after 3 caesareans. Next surgical delivery. What do doctors think

Surgical obstetrics has long ceased to be an exception in obstetrics. For many women, this is the only possible chance to have a child, since natural childbirth is contraindicated for them. Cases of repeated and even multiple operations are also not uncommon.

The third caesarean section after the previous two carries more risks than the first intervention. Often, doctors even offer to perform sterilization to mothers who have already passed through them. The reason is the skepticism of doctors about the successful bearing of a pregnancy after repeated suturing on the wall of the uterus. Violation of the integrity of the organ leads to dangerous complications, which can result in internal bleeding, death of the fetus or woman.

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What could be the danger of a third caesarean

A caesarean section leaves behind not only a scar on the abdomen, but also a number of changes in the structure of internal organs that may remain undetected for a long time. In the case of successful first and repeated operations, a scar is formed at the site of the incision of the uterine wall. A large amount of connective tissue is deposited in this area.

Unlike muscle fibers that can stretch and contract, it is completely inelastic. During subsequent pregnancies, the organ does not have the ability to increase in volume evenly: the back wall stretches more, and the front wall experiences increased stress due to an unyielding scar. The chance of a successful outcome exists only if there is a consistent suture, when the altered area is able to resist stretching, is not prone to tearing, and there are no cavities in it.

As a result of the operation, other organs of the small pelvis and the pelvic cell may suffer.

Possible consequences of this operation:

The terms of the third cesarean are negotiated in advance. With a successful course of pregnancy, the operation is carried out in the period from the end 35 to 39 obstetric weeks.

Features of the third cesarean

Depending on the physical condition of the future woman in labor, she is hospitalized in a hospital a few days or weeks before the operation. In difficult cases, the period of the earlier appointment is changed. Before artificial childbirth, all traditional events are carried out: a control examination, cleansing of the intestinal cavity.

The incision for the third caesarean section is performed in the same area as in previous operations. During the intervention, special control is necessary for blood clotting. The previously operated uterus contracts worse. For this reason, the likelihood of hypotonic bleeding is much higher than with the first caesarean. During the intervention, such women in labor are more likely to receive injections of oxytocin.

The type of anesthesia does not depend on which operation is billed. Other indicators matter:

• state of the nervous and cardiovascular systems;
• risk of fetal harm.

Spinal epidural anesthesia is considered the least dangerous for a woman's health. Some pediatricians claim that it has a pathological effect on the child's brain, although convincing arguments for this still do not exist.

In some cases, the duration of the operation for the third time is somewhat longer. This is due to the care with which the doctor examines the condition of the tissues of the walls of the uterus and sutures.

After a cesarean for the third time, the stay in intensive care may be delayed for several days. In bed, it is recommended not to lie for a day, but longer, until health is restored.

What to pay attention to

It will be necessary to monitor changes in the structure of the suture and the development of the fetus throughout the entire period of pregnancy. An emergency visit to the clinic is necessary if there are cramps or a feeling of heaviness in the abdomen, a sharp decrease or increase in blood pressure, dizziness, bloody clots, fresh blood, or a strange type of discharge from the genital tract.

The previously established period, after which the planned caesarean section is made, is postponed to an earlier one if the woman in labor is diagnosed with an infectious disease, an exacerbation of a chronic pathology, and an incorrect presentation of the fetus.

If a woman planned and became pregnant for the third time after two operations, natural childbirth is excluded. Resolution is possible only by surgery. The presence of repeated intervention is a direct indication for the next cesarean.

How long is the third caesarean?

The time of the third caesarean section depends on the period at which the previous interventions were performed. If the first operation was performed after 38–39 obstetric weeks, subsequent operations are traditionally transferred 1–2 weeks earlier. The usual period of the third intervention is 35–37 weeks. Until 39 weeks, they rarely wait, in which case the risk of complications is very high.

The reduction of the term is affected by such circumstances as:

• complete placenta previa ;
• breech presentation fetus;
• multiple pregnancy;
• signs of seam divergence;
• the threat of internal bleeding;
• detection of HIV, infection with hepatitis or other dangerous infection;
• deterioration in the physical condition of the mother.

At what time is a planned caesarean section performed during a difficult pregnancy, depends on each specific case. In the most severe cases, the operation is postponed until the end of the 32nd week. The fetus at this stage of development is quite viable. After extraction, the children are placed in special boxes, where they are kept under supervision. neonatologists until they reach the required body weight.

In the event of a direct threat to the health of the mother, delivery is carried out at any time.

Features during childbirth

With the successful management of pregnancy and the absence of complications for the woman in labor during the operation for the third time, nothing changes. After the birth of the child, the wall of the uterus and the abdominal cavity are sutured, the woman moves away from anesthesia, the postpartum period begins: the release of lochia, the formation of lactation.

The age of a woman at which she undergoes her third caesarean section also means a lot. Most cases of repeated operations occur after the age of thirty or forty years, when various disorders begin to accumulate in the body: cardiovascular diseases develop, problems in the reproductive sphere, and the metabolic rate decreases. This increases the risk of complications after surgery and causes a long recovery.

What do doctors think

Doctors "do not like" pregnant patients with a history of several cesarean deliveries. It's not about some prejudice, but about the risk to the future mother and fetus. Nature has not provided an alternative method of delivery, except for natural ways, and the surgical method is more dangerous, especially if the intervention is repeated. In fact, the area of ​​operation, which must be protected from any aggressive influences, is subjected to continuous stress. The volume of the uterus increases during pregnancy by almost 500 times, the walls become thin, stretched. For tissue with scars, this is the worst option. At any moment, the seam may not withstand and disperse, and in such a case it can be problematic to save the patient's life.

To reduce the risk of ruptures and possible complications before the onset of childbirth, women should avoid additional physical activity: do not lift weights, give up sports training. Even intimacy may be undesirable if the doctor determines any violations in the structure of the scar.

After the previous two operations, the risk of trauma to surrounding tissues and postoperative complications increases. As a result of the third cesarean, many develop adhesive processes in the pelvic area, and persistent disorders in the work of the intestines, kidneys, and bladder may develop. There are frequent cases of subsequent infertility, amenorrhea. The risk also increases after a repeat caesarean. Due to the early deadline, lactation may not occur.

