3. How long is a caesarean section performed? At what date is the third planned caesarean section performed? When is a planned caesarean section performed?

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:

Presence of cavities according to ultrasound results.
Thickness 1.5-2.5 mm.
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.

However, if pregnancy occurs within a year after the second cesarean section, abortion is not a safe way to solve the problem! In this case, it is necessary to examine the condition of the uterine scar using ultrasound and visit an obstetrician-gynecologist.

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

Pregnancy is one of the brightest and happiest events in the life of every married couple. However, the process of gestation and delivery does not always go as desired. Due to pathological conditions associated with pregnancy, both on the maternal and fetal sides, situations occur in the second and third trimester that require both emergency and planned cesarean section. After a cesarean section, a scar invariably remains on the uterus. This condition leaves its mark on all subsequent pregnancies, and sometimes on the reproductive function of the woman as a whole. The minimum period that must pass after a cesarean section to permit the next pregnancy is 2 years. However, even this time is not enough to completely restore the body and form a healthy scar on the uterus.

Two scars. Dangerous?

If a woman receives a second uterine scar after a second delivery by cesarean section, then the rubber receives a diagnosis of a uterine scar. Two scars on the uterus are a rather dangerous condition, which can be fraught with severe complications in subsequent pregnancies that can be dangerous for both the life of the mother and the life of the fetus. In some cases, the presence of two scars on the uterus is the cause of infertility and the inability to have a child in the future.

Often, a woman who comes to an obstetrician-gynecologist with pregnancy and the presence of two scars on the uterus is not greeted very warmly by the doctor. The third caesarean section after 2 cases receives unflattering reviews from doctors.

This is very easily explained by the doctor’s qualifications and his knowledge of how dangerous a pregnancy with two scars is.

The danger of a third caesarean section

Reasons why performing a 3rd caesarean section is dangerous:

After any abdominal surgery, adhesions inevitably remain in the abdominal cavity. If the postoperative period does not proceed entirely smoothly with an increase in body temperature, chills, that is, all signs of inflammation and infection, then the number of adhesions inevitably increases, and such interrelations of adjacent organs are formed that interfere with their normal functioning.
A complication of cesarean section is endometriosis. With a repeat cesarean section, the risk of its occurrence and progression increases. Endometriosis of the peritoneum and intestines are additional reasons for the formation of an even greater adhesive process.
If there are two entries into the abdominal cavity for cesarean section operations, the formed adhesions can play a role in the process of accessing the abdominal cavity; entry can be problematic, and in some cases almost impossible.
The presence of a scar on the uterus can prevent normal implantation of the fertilized egg and cause the formation of abnormalities in the localization of the placenta in the form of central presentation, marginal presentation, or low placentation. This is an increased risk of bleeding, firstly. And secondly, this is the cause of placental dysfunction, which leads to chronic fetal hypoxia, which can be fraught with fetal distress, and in some cases, antenatal death.
When placentation occurs in the area of a postoperative scar, there is a high risk of its failure. Failure of the uterine scar - its thinning - can lead to the most dangerous condition during pregnancy with a uterine scar - uterine rupture. If such a condition occurs, the woman should receive assistance immediately. Since both the fetus and the mother can die in a matter of minutes. This is a complication that all obstetricians-gynecologists and doctors who work with pregnant women with a scar on the uterus are afraid of. And true placenta accreta may also occur, as a result of which the third cesarean section ends with hysterectomy - removal of the reproductive organ.

The entire gestation period should be accompanied by ultrasound monitoring of the thickness of the postoperative scar. It is mandatory for a woman to be hospitalized at 36-37 weeks of pregnancy to monitor the woman’s condition.

Features of the third cesarean

If, for some reason, a woman still undergoes a 3rd caesarean section, there are some peculiarities in it.

Surgical intervention is carried out within the scars that already exist on the reproductive organ.

All manipulations must be performed very carefully with control of hemostasis and caution, since there is a high probability of injury to adjacent organs.

