Can a woman get pregnant after a caesarean? Planning for pregnancy after cesarean: far-fetched fears and real risks

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

Pregnancy after the second caesarean: when is it prohibited?

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

Why are obstetricians and gynecologists so worried when it comes to the third pregnancy after 2 operative births? There are several reasons for this.

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

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

Secondly, a frequent consequence of a caesarean is genital, which reduces the chances of becoming a mother. But even if the pregnancy has taken place, there is a threat of spontaneous miscarriage. The probability of a tragic outcome is especially high in the early stages, but there is also a risk of abortion in later periods.

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 can migrate along the wall of the uterus. Another complication associated with this is ingrown villi, which leads to.

Violations of the attachment of the placenta can lead to chronic placental insufficiency and fetal hypoxia, which is dangerous intrauterine growth retardation.

The most formidable complication is uterine rupture - an acutely developing condition, which is accompanied by massive bleeding. Often the child does not survive after this, all the efforts of doctors are aimed at saving the life of the mother.

When the uterus ruptures, a syndrome of disseminated intravascular coagulation develops: first, increased blood clotting 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 the third pregnancy - the third caesarean section is absolutely contraindicated with signs of insolvency of the scar on the uterus. These include:

1. The presence of cavities according to the results of ultrasound.
2. Thickness 1.5-2.5 mm.
3. Edema in the area of ​​the scar.

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 caesarean?

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

The fears of doctors about the course and results of the operation are associated with the following:

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

Despite the dangers of a caesarean section, natural childbirth 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 and possible complications

How is the third cesarean performed? In general, the procedure is the same as in the previous ones. However, there are some features:

• The operation is performed within the already existing scar on the uterus.
• During manipulation, control of hemostasis is very important in order to prevent the development of bleeding from the vessels of the uterus or abdominal cavity.
• The uterus with a scar shrinks worse, therefore, hypotonic bleeding is prevented - intravenous administration of oxytocin.

What week of pregnancy is the third caesarean? It depends on the condition of the mother and child. According to medical standards, you can give birth as early as 38 weeks. In some maternity hospitals, they prefer to carry out a subsequent caesarean at the same time as the previous one.

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

After surgery, various complications may occur:

• bleeding in the postoperative period;
• intestinal hypotension;
• purulent-septic infection;
• thrombotic complications;
• subinvolution of the uterus;
• failure of the scar;
• anemia.

When to plan a pregnancy after 2 cesareans?

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, carefully examined and only then decide on the next birth.

However, if the pregnancy occurred within a year of the second caesarean, abortion is not a safe way to solve the problem! In this case, it is necessary to examine the state of the scar on the uterus by ultrasound and visit an obstetrician-gynecologist.

Any intervention 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, specially for the site

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In order for a woman to become pregnant again, at least 18 months must pass after a caesarean section. During this period, a scar is formed, the woman's body is restored, blood loss is replenished, which is 3 times higher than blood loss during natural childbirth. It is possible to give birth to a child again only after 2-3 years, when the body is fully restored, a scar will form.

There are no contraindications for getting pregnant after a caesarean section. However, it is advisable not to rush, to plan a child 3 years after the intervention. Provided that the woman's body is fully restored, natural childbirth is possible.

In Europe, the United States, most of the women in labor (up to 70%) give birth naturally, which is associated with a more gentle way of performing the operation. A transverse incision is made in the lower part of the uterus, which avoids complications in the next birth.

Previously, the incision was made longitudinally and in the upper part of the uterus, which increased the likelihood of suture ruptures. Today, the probability of successful natural childbirth with surgical intervention on the uterus is more than 60%. For this to be possible, the following conditions must be met:

• get pregnant after 3 years of contraception;
• transverse section of the uterus;
• high location of the placenta;
• head presentation of the fetus.

You can plan to become pregnant if ultrasound examination, hysteroscopy do not show deviations.