The mother's condition is recovering more slowly. The healing of the seam takes up to 3-4 months. Until the expiration of this period, it is forbidden to play sports, have sex, work hard at home.

To do a tubal ligation - sterilization, after the third intervention, a woman has the right by law, regardless of age. Subsequent pregnancies may be absolutely contraindicated for her health reasons. The proposal to perform the procedure comes to many even earlier - after the secondary operation. It should be regarded as a concern for the life of a woman, and not as a hostility of doctors to the process of childbearing.

In case of refusal of sterilization, the selection of a reliable method of contraception is required.

Conclusion

The latest date for a third caesarean section is 38 weeks. Further delay greatly increases the risk of complications. According to doctors, a long break after the previous operation, as well as too early pregnancy, is undesirable. If a woman decides to give birth to a third child, it is best to do this in the period from 2.5 to 6 years after. Natural childbirth in such cases is prohibited.

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As a child, I sincerely believed that when I grew up, I would have three children. But this is in childhood. And after the birth of my first child, I was sure for a long time that he would be my only child - he was so hard for me. But still, after 6 years I gave birth to a daughter. I wrote about it in my story.

To be honest, the question in the title of the story was purely rhetorical, at that time I did not think about any next child. The plan was fulfilled, there is a son and a daughter - everyone is healthy and happy. Life revolved according to the scheme: work - school - kindergarten - musician - dancing - English-pool: just have time to match the schedule, meet, see off, pick up. And suddenly, unexpectedly, "the idea of ​​a third child" surfaced. Where would you think? In the most fabulous corner of the earth, in the Terem of Santa Claus.

"Look into this magic mirror, make a wish, and it will certainly come true," said Father Frost's helper. Well, I looked. And she wished to "come here again, with three children." The next second, when this phrase came to my mind, I was stunned and looked around: "Is it actually me or not I thought? Or did someone say nearby?"

"Do you yourself understand that this is a mortal risk? Do you want to leave children as orphans?" - the local gynecologist almost shouted at me. In vain I decided to consult with her. I'd better go to the surgeon who cut me twice.

"Why not? Of course you can, if you really want to!" Her calmness shocked me a little. “But I already have two CSs,” I clarified once again, just in case. "So what, you already endured it once with a scar, so you can endure it again." "But I'm also Rh negative, and my husband is Rh positive." "But last time there was no conflict, why should there be now?" I, almost in shock from her answers, began to remember what else alarmed me in my thoughts on the topic "To be or not to be?". Oh yes. "But I'm also old." The surgeon somehow incomprehensibly-tensely began to peer into my face. "And how much you?" Well, I think, everyone, they have sailed, now they will say that the muscles have become inelastic and it is no longer possible to cut (that's what kind of nonsense will not come to mind!). "Thirty-seven," I said in a barely audible voice. "What? Is this age? Don't fool me, go get pregnant already."

The first step on the path to "being" has been taken. But, having received such a blessing, for some reason I chickened out. And the habitual meditation on the topic “To be or not to be” that has been habitual in recent months raged in my brain with renewed vigor, and there were clearly more arguments in favor of “not to be”. But I thought that it wouldn’t hurt to be examined and pass all kinds of tests anyway, suddenly a bunch of infections show up (I was periodically treated for one or the other, having chronic right-sided adnexitis). It wasn't there. "Everything is fine with you, you can get pregnant," the doctor's verdict sounded in the department of the perinatal center. Wow! This was the second step.

It remained to make the most responsible - the third, i.e. get pregnant. It didn't work the first month. "Maybe here it is - a sign that it is not necessary to do this," the thought tormented me. Okay, I'll try again and back off with a clear conscience. A little more than a month has passed, and here they are - two strips. Apparently, the kid realized that this was his last chance.

So, with my own hands, as they say, I broke myself a relatively calm, carefree life in an average family with two children.

"Whom are we waiting for so much - a boy or a girl?" - asked the uzistka, having learned that the third KS is planned. "We don't care, we have both a boy and a girl already," I answered. "And yet you need another one? Do you know what risk you're putting yourself in? For what?" Well, it ruined the whole mood. Of course I know.

To my surprise, the doctor in the LCD, where I got registered, did not read me any notations, led my pregnancy under the motto "What will be - will not be avoided." In her practice, I was not the first to go to the third CS, and the previous story ended happily, so she set me up for the same outcome.

I read on the Internet that pregnancy in the case of the third CS is carried out more carefully, ultrasound is done more often, etc. In my case it didn't work out. I went to the appointment with the same frequency as in previous times, I did ultrasound 3 times, as usual: at 12, 22, 32 weeks and already before the operation in the maternity hospital.

This pregnancy was the easiest. If in the first pregnancy I got into pathology twice, in the second - once, then in the third time - zero. There was not a single bad analysis, including, and the analysis was negative. Ultrasound showed that everything was normal. I am still surprised by this, because there is an opinion among the people that with age, pregnancy is more difficult to bear. I did not protect myself more than in previous times, maybe even less - with two children there is no time to protect myself. We even made a planned trip by car through Scandinavia. And even cooler - we went camping with our eldest son and spent the night in a tent. As they say, we had a great summer vacation.

Then I still worked, as expected, until 30 weeks, even a little more. At 33 weeks I called the surgeon to "build bridges". She was not at all surprised by my call, it seems that she was even waiting for it: "Call me at 36 weeks, you will lie down at 37." Of course, I read that for the third CS at 37 weeks they will definitely be hospitalized, but I myself was not ready for this. On the one hand, of course, it’s calmer this way, on the other hand, I wanted to reach the deadline, and there was neither desire nor a special opportunity to do this in the maternity hospital for 3 whole weeks - it was a pity to leave the children for so long.

And, apparently, God heard me. Called at 36 weeks. Some kind of “exercises” were going on in the maternity hospital, my surgeon was “sutured up”, so they told me to go home for another week. I called 37. There was a CS boom in the maternity hospital, the department was packed to capacity, and, having learned that everything was in order, I was sent to walk for another week. As a result, I ended up in the department at 38.5 weeks.

