A small gap between two Caesareans - what are the dangers? Caesarean section Break between Caesarean sections.

Quite often in antenatal clinics you can hear that a repeat birth after a cesarean section will follow the same scenario, and that natural childbirth is excluded in this case. However, in fact, this practice is increasingly being abandoned, since there is a real chance of giving birth naturally, even if the previous birth ended in surgery.

Today, a second caesarean section is performed only for strict medical reasons. And if the second pregnancy, like the first, ends in a caesarean section, then the woman is offered complete sterilization. Since a third pregnancy after a second cesarean section is extremely undesirable, it becomes dangerous not only for the health, but also for the life of the mother and child.

When is a second caesarean section indicated?

Caesarean section during the second birth is done if a woman has diabetes, high blood pressure, myopia, retinal detachment, or a recent traumatic brain injury.

In addition, a second planned cesarean section is performed if a woman has such anatomical features as a narrow pelvis, bony protrusions in the pelvis, and various deformities. There is a high probability of repeat cesarean if the pregnancy is multiple.

The outcome of the first cesarean plays a big role: if the operation was completed with complications, the scar after it is incompetent, then the second birth will be carried out using cesarean.

Those women who became pregnant again earlier than 2 years after surgery, as well as those who had abortions between a previous cesarean section and this pregnancy, are also at risk. Curettage of the uterus has an extremely negative effect on scar formation.

Repeated surgery cannot be avoided by those women who have a longitudinal suture after the first cesarean section and those who have placenta previa in the scar. And also if the scar is dominated by connective tissue instead of muscle.

Is a second cesarean section dangerous?

If you are considering a second planned caesarean section, you need to understand that it carries greater risks than the first. Repeated cesarean section often causes complications such as injury to the bladder, intestines, and ureters. This is due to adhesive processes - frequent companions to cesarean section and other strip operations.

In addition, the frequency of complications such as anemia, thrombophlebitis of the pelvic veins, and endometritis also increases. And sometimes a situation arises when, due to hypotonic bleeding that has opened and cannot be stopped, doctors have to remove a woman’s uterus.

But it is not only the mother who suffers from the operation. For a child, a second cesarean section is associated with such risks as impaired cerebral circulation and hypoxia - a consequence of a longer stay under the influence of anesthesia. Indeed, during the second cesarean section, it takes much more time to penetrate and extract the fetus from the woman’s abdominal cavity than the first time.

How is the second caesarean performed?

For a repeat cesarean section, the incision is made along the existing suture. In other words, the old seam is excised. This somewhat more difficult and longer than during the first operation. And the healing period increases. A woman will feel post-operative pain longer.

The suture after the second cesarean section takes a little longer to form than after the first time. This process needs control, since various complications such as adhesions, suppuration and other unpleasant moments cannot be ruled out.

But there is no need to get upset ahead of time. Probably, your doctor, taking into account the reason for the cesarean last time, will try to do everything to eliminate the possibility of a second operation, and you will give birth to the baby naturally.

Despite the warnings of gynecologists, many women decide to have a third pregnancy, having had two caesarean sections behind them. Is it possible to have a third caesarean section after 2 caesarean sections and what dangers can this manipulation entail?

Pregnancy after the second cesarean section: when is it prohibited?

After the second cesarean section, most doctors insist on tubal ligation - sterilization. This manifestation of concern for a woman’s health is not accidental - not everyone manages to endure a third pregnancy without complications after two surgical births. Problems can begin from the first weeks. To minimize them, pregnancy should be planned together with your doctor.

Why are obstetricians-gynecologists so worried when it comes to a third pregnancy after 2 surgical births? There are several reasons for this.

Firstly, a previous cesarean, like any abdominal operation, can lead to the formation.

Adhesions are strands of connective tissue that can change the position of internal organs, tighten the fallopian tubes and thereby narrow their lumen. Pelvic pain in those who have undergone surgery is an indirect indicator of the development of the adhesive process. In such a situation, even getting pregnant becomes problematic.

Secondly, genital complications become a common consequence of cesarean section, which reduces the chances of becoming a mother. But even if pregnancy takes place, there is a risk of spontaneous miscarriage. The likelihood of a tragic outcome is especially high in the early stages, but there is also a risk of miscarriage in later stages.