Also very important is the prevention of atony, hypotension of the uterus, since the reproductive organ, which has undergone the third surgical intervention, contracts poorly. Intravenous administration of oxytocin is mandatory.

Postpartum contraception is very important, since pregnancy after a third cesarean section is deadly.

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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 - it was so difficult for me. But still, 6 years later I gave birth to a daughter. I wrote about this in a story

To be honest, the question in the title of the story was purely rhetorical; at that time I was not thinking about any next child. The plan was fulfilled, there is a son and daughter - everyone is healthy and happy. Life revolved according to the scheme: work - school - kindergarten - music class - dancing - English - swimming pool: you just have time to coordinate the schedule, meet, see off, pick up. And suddenly, out of the blue, the “idea of a third child” surfaced. Where would you think? In the most fabulous corner of the earth, in the Terem of Father Frost.

“Look in this magic mirror, make a wish, and it will certainly come true,” said Santa Claus’s assistant. Well, I looked. And she wished “to come here again, with three children.” The next second, when this phrase reached my consciousness, I was stunned and looked around: “Was it actually me or not I thought? Or did someone nearby say it?”

“Do you understand that this is a mortal risk? Do you want to leave your children orphans?” - the local gynecologist almost shouted at me. I shouldn't have decided to consult 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 somewhat. “But I’ve already had two CSs,” I clarified once again, just in case. “So what, you’ve already endured it with a scar once, 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 one now?” Almost in shock from her answers, I began to remember what else alarmed me in my thoughts on the topic “To be or not to be?” Oh yes. “But I also have age.” The surgeon somehow strangely and intensely began to peer into my face. "And how much you?" Well, I think everyone has arrived and will now say that the muscles have become inelastic and can no longer be cut (that’s all the nonsense that comes to mind!). “Thirty-seven,” I said barely audibly. “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 usual thinking in recent months on the topic “To be or not to be” 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 get examined and undergo all sorts of tests, in case a bunch of infections were discovered (I was periodically treated for one or the other, having chronic right-sided adnexitis). Not so. “Everything is fine with you, you can get pregnant,” was the verdict of the doctor in the department of the perinatal center. Wow! This was the second step.

All that remained was to do the most important thing - the third one, i.e. get pregnant. It didn't work out in the first month. “Maybe this is a sign that you shouldn’t do this,” the thought tormented me. Okay, I'll try one more time and give up with a clear conscience. A little over a month has passed, and here they are - two stripes. Apparently, the kid realized that this was his last chance.

This is how, with my own hands, as they say, I broke my relatively calm, carefree life in an average family with two children.

“Who are we waiting for so much - a boy or a girl?” - asked the uzistka, having learned that the third CS was planned. “We don’t care, we already have a boy and a girl,” I answered. “And at the same time, you needed another one? Do you know what risk you are exposing yourself to? For what?” Well, I ruined the whole mood. Of course I know.

To my surprise, the doctor at the residential complex where I was registered did not read me any lectures, she managed my pregnancy under the motto “What happens, cannot be avoided.” In her practice, I was not the first to be going 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 a third CS is managed more carefully, ultrasounds are performed more often, etc. In my case this was not confirmed. I went to the appointment with the same frequency as the previous times, I did an ultrasound 3 times, as usual: at 12, 22, 32 weeks and just 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 test, including the test that was negative. An ultrasound showed that everything was normal. I am still surprised by this, because there is an opinion among people that pregnancy becomes more difficult with age. I didn’t protect myself any more than in previous times, maybe even less - with two children there is no time to take care of myself. We even went on a planned car trip around Scandinavia. And even cooler - we went on a hike with our eldest son, spending 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 seemed that she was even waiting for it: “Call me at 36 weeks, you’ll go to bed 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 was calmer this way, on the other hand, I wanted to reach my due date, and there was neither the desire nor the 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. I called at 36 weeks. There were some “exercises” going on in the maternity hospital, my surgeon was “stitching up”, so they told me to walk at home for another week. I called at 37. There was a boom in CS in the maternity hospital, the department was packed to capacity, and, having learned that everything was fine with me, they sent me to go for another week. As a result, I ended up in the department at 38.5 weeks.