For some reason, my doctor thought that my term should be shorter, and she got so excited and fussed when she found out that she was about 39. She immediately ran with me for an ultrasound scan. We measured the thickness of the uterus in the area of ​​the scar 3 mm - ugh, this is the norm, thinning is considered to be less than 2 mm. It was stated that the fetus does not suffer, the blood flow is normal, and all sizes correspond to the term. She felt the scar on the chair by hand and said that everything was fine, the neck was closed, and ... "Why hurry?" - I almost fell off the chair, I was already ready to run to the operating room. In general, for another 5 days I "holiday" in a separate room. Ate, slept and embroidered.

In the meantime, they took a bunch of tests from me, made all kinds of diagnostics. In general, the planned CS was prepared according to all the rules. The operation was performed on December 17, 2007. At 9.50 they let me breathe the drug, at 10.05 they took my daughter out, at 10.25 they finished. At the same time, they managed to “kill two birds with one stone”: they tied the tubes and cut off the very ovary that had not allowed me to live in peace for the past 15 years. They did it under general anesthesia, for some reason our local anesthesiologists are not friends.

The retreat went well, especially since my neighbor in the intensive care unit turned out to be a "kindred spirit" - also an associate professor, also a candidate, and we work at the same university. In general, we arranged a scientific conference with her, and even gave a lecture to a young doctor on the topic "how to defend a dissertation." They took away the soul, as they say.

From a medical point of view, compared to the last time, there were two minuses: the first - immediately after the operation there was no blood discharge, and the nurse greedily pressed on my stomach so that I was ready to strangle her as soon as I got to my feet. But a neighbor in the ward told a horror story that, they say, she knows a girl who, after a CS, had many clots formed inside, which "crawled" into the uterus, and had to be cleaned. As soon as I heard this, I practically began to rejoice when they pressed me on my stomach. The second minus: already on the second day, due to a full house of caesarean sections and a lack of places in intensive care, I was transferred to the postpartum. There, no one even thought to help me get up, I had to get up myself, go for injections and go to the toilet - a nightmare. Everything hurt as if I had been unloading the wagons for a couple of days without a break. The doctor said it was a reaction to anesthesia.

But on the third day I felt better, on the fourth day I was already running along the corridor.

So, Arinka was born at 39 weeks and 2 days, 3440 gr, 55 cm, 8-9 points. Feed was brought 8 hours after the operation. Then they brought every 3 hours, on the fourth day they settled with me. Arina turned out to be even that glutton, there was not enough milk, but I did not supplement, gave water to drink and often applied to an empty breast. A day later, the milk came, so we are completely on GW, and I hope that this is for a long time.

The stitches were removed on the seventh day, on the eighth - they were discharged, as usual. A husband with children came to the discharge - how happy they were, this is something! Here I would like to deviate a little from the topic and say that I was lucky - my older children Stepan and Lida are very attached to each other, despite the age difference of 6 years. They work together with great pleasure, play, come up with something new, and the concept of childish jealousy has bypassed us. They were looking forward to the arrival of their sister. And in the maternity hospital they asked for it to go to the room where Arisha was changed for discharge. From there came their enthusiastic exclamations: "Oh, how small she is", "How beautiful she is", "Why does she have a red face", "She looks like my Lyalya", "Let me hold her." Since then, my older children help me in everything with the younger one and sometimes even argue for the right to do something for Arinka. This is the kind of princess we have.

In general, as you can see, everything went well. Being at the stage of developing my plan, I practically did not hope for such an outcome. The result of "death risk" snores peacefully next to me, and there are no words to express the feelings that I feel, hugging my chubby daughter to me. Only sometimes I get scared - when I think that I could choose the path of "not being."

Discussion

MRI signs of osteochondrosis of the lumbosacral spine. Disc protrusion at the level of L5-S1. Anatomical variant of the relative bone narrowness of the spinal canal. These diseases will not interfere with pregnancy and future health. you can give birth after 3 CS

I have 3 ks.2003, 2006 and September 2012. With the third pregnancy, I never lay in storage. All frightened and doctors and relatives. they said that you would leave your children orphans. And I knew that everything would be fine. Procesarean at 37 weeks. They offered to get in touch. but I didn't agree. So go ahead if you want. All good luck!

Girls, I also have three cesareans - all boys. The youngest is now 4 years old, I want to go to the fourth caesarean. Does anyone have such experience? Please share how it went?

Girls, I have three caesareans. All boys. I really want a girl. Has anyone had a fourth caesarean?

I will also have 3KS. when I found out that I was pregnant, I ran to a paid (good) gynecologist, she said that it was better not to risk it ... after her, I suffered, thought, and after 1-1.5 weeks I went to my district police officer: she listened to me calmly, and said, "Well, give birth!", And I "what about two seams, and the youngest is 2.8 years old." She "just in time for childbirth 3 will." and I decided, happiness knew no bounds. I also thought, I’ll just get dressed up, and I won’t “steam” with protection. Now I'm 37 weeks old, everything is ok, only now I'm "worried" about the dressing, my husband says "no need", and I myself don't want to or something ...

My friend recently gave birth to 3 children by caesarean section, and she has 4 in total .... and besides, she has diabetes .. everything went fine, the main thing is to believe in yourself and not be afraid ...
I have 1 child so far, my son is a year old and I had an emergency CS, so I think when the second one comes, I will also have to do a caesarean section and if the third one too ... so I'm not afraid of this ...

GOOD ARTICLE WITH A GOOD END!
I HAVE TWO CAESARIES, I'M AFRAID OF THE THIRD, BUT I WANT TO, I ALMOST LOST THE SECOND BECAUSE OF THE SCAR, THE WHOLE SET WAS WHETHER I WILL GET THE THIRD TIME, I DON'T KNOW........

Dasha, thank you very much! I also have two CCs. I decided to check before I get pregnant again and now there is a 4 mm seam on the ultrasound - they say that this is a complete contraindication, but I really want a third one. The doctor just doesn't throw objects at me. He says that if it’s so unbearable, then you first need to do the plastic of the seam, well, he prays day and night. But I can’t help myself, all the fibers of my soul dream of a third child, although I have a set: a girl and a boy. But madly want another karapuzinka.

Dasha, thanks for the article. This is my third pregnancy and will be my third COP. The doctor was terrified. But everything will be fine!

You are really great! They thought of everything perfectly, tested their strength, capabilities, health. I myself have two CS and everyone around me says that the third CS is simply impossible. Thanks for the article, now I know it's not.