Thirdly, a scar on the uterus can become an obstacle to the normal attachment of the placenta. In search of a suitable place, the placenta may migrate along the wall of the uterus. Another related complication is villi ingrowth, which leads to.

Disorders of placental attachment can lead to chronic fetoplacental insufficiency and fetal hypoxia, which is dangerous due to intrauterine growth retardation.

The most serious complication is uterine rupture - an acutely developing condition that is accompanied by massive bleeding. Often the child does not survive after this; all the doctors’ efforts are aimed at saving the mother’s life.

When the uterus ruptures, disseminated intravascular coagulation syndrome develops: first, increased blood coagulation develops, then a transitional state occurs in which blood clots alternate with the liquid part, then hypocoagulation and severe bleeding develops, which is almost impossible to stop.

Before getting pregnant for the third time, you need to weigh the pros and cons. The combination of a third pregnancy - a third cesarean section with signs of incompetent scar on the uterus is absolutely contraindicated. These include:

1. Presence of cavities according to ultrasound results.
2. Thickness 1.5-2.5 mm.
3. Swelling in the scar area.

The list of other contraindications corresponds to those when planning any pregnancy. Mainly:

• chronic diseases of internal organs of high severity;
• diseases in the stage of decompensation;
• autoimmune diseases;
• infectious diseases in the acute stage.

What is the danger of a third cesarean section?

Any operation carries a hidden threat. This also applies to cases where a third caesarean section is performed.

Doctors’ concerns about the progress and results of the operation are related to the following:

• adhesions from previous interventions increase the risk of injury to the intestines or bladder;
• true placenta accreta is possible - in this case, the operation is completed by removing the uterus without appendages.

Despite the dangers of a caesarean section, giving birth naturally should not even be considered.

The presence of two or more scars on the uterus is an absolute indication for surgery.

Features of the third cesarean section and possible complications

• How is the third caesarean performed? In general, the procedure is the same as in the previous ones. However, there are some features:
• The operation is performed within the existing scar on the uterus.
• During manipulation, control of hemostasis is very important to prevent the development of bleeding from the vessels of the uterus or abdominal cavity.

A uterus with a scar contracts worse, so hypotonic bleeding is prevented by intravenous administration of oxytocin. At what week of pregnancy is the third cesarean section performed?

It depends on the condition of the mother and child. According to medical standards, delivery can begin as early as 38 weeks. In some maternity hospitals, they prefer to perform a subsequent cesarean section at the same time as the previous one.

According to vital indications, the operation is performed at any time.

• Various complications may occur after surgery:
• bleeding in the postoperative period;
• intestinal hypotension;
• purulent-septic infection;
• thrombotic complications;
• subinvolution of the uterus;
• scar failure;

anemia.

When to plan a pregnancy after 2 caesarean sections?

If a woman is planning children, then a third pregnancy a year after a cesarean section is not the most suitable option. It is recommended to wait 2-3 years, undergo a thorough examination and only then decide on the next birth.

Any interventions in the uterine cavity can lead to serious consequences and worsen the prognosis for pregnancy. Therefore, it is important to choose the most suitable method of contraception for yourself after childbirth.

Yulia Shevchenko, obstetrician-gynecologist, especially for the site

Useful video

Having already once gone through a serious complication of childbirth (caesarean section), women who decide to have a second birth ask themselves many questions: how to give birth, at how many weeks, how to prepare themselves for childbirth, and others. We will try to answer the main ones.

To do or not to do?