For some reason, my doctor thought that my due date should be shorter, and she got very excited and fussed when she learned that I was about to turn 39. She immediately ran with me to the ultrasound. We measured the thickness of the uterus in the area of the scar to be 3 mm - uh, this is normal, thinning is considered less than 2 mm. It was stated that the fetus is not suffering, the blood flow is normal, and all sizes correspond to the term. She felt the scar on the chair manually and said that everything was fine, the cervix was closed, and... “Why the rush?” - I almost fell out of the chair, I was already ready to run to the operating room. In general, I spent another 5 days at the resort in a separate room. She ate, slept and embroidered.

In the meantime, they took a bunch of tests from me and made all sorts 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 gave me the drug to breathe, at 10.05 they took my daughter out, and at 10.25 they finished. At the same time, they also managed to “kill two birds with one stone”: the tubes were tied and the very ovary that had not allowed me to live in peace for the last 15 years was cut off. They did it under general anesthesia; for some reason our local anesthesiologists are not friends.

The “departure” went well, especially since my neighbor in the intensive care unit turned out to be a “soul mate” - also an associate professor, also a candidate, and we work at the same university. In general, we organized a scientific conference with her, and even gave a lecture to a young doctor on the topic “how to defend a dissertation.” They took their souls away, 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 bleeding, 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 she supposedly knew a girl who, after a CS, had a lot of clots forming inside her, which “climbed” into her uterus, and she had to have a cleaning done. As soon as I heard this, I practically began to rejoice when they pressed 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 the intensive care unit, I was transferred to the postpartum room. There, no one even thought of helping me get up; I had to get up myself, go to injections and go to the toilet - a nightmare. Everything hurt as if I had been unloading the cars for a couple of days without rest. The doctor said it was a reaction to the anesthesia.

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

So, Arinka was born at 39 weeks and 2 days, 3440 g, 55 cm, 8-9 points. They brought food 8 hours after the operation. Then they brought me every 3 hours, and on the fourth day they moved me in with me. Arina turned out to be such a glutton, there was not enough milk, but I did not supplement her feeding, gave her water and often applied it to her empty breast. A day later the milk came in, so we are completely breastfeeding, and I hope this will last for a long time.

The stitches were removed on the seventh day, and on the eighth day he was discharged as usual. My husband and children arrived for discharge - how happy they were, this is something! Here I would like to step back a little from the topic and say that I am lucky - my older children Stepan and Lida are very attached to each other, despite their 6-year age difference. They study together with great pleasure, play, come up with something new, and the concept of childhood jealousy has bypassed us. They were looking forward to the appearance of their sister. And in the maternity hospital they asked to go into the room where Arisha was being changed for discharge. From there they could hear their enthusiastic exclamations: “Oh, how small she is,” “How beautiful she is,” “Why does she have a red face,” “She looks like my Lala,” “Let me hold her.” Since then, my older children have helped me with everything with the younger one and sometimes even argue over the right to do something for Arinka. This is the kind of princess we are growing up with.

In general, as you can see, everything went well. Being at the stage of developing my plan, I had little hope for such an outcome. The result of the “deadly risk” is snoring peacefully next to me, and there are no words to express the feelings that I experience while hugging my chubby daughter. Only sometimes I get scared - when I think that I could choose the path “not to be.”

Discussion

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

I have 3 ks. 2003, 2006 and September 2012. With my third pregnancy I was never in conservancy. Everyone was scared, both doctors and relatives. They said that you would leave the children orphans. And I knew that everything would be great. I was cesareaned at 37 weeks. They offered to change the bandage. but I didn’t agree. So go for it if you want. Good luck everyone!

11.11.2012 11:56:04, Alya 79

Girls, I also had three caesarean sections - all boys. My little one is now 4 years old and I want to go for a fourth cesarean section. Does anyone have such experience? Share how it went?