You are well done! You did everything right. You were really lucky with a surgeon who did not intimidate you, but on the contrary, reacted positively to this, which is extremely surprising. In all civilized countries, Caesars are born many times and no one dissuades the mother, and even more so intimidates ... I have three children and we are expecting a fourth. I gave birth to the very first one in Kyiv in 1990, so I got acquainted with all the "charms" of our maternity hospitals, and especially with the staff. And the next two have already given birth in Canada. What is the difference to give birth abroad! It is indescribable, even considering that medicine is free here. Now it’s hard for you to imagine that you might not have had such a nice little “havroshechka” if the surgeon had dissuaded you then. You are a very brave woman who went through this whole nightmare. Good luck to you and your kids!

What good fellows you are! I really didn’t have a COP - she gave birth herself. I just went to read it, because my girlfriend has 2 CS and really wants more, and the doctor, just like in your case, prophesies a fatal outcome! :(It’s sad that we are so far behind the world! But there is also a positive, my another friend gave birth to her second son herself exactly 2 years after the first COP! True, there is only one doctor who takes us for such cases, and, oddly enough , he is a man!I wish health and happiness to your large and friendly family!

Well done!
The main thing is a good attitude - and everything will work out. Itself with three cesareans - but the third one was even obtained for me under the epidural :-)
Have you already met with benefits for large families?

Dash, great! Well, when you do everything, and you get such cool stories! Write more!
Happiness and health to all your friendly family!

2016-09-12 12:45:09

Irina asks:

Hello, tell me please, I have a planned caesarean section, I have a term of 39 weeks and have a small temperature of 37, there are no more manifestations of a cold, will they do a caesarean at such a temperature?

Responsible Bosyak Yulia Vasilievna:

Hello Irina! Subfebrile temperature may be normal during pregnancy and is due to the production of progesterone. Have you checked your kidney function? Is there no protein in the general urine test? If not, then you can plan a caesarean section.

2014-01-09 15:11:50

Xenia asks:

Hello! I had a laparoscopy in December 2013 (an ectopic on the right, the tube was saved), the period was 5 weeks. it was in the fimbrial section of the tube .. he says they let in blue - the tubes are passable, and at the same time he says the right tube was soldered to the ovary. In the past, a caesarean section and an abortion. (10 pieces every other day), aloe (7 days intramuscularly). One of these days I am going to undergo physical procedures (electrophoresis, ultrasound) The doctor also advises to take a course of hydrotubation 10 times ... Please tell me if I need to check the pipes before planning, what other treatment to pass? And most importantly, is it worth doing hydrotubation????

Responsible Palyga Igor Evgenievich:

In my opinion, hydrotubation is an outdated ineffective procedure. Conservative treatment is enough. Even if one tube is impassable, the second will function and therefore pregnancy is possible. It is almost impossible to effectively restore the patency of the pipe, on which there was surgery. The visual patency has been restored (the bluing has passed), but it is very difficult to restore the functioning of the fimbriae (villi). It is only necessary to check the patency of the tubes if pregnancy has not occurred for 6 or more months of open sexual activity.

2012-11-19 09:30:01

Marina asks:

Good afternoon I am 36 years old. There is a child 11 years old, caesarean section. In September there was a frozen pregnancy, a period of 6 weeks. I really want to have more kids. As a result of cleaning, there is endometriosis of the postoperative scar (before pregnancy there were no diseases, the examination by the gynecologist took place every 5-6 months, the smears were always normal, the histology was good). And since spotting began in the middle of the cycle, destreptase 12 suppositories were prescribed for this cycle and from the 16th day of the cycle, utrozhestan vaginally 10 suppositories. The ultrasound was done on the 13th day of the cycle, the endometrium was three-layered, of the correct form (as they said beautiful), but only 5-6 mm. From the first day of the cycle prescribed COC. They offered several options - ZHANIN, YARINA, MEDIAN, REGULON. Tell me, please, which COCs are better to take in my case? I am also ready to listen to your suggestions.

Responsible Gritsko Marta Igorevna:

The treatment was prescribed correctly, regarding COCs, I can advise you to donate blood for sex hormones - FSH, LH, prolactin, estradiol, which are taken on the 3-5th day of m.c. and progesterone, which is taken on the 21st day of m.c. This will make it possible to assess your hormonal background and choose the appropriate contraceptive. Given your age, I think Regulon or Jeanine would be the best choice. Midiana and Yarina are similar drugs, in which the dose of progestogen is higher. Than in Jeanine and Regulon.

2011-04-15 04:22:10

Tatyana asks:

Hello! Please tell me. On December 20, 2010, a small caesarean section was performed at a period of 21-20 weeks, Diamniotic Monochorionic twins, the girls died. A diagnosis of polyhydramnios was made. How long can you get pregnant and if there is a chance that there will be twins again. What examinations need to be done to prevent this from happening again?

2008-12-22 12:35:25

Tatyana asks:

Hello, Doctor!
I have a pregnancy, a period of about 3 weeks, there is no way to save it, so we decided to have an abortion. I already have a child, the birth was 2 years 8 months. ago, an emergency caesarean section due to a clinically narrow pelvis. The postoperative period was uneventful, there was no inflammation, no cleaning. This is the second pregnancy, there were no abortions. There are no gynecological and venereal diseases. Age 24 years. The doctor suggests medical abortion. At the time of taking the pills, the delay will be 9 days. Cycle 28-30 days. I have the following questions for you:
Can I have a medical abortion after a caesarean? Will the suture on the uterus come apart? What are the possible consequences on my term.
Thank you in advance!

Responsible Filippova Olga Yurievna:

Hello. Medical abortion is indicated with a delay of no more than 10 days. It does not affect the state of the uterine suture, after a cesarean section, medical abortion can be performed, some complications are possible (your gynecologist should tell you about them.