Ways to assess the condition of the scar

Diagnostic medical research methods make it possible to visually assess the condition of the scar, draw a conclusion about how the woman's body is ready for childbearing and childbirth. To assess the condition of the seam resort to hysteroscopy. With the help of an optical system, not only the condition of the scar is precisely determined, but also the condition of the surrounding tissues, it is determined from which tissues the scar is formed.

A good indicator that increases the likelihood of a successful birth is a scar formed from muscle tissue. The possibility of scar divergence during pregnancy increases if the scar is formed by connective tissue fibers. In this case, the probability of divergence of the seam is high, and the doctor does not allow the next pregnancy.

A sign that a woman is ready for the onset of the next pregnancy is the good healing of the scar, its almost complete absence. For control, the hysteroscopy procedure for the first time can be carried out no earlier than 6 months after a cesarean section. With good healing of the suture on the wall of the uterus, hysteroscopy is repeated after 12 months.

A woman can become pregnant again if during this time no adverse changes have been detected during the re-examination. If there is a need to hurry with a new pregnancy, the doctor should assess the condition of the woman and make a conclusion. A more accurate assessment of the state of the seam and the readiness of the uterus for conception is carried out by the method of hysterography.

With an unplanned conception, when the scar has not yet healed, a medical abortion is performed if the period is not more than 49 days.

What happens if the scar does not heal

If the scar has not healed, conception is not desirable. A new pregnancy may result in:

• to anemia;
• seam divergence;
• miscarriage.

An unformed scar poses a threat to both the mother and the fetus. The ongoing scarring of the surgical suture causes circulatory disorders, fetal developmental defects. If you happen to become pregnant less than 6 months after caesarean section, consider the possibility of termination. The criterion for assessing the condition of the scar is its thickness. It must be thicker than 5 mm.

In the case of twins, the probability of divergence of the seam increases, a caesarean section is performed, without waiting for complications at 37-38 weeks.

Conditions of natural childbirth

Pregnancy after caesarean section proceeds as usual. And if before conception the scar on the uterus was in good condition, natural childbirth is possible, the main conditions of which are:

• one fruit;
• the weight of the child should not exceed 3.5 kg;
• absence of pathologies.

Natural childbirth is more likely after a cesarean caused by emergency situations, for example, placental abruption, fetal presentation, herpes. If the reason for the operation was chronic diseases, a serious condition caused by hypertension, kidney failure, then most likely the second birth will take place with the help of a caesarean section.

When not to get pregnant

Danger during pregnancy threatens not only the woman. You need to know that some diseases of the mother negatively affect the development of the fetus.

• Diseases of the heart, circulatory system - lead to oxygen starvation of the fetus.
• Diseases of the thyroid gland lead to mental disorders, creates a threat of miscarriage.
• Inflammatory diseases of the urinary system, reproductive organs can infect a child in utero.
• Diseases of the lungs and bronchi lead to oxygen starvation of the embryo, causing malformations.

In such cases, giving birth is not recommended, women are advised to protect themselves or tie the fallopian tubes. It is believed that a woman cannot have more than 3 cases of childbirth with the help of surgical intervention, although it is known about the safe birth of children in the case of 4 and even 5 caesarean sections.

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Complicated by a number of factors. After a cesarean section, a long recovery time for the female body is necessary, otherwise pregnancy may be under.

Possible problems during pregnancy after a caesarean section

If the reasons for the operation in the natural birth process are interconnected with various complications of a particular pregnancy, then in the future a woman is not forbidden to have children. But after a caesarean section, the doctor who performs the operation warns the new mother about the need to use contraceptives. This may be due to the fact that a soon-to-come pregnancy immediately after a cesarean will cause irreversible processes. Complications can be very scary.

That's what's dangerous second pregnancy after caesarean section if not planned. If you do not listen to the advice of doctors, do not use protection immediately after childbirth, you will have to terminate an early pregnancy in order to avoid significant complications. It goes without saying that there are also situations with the successful bearing of a child who was conceived almost immediately after a cesarean (after 4-6 months, and sometimes even earlier). But one should be aware that these are exceptional cases, not the rule, and one should take into account the consequences to which both the woman and the child will be exposed.