Girls, I have had three caesarean sections. All boys. I really want a girl. Has anyone had experience with a fourth cesarean section?

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 take risks... after her I suffered, I thought, and after 1-1.5 weeks I went to my local doctor: she calmly listened to me and said, “Well, give birth!”, and I, “What about two stitches, and the youngest is 2.8 years old.” she’ll be “just in time for giving birth 3.” and I made up my mind, happiness knew no bounds. I also thought, I’ll just put on a bandage and won’t “fuss” with protection. Now I’m 37 weeks, everything is ok, but now I’m “worried” about the dressing, my husband says “no need”, and I don’t want to either...

A friend of mine 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 one year old and I had an emergency CS, so I think when the second one comes, I will also have to do a cesarean section and if the third one too... so I’m not afraid of it...

05/01/2009 11:05:37, e-girl

GOOD ARTICLE WITH A GOOD ENDING!
I HAVE TWO CESAREANS, I’M AFRAID OF A THIRD, BUT I WANT IT, I NEARLY LOST THE SECOND DUE TO A SCAR, THE WHOLE SET WAS, WHETHER IT WILL WORK A THIRD TIME, I DON’T KNOW........

11/27/2008 08:37:04, vikunchik

Dasha, thank you very much! I also have two CS. I decided to get checked before getting pregnant again and the ultrasound now showed a 4 mm stitch - they say that this is a complete contraindication, but I really want a third one. The doctor doesn’t just throw objects at me. He says that if it’s so unbearable, then you need to do suture plastic surgery first, and he prays day and night. But I can’t help it, every fiber of my soul dreams of a third child, although I have a set: a girl and a boy. But I really want another little one.

11/21/2008 00:37:14, Olga

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

09.11.2008 01:54:07, Margarita

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

05/16/2008 23:13:28, Natalya

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, Caesareans are performed many times and no one dissuades the mother, much less intimidates her... I have three children and we are expecting a fourth. I gave birth to my very first one in Kyiv in 1990, so I got to know all the “delights” of our maternity hospitals, and especially the staff. And she already gave birth to the next two in Canada. What a difference it makes to give birth abroad! This 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 “havrochka” if the surgeon had dissuaded you then. You are a very brave woman for going through this whole nightmare. Happiness to you and your children!

05/16/2008 00:58:55, Love

What a great fellow you are! I really didn’t have a CS; I gave birth myself. I just came in to read it because a friend has had 2 CSs and really wants more, but the doctor, much like in your case, predicts a fatal outcome! :(It’s sad that we are so behind the world! But there is also a positive thing, my another friend gave birth to her second son herself exactly 2 years after the first CS! True, there is only one doctor who takes on such cases with us, and, oddly enough, , he is a man! I wish health and happiness to your large and friendly family!

05/14/2008 06:20:15, Tanya

Well done!
The main thing is a good attitude - and everything will work out. I myself have three caesareans - but they even got me a third one with an epidural :-)
Are you already familiar with the benefits for families with many children?

Dash, great! Well, when you manage to do everything, and you come up with such great stories! Write more!
Happiness and health to your entire friendly family!

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

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.

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

Presence of cavities according to ultrasound results.
Thickness 1.5-2.5 mm.
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.

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?

Yulia Shevchenko, obstetrician-gynecologist, especially for the site

Useful video

2016-09-12 12:45:09

Irina asks:

Hello, please tell me I have a planned cesarean section due at 39 weeks and I have a low fever of 37 and there are no other manifestations of a cold, will they do a cesarean section at this temperature?

Answers Bosyak Yulia Vasilievna:

Hello Irina! Low-grade fever can be normal during pregnancy and is caused by the production of progesterone. Have you checked your kidney function? Is there no protein in a general urine test? If not, you can plan a caesarean section.