2008-04-19 17:24:39

Ludmila asks:

Hello. I had a Caesarean section in November 2005, my water broke and there were no contractions, I want another baby and I want to give birth on my own. What examinations do my husband and I need to undergo, what tests to take?
My husband and I also have different Rhesus (I have a negative one), the first pregnancy went like this:
from 3 to 16 weeks there was nausea and there was absolutely no appetite, as a result of which I did not gain weight during this period, at a period of 19.5 weeks I was put on support with the threat of a breakdown (there were pains in the lower abdomen). The rest of the pregnancy went great.
I recently found out that injections are given for different rhesus, but my gynecologist didn’t tell me anything about such people then, but now he says that he is not a supporter of this. Why? Should I be worried about my Rh, do I need this injection?
Thank you in advance for your response

Responsible Tarasyuk Tatyana Yurievna:

Hello! Examination before pregnancy consists in a general clinical examination (general blood tests, urine tests, reactions to syphilis, hepatitis, possibly HIV) to assess the state of the body. At the expense of different Rh-belongings. The basis in this matter will be the degree of manifestation of the Rh conflict = the reaction of the mother's body to the Rh-positive child. To diagnose such a condition during pregnancy, the level of anti-Rhesus antibodies (killer proteins) is determined and, if they increase, treatment is carried out. The injections you are talking about are anti-Rh immunoglobulin - a blood product that "eats" the anti-Rh antibodies formed in your body and, thus, can reduce the reaction in subsequent pregnancies.
I must upset you - if the first pregnancy was resolved by caesarean section, then with the second one, rarely will anyone dare to let a woman into childbirth. A scar on the uterus can cause serious complications (up to uterine rupture). Is it worth the risk?

2007-09-28 16:29:08

Nelya asks:

Hello! I am now 36 weeks pregnant. At the 15th week of pregnancy, tiny (less than 1 mm) bubbles appeared on the stomach for the first time - 5-6 pieces (a clear liquid appeared when trying to squeeze them out). After this first appearance, the bubbles began to appear in a small amount under the armpits, on the thighs. There was no pain, only a little itching, and everything quickly passed in 2-4 days. At the 33rd week of pregnancy, the bubbles appeared in the groin, in the area of ​​​​the sacrum and in large numbers on the chest (under the nipples), and on the chest they were accompanied by slight redness. The sensations are the same: it does not hurt, but it itches a little. At the same time, there were no complaints about headaches or simply a bad general condition or anything else, except for the appearance of these bubbles. Now, at 36 weeks, they healed and disappeared (on the chest they healed for a long time, 3 weeks, unlike past rashes). Now there is no itching or other discomfort. A week ago, the gynecologist examined the vagina (just in case) and did not find any rashes (according to my feelings, there were none in the vagina at all). Since infections during pregnancy are dangerous, and I have a suspicion that this is genital herpes and I passed the tests. The first analysis (for a period of 21 weeks) by PCR: checked for herpes 1.2 and cytomegalovirus. All results were negative, ie. I didn't find anything. After the appearance of rashes on the chest (at 33 weeks), I donated blood from a vein. Result: IgM - negative, IgG - 1:64 titer (>1:16 Past infection). Those. it turns out that I have found "old" antibodies to genital herpes. But before pregnancy, I NEVER had such rashes and in general any complaints related to this. I assume that the infection was either latent, or I became infected during pregnancy, but then either PCR or a blood test would have shown the presence of an infection (IgM would be positive, for example). There are no complaints now (there are no new rashes, at least not yet); Ultrasound shows that the baby is developing normally (structure, weight, heartbeat, condition of the placenta, etc.). I would like to know what to do now. The problem is that I am not in Russia (I am in Cyprus), and, unfortunately, there are no specialists here. My local gynecologist advises to do an analysis again at week 38: blood for IgM, and if it is negative again, then there will be nothing to worry about. But I asked my Russian gynecologist for advice (by phone). He said that it is necessary to do an analysis at 37-38 weeks only by PCR (because a blood test in this case will not give anything). And in general, you can drink something that strengthens the immune system a couple of weeks before giving birth. Tell me, please, your opinion about my situation: 1. Which test for genital herpes should I do: IgM? IgG? or is it PCR - what will really help determine the presence of an infection? 2. When is the best time to do it - how many weeks before delivery? 3. Which medications to take (which ones are just tonic and which ones, if the analysis shows the presence of an active infection) - harmless to the child 4. And one more thing: doctors here just do a cesarean section right away. And I read that in the case of genital herpes, it does not help, and especially if there is no outbreak of the disease during childbirth, and the birth canal is without infection, then you can give birth naturally, only at the same time treat the birth canal and skin of the child with an antiseptic. Is it necessary to process? Isn't it harmful for the baby? And is it necessary to do an analysis for genital herpes to a child immediately after his birth? By what method? How would you advise? I really hope to get an answer from an expert. Thank you.

Responsible Markov Igor Semenovich:

Hello! The clinical picture of the disease described in the report does not correspond to the clinical picture of HSV infection during pregnancy. However, more accurate and complete information could be obtained by examining the contents of the vesicle by PCR, which makes it possible to detect HSV DNA. To detect the replicative activity of the herpes simplex virus (which you have - this is confirmed by the presence of IgG antibodies), you should do PCR of blood, vaginal discharge and scraping of the epithelium from the cervical canal and urethra. This analysis should be done as soon as possible, so that if the answer is positive, there will be time for preventive treatment, which will protect the fetus from infection. In this case, the analysis will have to be repeated weekly - up to childbirth (monitoring of HSV). The only fetal-safe and effective drug against HSV infection is human HSV immunoglobulin for intramuscular injection. If you start giving birth before preventive therapy, you will need to have a caesarean section (regardless of the localization of the virus). If the PCR tests give a negative result, it will be possible to give birth naturally. Treatment of the genital tract with disinfectant solutions does not give a 100% guarantee of protecting the child from infection directly during childbirth. Also, I do not really advise you to treat the skin of a newborn (during childbirth through the natural birth canal). Only some areas of the skin and mucous membranes (umbilical wound, conjunctiva of the eye, skin and mucous membranes of the external genital organs in a girl, mucous membranes of the oral cavity) are subject to processing. The child will also need to be examined shortly after birth - to donate cord blood for both types of HSV. The ELISA method is used to test for antibodies of the Ig M and Ig G classes, by PCR - for viral DNA. Before delivery (or immediately after) in your blood, the level of IgG antibodies to HSV ½ should also be determined and compared with the level of antibodies in the baby. If the child is not infected, this indicator will be lower than that of the mother. Be healthy!

Well, now, when a month and a half has passed since my cesarean section, I am ready to tell you how it was. The third time is no joke. 2 scars on the uterus. After the second cesarean, the doctor no longer advised giving birth, but it just so happened.