The first thing that worries expectant mothers is whether a planned second cesarean section is necessary. In principle, situations quite often occur when women, after the first cesarean section, give birth to their second child naturally. Of course, more attention should be paid to such a woman in labor, but this is a fact. If your doctor, conducting an examination before childbirth, concludes that you are capable of giving birth on your own, then you should not be afraid: the doctor definitely knows better. Before making a conclusion, your gynecologist:

• Assess the condition of the uterine scar, whether it is sufficiently strong and formed. If your subsequent pregnancy occurred no earlier than 2-3 years from the previous one (that is, the first cesarean was performed at least 2 years ago), spontaneous childbirth is likely, but if there are other complications, a cesarean section is also possible.
• Find out how many pregnancies ended in childbirth, and what features they had. If you have given birth by cesarean more than once, this birth will also require surgical intervention.
• Summarizes your general health. If you had your first cesarean section for medical reasons that have already been eliminated, the diseases have been cured, and your health is at a good level, then it is quite possible that you will have to choose between a natural birth or a second cesarean section. If the reason for the cesarean was the characteristics of the body that do not allow childbirth, then the question is resolved by itself: the doctor will insist that the second delivery be also by cesarean section.
• Draw conclusions about the condition of the fetus (its presentation, size), location of the placenta, single or multiple births. If these parameters allow you to give birth on your own (correct presentation, singleton pregnancy, low baby weight, placenta far from the scar area), then you will most likely be able to give birth to a second child without a cesarean section.
• Pay attention to the technique of performing the previous operation. If a longitudinal incision was used (which is technically easier), you are practically guaranteed a second cesarean section, also longitudinal, and if you had a transverse incision, then such a scar, due to its density, can allow you to plan a natural birth.

Pregnancy after cesarean section is monitored more carefully from the first weeks; such a woman is often sent for an ultrasound and her condition is monitored. Responsible young ladies attend consultations more often than expected, this applies to the second and third trimester, especially the last weeks.

Timing of delivery through repeat cesarean section

Of course, it is important for pregnant women to know at what stage a planned second caesarean section is performed in order to prepare and how it goes. This depends on the condition of the pregnant woman and the fetus: the more complex the pregnancy, the larger the fetus, the thinner the scar, the sooner a planned cesarean section is prescribed. It is also important how many children you are carrying: if the pregnancy is multiple, surgery is scheduled earlier than usual. Most often, the date for surgical intervention is set a couple of weeks earlier, that is, at 38 weeks, but in special cases they can even be scheduled at 37 weeks or earlier, if there are indications for such an early delivery.

There are cases when a woman does not even carry her to term until 36 weeks: the scar is dissolving. If such a complication of pregnancy is discovered by the doctor, then the patient is immediately sent to the operating table, and it does not matter how many weeks of her pregnancy she is, since it is primarily about saving the life of the woman in labor.

If you want to know how long it takes for most women to have a repeat cesarean section, you can read their reviews of the procedure. On pages on Internet blogs and forums, ladies animatedly discuss the topic of “repeat cesarean section,” share their experiences, give each other advice, form groups by city, and even write contacts of specialists whose work they liked.

Complications

When preparing for an operation such as a second planned cesarean section, a woman should be prepared for various complications. Firstly, the second time, interference with the integrity of the uterine tissue can lead to serious bleeding, and the doctor, if necessary, to save the mother’s life will have to resort to complete removal of the organ - they do a hysterectomy.

Also, any surgical intervention can lead to the development of adhesions in the pelvic area, which means that the second cesarean section will be complicated, and precious time will be spent on excision of old scars (if necessary).

For a child (even if planned), a cesarean section (especially the second and subsequent ones) is also a very risky undertaking: he is in the womb of his mother, who is anesthetized with potent drugs, which means he receives a serious dose of them, regardless of what kind of anesthesia is given - epidural or general. During the second cesarean, labor begins in advance, so the baby is not yet fully developed, and its vital systems start with some lag. There is even a risk of asphyxia (lack of oxygen), which can have serious consequences.

In addition to all of the above, after a woman undergoes a second planned caesarean section, it is simply dangerous for her to become pregnant again. Even if the previous pregnancy ended successfully, the woman is still offered voluntary surgical sterilization - removal of the uterus. During pregnancy after a second cesarean section, the risk of rupture of the scar or the uterus itself is too high, and even with a favorable outcome of the next birth, the risk of developing immunodeficiency, inflammatory processes of the pelvic organs, and urinary and genital tract infections increases several times.

You need to think about whether you want to have a repeat cesarean section or whether it is important for you to give birth on your own, from the first weeks of pregnancy. The choice is always yours; it directly determines how many more children you will have. We hope it will be correct.