Baby after caesarean section

It happens that for the second time a woman is able to give birth not only with the help of a cesarean, but also herself. It is necessary to take into account the fact that only a doctor who monitors the entire pregnancy is able to make such a decision, since even in the process of childbirth there is a possibility that the scar may diverge.

Natural childbirth can take place in that situation, if the following conditions are taken into account:

• ultrasound after caesarean section showed that the scar is in perfect condition, there is no risk of suture divergence;
• outside the seam, you can see the localization of the placenta;
• only one transverse scar is created, which is called a “smile”;
• there is only one medium-sized fruit, the weight of which is not more than 3.5 kg;
• indications for cesarean delivery were directly only during that particular pregnancy (for example, during placental abruption, severe, abnormal presentation of the child).

Pregnancy a year after caesarean is quite normal. If the second pregnancy occurred later than a year after the cesarean, there is a chance that the woman will be able to give birth herself. But if this happens earlier, the doctor simply will not allow you to give birth naturally. It should also be remembered that doctors, as usual, do not allow more than three cesarean operations. After all, each subsequent operation will become more difficult, it will be much more difficult for a woman to undergo the operation.

After a cesarean has been done, a woman should be registered as early as possible, as well as conduct the necessary examinations. During the procedure, the doctor must determine the state of the seam after the operation.

In any situation, a strictly personal approach is required, a detailed study of the indications for a previous operation, since it is quite likely that a natural birth will be resolved. If a cesarean was prescribed to a woman due to the presence of such a disease as myopia, poor labor activity, or some kind of anomaly in the development of the pelvis, then you should not give birth yourself, because as a result, significant negative consequences for the life and health of a woman can form.

If the second pregnancy was also ended by caesarean, then the doctor may suggest sterilizing the tubes in the uterus, provided that she is not going to give birth to a third baby in the future. In such a situation, the third pregnancy is also capable of ending again with a caesarean. In a situation of a third pregnancy after two operations, the doctor is unlikely to allow the woman to give birth herself, because the risk will increase significantly.

Childbirth is a natural process. However, there are situations when delivery is carried out using a caesarean section. What if the baby was born in an unconventional way, and the mother would like to get pregnant again? Are pregnancy possible?

2 pregnancy after caesarean - planning

If the child was born with the help of an operation, then the next pregnancy after a caesarean section is possible no earlier than after 2 years. This is due to the fact that the scar on the uterus must be fully formed. If the second pregnancy occurred a year after the cesarean (or even earlier), when the muscle tissue had not yet had time to heal, then the woman may be in danger of uterine rupture along the scar - a situation that is extremely dangerous for the life of the expectant mother and child.

Planning for pregnancy after caesarean should begin with an examination of the scar on the uterus, not earlier than 6-12 months after the operation. The doctor will assess the condition of the scar using hysterography (x-rays in two projections) and hysteroscopy (examination with an endoscope that is inserted into the uterine cavity). Permission for a 2nd pregnancy after cesarean can only be obtained if the scar is almost invisible and is formed from muscle tissue. The situation is slightly worse when the scar tissues consist of mixed fibers. If the connective tissue predominates, the scar is recognized as insolvent, which means that a second pregnancy is contraindicated for a woman.

As a rule, the pregnancy of a woman who has undergone a caesarean section is no different from the usual one. True, at each appointment the gynecologist will examine the scar on the uterus. The expectant mother can even give birth naturally. However, this should be decided by the observing doctor, as well as the obstetrician-gynecologist of the maternity hospital, if the following conditions are met:

If the pregnancy occurs less than a year after the cesarean, you will not be allowed to give birth on your own. Pregnancy after the second caesarean, most likely, will also end in surgery. As a rule, doctors allow no more than three surgical deliveries, since each surgical intervention is more difficult to tolerate than the previous one.