I myself still don’t understand how I got pregnant, and my daughter is already a month and a half old.))) We have always had protected sexual intercourse. So how it happened, I have no idea.

On April 30, I saw implantation retraction. As a doctor, everything immediately became clear to me, except for one thing: WHERE?!

May 5th I went for an ultrasound. Pregnancy is not seen. I say look better, it is. They found a flattening in the uterus, where the embryo was just going to attach.

Everyone already knows me. I found out about all my pregnancies a week before menstruation for a period of 1-1.5 weeks.

How do they say you do it? I don't even know how :)

To be honest, there were torments about pregnancy. All the same, I was not recommended to give birth again. Both first pregnancies were threatening, on duphaston. Then I decided that everything is the will of God and duphaston did not drink. There were no threats during the entire pregnancy.

In the summer, a trip to Sochi was planned by car with two children. They did not refuse to rest, only the car was changed to a train.

But the due date was approaching and at 32 weeks I went to my invaluable and permanent doctor, who was the first to take all three of my children in her arms.

She, of course, said that I was a risky lady, but neither I nor she had anywhere to go)))

She brought my pregnancy to 39 weeks and hospitalized me in the maternity hospital on January 5th. A planned caesarean section was scheduled for January 7th.

For two days I rested in the hospital, I was terribly afraid. It seems to me that only those who do not know what it is are not afraid. I knew... I knew inside and out. I knew that the worst thing is to survive the operation - it only gets better and better every day.

Well, here it is day X.

In the morning I was awakened by an invigorating enema. This is worth a separate discussion, because THIS is how I have never had an enema!

I came across a very responsible nurse, apparently of Soviet hardening.))) She poured water into me, and I was also very responsible and really endured to the last, and when I lost my strength, I raised my voice, but she didn’t say everything and continued. I thought, girls, I'm going to burst in FIG. And then she said that's it! I'm anticipating, my own toilet bowl joyfully jumped off the couch ... yeah, NOW !!! For 10 minutes she took me by the hand around the department so that the enema would work better. But then EVERYTHING came out of me)) and I was solemnly lowered into the operating room.

First, the nurse of the anesthesiologist doctor changed me, put all the catheters in, connected the equipment.

She amused me as much as she could, because I was shaking with fear, but I held on at this stage. She really muttered under her breath: "Here, who came up with the idea of ​​letting blood on Christmas, this is a sin, then what." I was getting absolutely terrified. And there is no time and nowhere to run - she tied me up))

The anesthetist appeared next in the operating room, who dispelled the situation a little. Ever since my college days, I remember that anesthesiologists are the most cheerful. Apparently constantly being "on the verge" in the profession, a sense of humor strengthens - nowhere without it. He jokingly manipulated. Measured the pressure, read the map. I wanted spinal anesthesia. We discussed everything and started the procedure. He turned me on my side and prepared the injection site.

And then my doctor came into the operating room, I was just turned to the door. And apparently, something in me turned off. All the same, she already gave birth to two children with her. And I started to sob. From fear, from self-pity, from the words of a stupid nurse. The doctor looks at me and says: “Katrin, should I leave?”)))

Doctors began to insist on general anesthesia. They explained to me that in my sobs they would not be able to perform the operation. Yes, I understood it myself. And I understood the stupidity of the situation. Mother of two children, an adult aunt came to give birth to a third and roar like a girl.

I was given 2 minutes. Either I pull myself together, or general anesthesia. At the first two cesareans, they did a common one.

I understood that I was probably giving birth for the last time, but I had never been present at my birth. And from a professional point of view, it was still interesting. Sick people doctors))

I pulled myself together. The anesthetist instructed the surgeon to go wash and began to administer anesthesia.

When the doctor came in, I already pulled myself together, we could communicate quite adequately. Discussed news, colleagues, weather. She got up to the table. I say: “you somehow check, don’t cut me right away!))”

The anesthesiologist told me to poke me with a scalpel. Well, apparently they poked, because the command “start” was heard.

And in a second I felt warm under me. I realized that the blood was let out. The doctor told me what she was doing, that according to the standards she should extract the child up to 4 minutes. I waited...

And then I felt that something was being pulled out of me with a pump and dissatisfied groaning))) still in my stomach, but already groaning. And for a moment, when my stomach deflated, it became easy, and the doctor held my daughter over me. I was tied, I could only look. This moment and the look of my daughter is still very clear in my memory. After a few seconds, they put it on a tray, brought it to my face again and took it away for inspection.

A minute later, the pediatrician said: "The child is healthy, weight 3750, height 56cm."

The surgeon clarified with me again about the tubal ligation, I said that everything was in force, I did not change my mind. She started dressing. I felt so good that I decided to sleep. But my "kind" anesthetist began to ask why I closed my eyes, am I feeling sick or am I sleeping? I said that I was sleeping and he said that it was not worth sleeping, let's talk better and asked questions, how to call me, etc. And then it became so painful that the dream vanished. The doctor began to "dry". This is when the abdominal cavity gets wet inside from the blood. I thought, now I'm definitely giving birth. I tried to squirm on the table, but I was motionless and only moaned. After drying, they began to sew up and I felt every stitch of the seam. And only asked the anesthesiologist soon or not it will end. But the surgeon said: “Catherine, that's it. Operation was successfully completed. The mother was saved. The pipes were tied. The uterus is distended. She can no longer bear pregnancy. Now you will be transferred to the intensive care unit and I will come.” I got really good. Everything is behind. My daughter is healthy on the first examination and nothing hurts me yet. There is a time to accept congratulations. Meanwhile, the daughter was taken out of the operating room to show her husband and then she went to the nursery.

I was transferred to the bed and taken to the ward. There were already girls, everyone had fun. The anesthesiologist asked me how I felt and asked if he could go out for coffee. “And then,” he says, “it’s time to shit, but we didn’t eat)) I asked me not to make me laugh, because the anesthesia began to fade))

I was waiting for the doctor. Because, firstly, she would bring the baby to the first application, and secondly, I understood that another terrible procedure awaited me - uterine massage. It cannot be avoided if unpleasant consequences are not needed. And so she came, her daughter took her breasts right away, as she was here - you can’t drink away the experience. I also saw the sky in diamonds. Now you can relax, call everyone.