2014-01-09 15:11:50

Ksenia asks:

Hello! I had a laparoscopy in December 2013 (ectopic on the right, the tube was saved), the period was 5 weeks.. nothing bothered me, I saw the test was positive, I went for an ultrasound myself.. the next day and they operated on.. the doctor said that the fertilized egg it was in the fimbrial section of the tube.. he says they let in the blue - the tubes are passable, and at the same time he says the right tube was fused to the ovary. In the past there was a cesarean section and an abortion. Now I have undergone treatment - Amoxiclav (7 days), metronidazole, nystatin, longidaza suppositories (10 pieces every other day), aloe (7 days intramuscularly). The other day I’m going to undergo physical procedures (electrophoresis, ultrasound). The doctor also advises me to take a course of hydrotubation 10 times... Please tell me whether I need to check the pipes before planning, what other treatment pass? And most importantly, is it worth doing hydrotubation????

Answers Palyga Igor Evgenievich:

In my opinion, hydrotubation is an outdated, ineffective procedure. Conservative treatment is sufficient. Even if one tube is obstructed, the second will function and therefore pregnancy is possible. It is almost impossible to effectively restore the patency of a pipe that has undergone surgery. Visual patency has been restored (the bluing has gone away), but it is very difficult to restore the functioning of the fimbriae (villi). It is necessary to check the patency of the tubes only 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 of 11 years old, caesarean section. In September there was a frozen pregnancy, 6 weeks. I really want to have more children. As a result of cleaning, there is endometriosis of the postoperative scar (there were no diseases before pregnancy, I was examined by a gynecologist every 5-6 months, smears were always normal, histology was good). And since bleeding 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. I did an ultrasound on the 13th day of the cycle, the endometrium was three-layered, of the correct shape (as they said, beautiful), but only 5-6 mm. From the first day of the cycle, a COC was prescribed. They offered several options - ZHANINE, YARINA, MEDIAN, REGULON. Please tell me which COCs are best to take in my case? I am also ready to listen to your suggestions.

Answers 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 donated on the 3-5th day of the m.c. and progesterone, which is given on the 21st day of m.c. This will make it possible to assess your hormonal levels and select the appropriate contraceptive. Considering your age, I think Regulon or Janine would be the best choice. Midiana and Yarina are similar drugs, in which the dose of gestagen is higher. Than in Janine and Regulon.

2011-04-15 04:22:10

Tatiana asks:

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

2008-12-22 12:35:25

Tatiana asks:

Hello, Doctor!
I’m pregnant, I’m about 3 weeks pregnant, and there’s no way to continue it, so we decided to have an abortion. I already have a child, the birth was 2 years 8 months. back, emergency caesarean section due to a clinically narrow pelvis. The postoperative period was without complications, there was no inflammation, and there was no cleaning. This is the second pregnancy, there were no abortions. There are no gynecological or venereal diseases. Age 24 years. The doctor suggests a medical abortion. At the time of taking the pills, the delay will be 9 days. The cycle is 28-30 days. I have the following questions for you:
Is it possible to have a medical abortion after a cesarean section? Will the suture on the uterus come apart? What are the possible consequences for my term?
Thank you in advance!

Answers Filippova Olga Yurievna:

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

2008-04-19 17:24:39

Lyudmila 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 should my husband and I undergo, what tests should we take?
My husband and I also have different Rhesus tests (mine is negative), our first pregnancy went like this:
from 3 to 16 weeks I had nausea and absolutely no appetite, as a result of which I did not gain weight during this period; at 19.5 weeks I was put on support with the threat of failure (there were pains in the lower abdomen). The rest of the pregnancy went well.
I recently found out that injections are given for different rhesus conditions, but my gynecologist didn’t tell me anything about such things then, and now he says that he is not a supporter of this. Why? Should I worry about my rhesus, do I need this injection?
Thank you in advance for your response

Answers Tarasyuk Tatyana Yurievna:

