing time of the external and internal sutures does not coincide. On the skin, the seam grows together much faster, which is associated with the contact of the skin tissue with the air environment. The suture on the uterus heals for the longest time. The type of incision in the uterus is important.

Features of scar formation in the lower segment

It has been proven that when accessing the lower segment, the regeneration process takes place much faster.

This is due to the fact that the incision runs parallel to the muscle fibers, which means that most of the smooth muscle cells retain their integrity, and hence their functionality.

In addition, due to the good blood supply to this area, the healing process is faster and better.
Another argument in favor of access in the lower segment is the peculiarity of uterine contraction in the postpartum period.
The processes of involution (reverse reduction of the size) of the uterus take place in such a way that the area of \u200b\u200bthe lower segment is almost completely reduced, which means that the area of \u200b\u200bthe scar is noticeably reduced.
In general, within 3 months, regeneration processes take place in the seam area.

"Scar phenomenon" after corporal cesarean section

Completely different processes occur with longitudinal access. This area is much less well supplied with blood. In addition, with this incision, a large number of muscle cells are dissected, which leads to a noticeable decrease in the contractility of the uterus.

Moreover, it has been proven that for a long time after the operation, almost complete replacement of the scar tissue suture site gradually occurs. This means that with a longitudinal section along the course of the seam, there are practically no muscle cells left, their almost complete atrophy occurs.

This is the “uterine scar phenomenon” after corporal access. It doesn't get stronger over a long period of time. The longer the better principle does not work here.

But this does not mean that with this access it is necessary to plan pregnancies earlier than two years after the operation. Too early pregnancy is also dangerous with the risk of rupture of the uterus due to a defective scar.

Thus, the process of regeneration of the uterus after corporal incision proceeds much more slowly, worse, often with the formation of a defective scar, and many years after the operation, the suture site is almost completely represented by connective tissue.

The second pregnancy after cesarean is possible in 2-6 years. Many women neglect this rule and try to get pregnant within a year after cesarean. Although for some this does not happen planned. Early pregnancy after cesarean has its own risks, since the uterus is not yet ready for repeated gestation.

How quickly is reproductive function restored after surgery?

It's no secret that caesarean section is an alternative method of delivery, which was not at all conceived by nature.

This bypass of the physiological processes that occurs with a woman during childbirth was not provided at all. It is for this reason that the so-called "scissors" arise.

The restoration of the reproductive function of the body occurs much earlier than it can be carried out in practice.

So, for example, in the absence of breastfeeding, the first menstruation (and hence the restoration of the menstrual cycle with possible ovulation) can occur as early as 2 months after the operation.

However, the suture on the uterus by this time is completely "not ready" for the processes of stretching the myometrium during the onset of pregnancy. Of course, it is not possible to get pregnant immediately after a cesarean, since the reproductive function of the body needs time to recover, but still the ovaries can begin to ovulate as early as 40-50 days after the operation.

The connection between ovulation and lactation

If a woman is breastfeeding her baby, then the likelihood of pregnancy is much lower. Since the lactation process leads to the suppression of ovulation.

While maintaining breastfeeding, you need to adhere to the following rules: feeding should be every 3-4 hours, at regular intervals.

In such a situation, the likelihood of ovulation is reduced. But you cannot rely only on breastfeeding. In women after surgery, the early onset of gestation is very dangerous, therefore, it is recommended to use contraceptive methods.

How long can you get pregnant after a cesarean?

The most optimal period for the onset of pregnancy is considered to be 2 years after the operation.

This period of time was chosen for many reasons: in 2 years, the final formation of a scar on the uterus occurs, besides, the woman's body has time to recover.

This period is defined with a certain "margin" in order to minimize the risk of complications.

However, this does not mean that any pregnancy occurring before this date must be terminated. The main factor determining the outcome of the onset of pregnancy is the assessment of the viability of the scar. In other words, an unplanned pregnancy requires an individual approach. So how long after a cesarean can you get pregnant?

In general, if pregnancy occurs a year after surgery in the lower uterine segment (with a satisfactory scar), then such a woman has a high chance of safely carrying the baby.

The situation is different with the corporal caesarean section. Usually, one year is not enough for a permanent scar to form. Therefore, in this situation, the decision to maintain pregnancy is made on the basis of methods for assessing the postoperative suture.

Steps on thin ice or what to do if pregnancy occurs within the first year after surgery?

Despite the fact that doctors advise not to plan a pregnancy in the first 2 years after surgery, it happens that an unplanned pregnancy occurs. Most importantly, don't panic! All risks should be weighed and a complete examination should be carried out.

What to do if a woman becomes pregnant 6 months after the operation?

If pregnancy occurs six months after cesarean, this situation should be taken extremely seriously. This pregnancy must be carried out under close monitoring of the condition of the suture on the uterus. It is important to remember that a woman must be admitted to the hospital in advance at 35 weeks.

Pregnancy started 3-4 months after surgery

In such a situation, a woman is offered an abortion, since its preservation is highly undesirable. There is a very high probability of rupture of the uterus, ingrowth of placental tissue into the site of the postoperative suture. These complications pose a serious threat to the life of the mother.

What to do if pregnancy occurs 2 months after cesarean

Pregnancy after 2 months is strictly subject to termination, since the risk of complications is extremely high. 2 months is not enough time for the formation of a scar on the uterus.

Such a strict approach to the possibility of maintaining pregnancy after surgery is due to the danger for the mother, and in some situations - the appearance of a real threat to her life. Uterine rupture is the most urgent (first aid) situation in obstetrics. The volume of blood loss in a matter of seconds reaches the entire circulating volume of blood in a woman's body!

Is it worth saying after this that the severity of the doctor during pregnancy, which occurred at unacceptably early periods after the operation, is due precisely to the care of the woman?

The method of termination of pregnancy deserves special attention in such a situation.

None of the abortion methods are safe. Any technique has its drawbacks.

The most dangerous is the classic surgical method, as there is a high probability of uterine perforation with a curette (especially in the presence of endometritis).
Medical abortion is also dangerous, since a uterus with a scar has a reduced ability to contract, which means that the ovum is not always eliminated (removed). In addition, drugs used for medical abortion can also cause sutures to open.
Vacuum aspiration is the "lesser of evils", but this method is also not safe.

Considering all the risks of early pregnancy after surgery, as well as the dangers of termination, the use of contraception is considered necessary in this category of women.

It is preferable to use either barrier methods (condoms), or hormonal drugs allowed during lactation (Charosetta, Laktinet, Excluton).

Compliance with the optimal time interval after surgery until the desired pregnancy, as well as the use of methods for assessing the scar on the uterus, significantly reduce the risk of possible complications. A favorable course of pregnancy and gentle delivery help preserve the woman's reproductive potential.