Until the evening we lay. In the evening the nurse girls came and got everyone up. I had to walk to another building, to a paid ward. It takes about 3 minutes to go there, well, I crawled, of course, longer.

And the country celebrated Christmas...

That's how it was for me)))

This is not the end of the story. The next day I started having complications from the anesthesia. Girls, I never thought my head could hurt like this. All day they tried to stop the pain - it's useless. And at night I was again taken to the operating room - they put a blood patch in the spinal space. It's also scary. But it's not like that anymore. The pain went away right away. And our recovery period began, getting used to each other))

When they took blood from her heel, I sobbed again. The third time)))

Everything again. I remembered the first birth, the second ...

At first I didn’t want to remember, but now it’s nostalgia. Thank God for everything! For the opportunity to give birth again, when no longer expected. For such a desirable daughter. For a team of professionals next to me.

I do not even know where to start! It seems that all this was already so long ago, although only two months have passed since the birth.

In general, ... I’ll start everything in order with my ideas and thoughts, but I had them in order to give birth to a third child - a girl. :)

Two sons is good, but it would be even more wonderful if our family male society (excluding, of course, me), consisting of one adult male and two small ones, was even more diluted with female ones. I was so intoxicated with this thought that I began to look at little Japanese women on the street. They were all so pretty that I already imagined how two boys and one girl were hanging around our dad’s neck, and when we went shopping and I walked past the rows of pink clothes, I wanted to have them even more and I constantly screaming from the heart: “Lord, please send it to me!”.

Some time passed and the pregnancy suddenly and easily came. I was sooo very happy, but when I called my most precious husband and told him this news, he somehow wasn’t very happy, but only handed it into the phone: “What, honestly, what?!?…”.

My third pregnancy began hard, with severe early toxicosis and, as always, with the threat of miscarriage. I remember how I absolutely did not want to eat anything. There was only one desire to lie down, lie down and lie down, but this was impossible, because. having two children and the absence of any outside help just made me move through the force.

A few weeks later I went to a private clinic where I refused to give birth to my eldest child, and at first I was observed there. The doctor prescribed me pills that prevent the threat of miscarriage, and I hardly stuffed them into myself for three whole months.

When twenty weeks came, the baby began to stir and the toxicosis somehow subsided imperceptibly. Why do I write the word "baby"? Yes, because I initially had no doubts that it was SHE who would be born! I constantly prayed to the Most Holy Theotokos and the holy righteous Fathers of God Joachim and Anna, so that they would intercede with the Lord for me, a sinner, and that, through their prayers, He would have mercy and send down to me a child of the female race. And so it happened!

I went to that private hospital for about 2-3 months, then I stopped, because. it was expensive. Later, I began to ask my husband to find a normal (in my opinion) hospital, where they receive not one, but several obstetrician-gynecologists, because. in my past stories about childbirth, I have already written about the problems of those hospitals where there was only one doctor available. My most precious husband did his best and found a large general hospital, also private, not far from home, called Tokushukai Byoin, where two obstetrician-gynecologists, a man and a woman, were visiting on the second floor. I got to a man. He was a sedate elderly uncle, gray-haired and very quiet, who began to observe me from the age of five months, and later he himself took birth, i.e. operated on.

Throughout my pregnancy, I felt fine, I ate excellently, especially sweets, the pounds were gaining with a whistle, and from my cherished 60s I ran as much as 80, which was a record high compared to the last two times. :) The kids were always joking with me. The little one kept patting my stomach all the time, saying that my mother had a big “mammoth” and that I had eaten a lot. And when I could not seat the eldest at the table, I remember always lamenting: “Son, sit down to eat! Look how skinny you are, your bones are covered with skin, and your stomach is generally stuck to your back! ”, To which he immediately answered me:“ But I don’t want it to be as big as yours! :))) Only at the very end of the 34th week, my legs began to swell a little, which was not observed during the first two pregnancies. But I did well, and the girl also developed normally.

The problems began a little later, just before the birth, when we were given a bunch of different pieces of paper and asked to fill them all in.

One of the questionnaires asked whether we want to give birth ourselves? Hmm... what's the question?! The most precious spouse, of course, ticked the box, because this is my eternal dream! But when the doctor read this, he immediately began to deny and say that they don’t “mess around” with caesarean women in their hospital, and that there will definitely be a caesarean section no matter what, and if we don’t want to, then we can look for others hospitals that practice this ... Having heard such an answer, I already somehow calmly reacted to this, and since I was too lazy to go somewhere and look for something, I told the doctor that I would definitely give birth to them. BUT after a while, for some reason, I suddenly again wildly wanted to look for another hospital, with a great hope that what if ... after all, someone would take care of me ?! This reaction was probably developed by previous pregnancies and was still stored in me in its original form, it did not leave me, it just hid and waited for its moment, and then automatically jumped out.

I began to fuss about this with my poor husband, who was already loaded with financial problems that had long arisen for us, but we must give him credit that he took it all with a serious approach and promised to look.

After a couple of weeks without finding anything, we turned to our doctor with this request. He was not at all embarrassed, but on the contrary, he happily wrote a small recommendation note and sent us to one of the largest centers of obstetrics and gynecology in Hokkaido, where they are exactly busy with caesarean sections, but immediately added that it was unlikely that anyone would take me seriously there either. , because I already had two of them, and the fetus at that time was lying upside down, but just in case, you need to go, but suddenly ...

Arriving at this hospital, we got an admission card and went up to the second floor. After sitting in line for three whole hours, we were about to leave, when suddenly we were invited to enter the office. A young doctor of 38 years old was there, and when he heard what was required of him, he said that it would be better if we went to give birth where we came from, because. with two cesareans in their hospital, it will be very difficult and dangerous for me to give birth on my own! In general, all obstetricians and gynecologists in Japan have the same song about the divergence of sutures, about possible complications, a number of dangers, etc.

Having flown out like a bullet after the reception, I, freaking out, jumped into the car and we drove home. My husband kept saying all the way that it would be like this everywhere and that you shouldn’t go anywhere, that if you chose one hospital, then you need to stop there, especially since giving birth there is much cheaper than anywhere else, and it is close to home (only 15 minutes drive).