Hello! Pre-pregnancy examination consists of a general clinical examination (general blood tests, urine tests, reactions to syphilis, hepatitis, and possibly HIV) to assess the condition of the body. Regarding the different Rhesus status. 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 this 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-Rhesus immunoglobulin - a blood product that “eats” the anti-Rhesus antibodies formed in your body and, thus, can reduce the reaction in subsequent pregnancies.
It should upset you - if the first pregnancy was resolved by caesarean section, then with the second, rarely will anyone risk letting the woman go into labor. A scar on the uterus can cause serious complications (including 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 abdomen for the first time - 5-6 pieces (when trying to squeeze them out, a clear liquid appeared). After this first appearance, bubbles began to appear in small quantities under the arms and on the thighs. There were no painful sensations, only a little itching, and everything quickly passed in 2-4 days. At 33 weeks of pregnancy, blisters appeared in the groin area, in the sacrum area and in large numbers on the chest (under the nipples), and were accompanied by slight redness on the chest. The sensations are the same: it doesn’t hurt, but it itches a little. At the same time, there were no complaints about headaches or simply poor general condition or anything else, except for the appearance of these bubbles. Now, at 36 weeks, they have healed and disappeared (on the chest it took a long time to heal, 3 weeks, unlike previous 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 it is genital herpes and I got tested. First analysis (at 21 weeks) using the PCR method: tested for herpes 1.2 and cytomegalovirus. All results were negative, i.e. They didn't find anything on me. After the rash appeared on my 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 they found “old” antibodies to genital herpes in me. But before pregnancy, I NEVER had such rashes or any complaints associated with it. I assume that the infection was either hidden, or I became infected during pregnancy, but then either PCR or a blood test would have shown the presence of infection (IgM would have been positive, for example). There are no complaints now (no new rashes, at least not yet); An ultrasound shows that the child 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’m not in Russia (I’m in Cyprus), and, unfortunately, there are no specialists here. My local gynecologist advises me to do another test at 38 weeks: blood for IgM, and if it is negative again, then there is nothing to worry about. But I asked my Russian gynecologist for advice (by phone). He said that at 37-38 weeks the test should be done only by PCR (because a blood test in this case will not give anything). In general, you can drink something to strengthen your immune system a couple of weeks before giving birth. Please tell me your opinion about my situation: 1. What test should I do for genital herpes: IgM? IgG? or PCR – what will really help determine the presence of infection? 2. When is it best to do it - how many weeks before giving birth? 3. What medications to take (which ones are simply strengthening ones and which ones in case the analysis shows the presence of an active infection) are harmless for the child 4. And one more thing: here the doctors almost immediately perform a caesarean section. But 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 the baby’s skin with an antiseptic. Is it necessary to process? Is this harmful to the baby? And should a child be tested for genital herpes immediately after birth? By what method? What would you recommend? I really hope to get an answer from a specialist. Thank you.

Answers 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 using the PCR method, 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 secretions and scrapings of the epithelium from the cervical canal and urethra. This analysis must be done as soon as possible, so that if the answer is positive, there will be time for preventive treatment that will protect the fetus from infection. In this case, the analysis will need to be repeated weekly - until delivery (HSV monitoring). The only drug safe for the fetus and effective against infection caused by HSV is human anti-HSV immunoglobulin for intramuscular administration. If you start giving birth before preventive therapy, you will need to have a caesarean section (regardless of the location of the virus). If the tests done using the PCR method give a negative result, it will be possible to give birth naturally. Treatment of the genital tract with disinfectant solutions does not provide a 100% guarantee of protecting the child from infection directly during childbirth. I also don’t really recommend treating the skin of a newborn (during vaginal delivery). Only certain areas of the skin and mucous membranes are subject to treatment (umbilical wound, conjunctiva of the eye, skin and mucous membranes of the external genitalia in a girl, mucous membranes of the oral cavity). The child will also need to be examined soon after birth - umbilical cord blood will be tested for both types of HSV. The ELISA method is used to test for antibodies of the Ig M and Ig G classes, and the PCR method is used to test for viral DNA. Before giving birth (or immediately after) the level of IgG antibodies to HSV ½ in your blood should also be determined and the result should be 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!