This time, I probably finally understood that the door to a caesarean woman in Japan in a natural birth is tightly locked.

Having calmed down a bit, we returned to our doctor. He did not say anything, but received us and continued to observe further. Everything would have gone well, but another test has come ...

The thing was that I was waiting for my mother, who was supposed to come to help us. She has already booked tickets for the end of May, but then our doctor, counting the last weeks, suddenly rearranges the date of the due date from the promised June 7 to May 12, which the nurse informs us about! I scream in shock that this is impossible, that we will have no one to leave the children with! Then she says that this is not yet accurate and assigns us the date and time of the next inspection. When I get home, I call my mom and explain the whole situation. She agrees to arrive earlier, and she begins to rigmarole with changing tickets, dates and everything else. It's good that everything ended successfully, and she should have arrived on May 12 for sure! Exactly a week later, at the reception, the doctor, having learned all our family details, suddenly reschedules the DA for May 20, where he says that it will be necessary to cut exactly at 38 weeks, without waiting for contractions, because. if you do it later, there may be dangers. I'm already starting to shake and pound from such changes, I'm getting annoyed and freaking out! How to caesarean without waiting for contractions ?! This is absurd! I was always operated on at 40 weeks for small contractions, as expected! And here…

I've been utterly disappointed! But then, after a little reflection on the situation, I understand that there is nothing to do, there is no other way out, and, having calmed down, after a while I agree, relying only on the Lord and His holy Will.

The DA was eventually rescheduled for 27 May. Mom arrives on the 12th, and exactly two weeks later, on the 26th, I go to the hospital.

On the day of the operation, as always, I was properly prepared. I haven't eaten or drunk anything since the evening of the previous day. it was impossible. The time was right, I was called for a conversation with a cardiologist (this time it was a woman), where they asked in detail about my previous anesthesia, what my reaction was to them and other other details, and then they said that they would immediately give me a general one, to which I protested and began to insist on local. At first they tried to convince me otherwise, but then, seeing my stubbornness, they agreed.

Later, I got on the phone and began calling all my acquaintances and friends, asking for prayer help. The caesarean was scheduled for 2:30 pm and the closer the hands of the clock moved to the appointed time, the more afraid I became! For the third time, for some reason, it was scary to go under the knife ...

I remember how in a panic I called our priest and asked him to pray fervently for me, a sinner, saying that the birth should begin soon. He reassured me, promised to pray and told me not to worry, because. sure everything will be fine. My heart became quiet and calm.

After a while, a nurse came into the ward and asked me to walk to the operating room. I'm going. My husband is walking behind me, then he waves his hand to me, wishes me good luck, the doors close and I am asked to lie down on the table. I am located. The cardiologist comes and starts preparing me. Now the spine has been pierced .... And again that feeling came, as if half of your body was missing ... She poked a needle into her hands: “... do you feel something here?” ...

- "Feel."

- "And here" - pricks the legs and stomach ...

“No,” I answer...

Then the doctor came with his partner, and it all started. I was given my name, date of birth and asked to confirm, after which the operation began.

The girl was taken out. She burst into tears so much that I felt terribly sorry for her. Then they brought it to me, quickly showed us, photographed us right on the operating table and took us away.

The operation lasted an hour and fifty. During this time, I managed to pray, sleep, wake up and pray again. This time everything went somehow quickly, so much so that before I really had time to come to my senses, they told me that now they would take me to the ward. God bless!

Half an hour later they brought my hungry screamer and put her at my side. She dug into her chest and began to eat greedily. The left one was practically empty, and the right one managed to dissolve a little. After taking a few sips, the baby was a bit full, calmed down and fell asleep at my side. I, too, next to her began to fall into postoperative oblivion. :)

Helpless days followed. The anesthesia started to wear off and the pain began. In the third caesarean, they were felt especially acutely. Tubes with droppers stretched from the hands, tubes with pain medication from the spine. I remember that I was lying down and injecting myself with several cubes every few hours, because. my whole body hurt at once. On the second day, when I was already twitching the poor nurses with requests to “bring it, take it away”, “give it”, the head nurse came and, having fulfilled my last whims, sternly, but with a smile, asked again: “Is that all? Or do you need something else, say right away, otherwise I’ll be tormented to go after something else! teeth in the sink! I came out: “But how? Only the second day has gone, and you are already tearing me off the bed! ”, To which she replied:“ If you lie down for a long time, then not only the seam will rot! ”... :) Toward evening, I moved along the wall to the washbasin, brushed my teeth , turned around, went to the bed and quietly lay down. The body still continued to hurt, but the first steps were taken. Thanks to the head nurse for her kind rigor. :)

In the following days of my stay in the hospital, I fought for breastfeeding. At first there was little milk, but then gradually it arrived and more and more arrived. The baby ate well, but because of the wrong grip, I got cracks on the nipples. I had no experience with previous feedings, because. almost all pregnancies in a row because of these wild pains, I pumped and fed my own milk from bottles, but this time I decided to try. How many times have I reached the point where I was about to give up everything and grab the breast pump, but praying at the icon of the Mother of God in the image of the “Mammary Feeder”, I came to my senses and received constant instructions and consolation from relatives and friends. GW gradually began to improve.

On the eighth day of our stay in the hospital, we were prepared a delicious festive dinner for the whole family “oiwai ryori” (which are made in almost all maternity hospitals in Japan in order to congratulate the family on a newborn baby), and then we were discharged.

That's how it all happened. :) Thank God for everything!

Now I constantly remember the words of my friend, who gave birth to four children herself, and she had difficulties with the fifth. She was in storage for two months, and as a result, she was cesareaned at the 34th week, and the baby was placed in an incubator. When we phoned her, the first thing she asked me was: “Zhenya, how do you give birth like that?! I'm just shocked! It's so unnatural, fuuu... Absolutely no emotions! It feels like you've been torn open, gutted and sewn up again! It's just wild horror! Whether business most to give birth! Just such a joy comes! And tuuut…”, to which I replied: “I don’t know… It’s so joyful for me when you hear the voice of a baby! After all, he is also born, only a little differently. It's just that you have something to compare with, but I don't. And now you can be greeted in the ranks of the Caesareans, because from that moment on, the natural path of the birth of the next child, if it suddenly takes place, is already closed to you! It's always like that here."