Hem on a uterus: Cesarean section or spontaneous childbirth?
the Question designated in the title is actual for huge number of women today. In - the first, considering high percent of childbirth by Cesarean section, it is possible to claim that the share of pregnant women with a hem on a uterus is big among povtornorodyashchy. In - the second, also the fact that modern women even more often decide on the birth of the first child after 30 years is important. In this case the hem most often is a consequence of removal of knots of myoma (a benign tumor) of a uterus as this disease is found in every third - the fourth woman at this age. At last, sometimes the hem on a uterus is formed after perforation (piercing of a wall) of a uterus during medical abortion. Whether the woman with a hem on a uterus can give rise in natural patrimonial ways, or operation of Cesarean section is inevitable?
What represents a hem at different types of surgery? > Cesarean section in the previous labor it is important to p to know
At what section on a uterus performed operation - cross or longitudinal. At planned operations Cesarean section is carried out by a cross-section in the lower uterine segment. The hem at such section more often happens fuller (edges of a section are well compared, grew together, and muscles of a uterus can transfer the subsequent pregnancy and childbirth), than at a longitudinal section on a uterus which is generally applied in need of an urgent rodorazresheniye (bleeding, sharp oxygen insufficiency of a fruit etc.) .
After of a conservative miomektomiya (KME - operation at which the uterus is kept and delete only myoma knots) if it was succeeded to remove myoma knots without opening of a cavity of a uterus at the small superficially located knots, the hem turns out fuller, than when opening a cavity of a uterus at intermuscular knots with growth tendency towards a uterus cavity.
If perforation of a uterus during artificial abortion did without operation and mending of a site of wound, so the punched opening was insignificant and, respectively, a hem - also small. At more extensive damages if operation with an ushivaniye of a punched opening was necessary, the assessment of a condition of a hem before the next pregnancy is necessary and during it.
What dangers is concealed in itself by a hem on a uterus? Of course, first of all it is a possibility of a rupture of a uterus on an old hem that can be at its inferiority both during pregnancy, and in labor.
As the uterus represents muscular body, it is very important to know how the uterus wall after any operation, whether it be Cesarean section, KME or an ushivaniye of a punched opening on a uterus begins to live. If there is full or almost complete recovery of muscle fibers, then usually the hem turns out full. Together with the term of pregnancy and growth of a uterus the hem is also capable to stretch, it is elastic. If instead of muscular tissue in a hem prevails connecting, then such hem is defective, and the probability of a rupture of a uterus on a hem in recent weeks of pregnancy or in labor is high.
Risk factors of formation of a defective hem on a uterus are considered as
korporalny Cesarean section - a section along a uterus, KME with opening of a cavity of a uterus;
inflammatory processes in the recovery period after operation;
small term (till 2 years) since formation of a hem on a uterus before this pregnancy;
abortions, a scraping in the postoperative period before this pregnancy;
pain in the field of a hem on a uterus.
That the hem on a uterus turned out full, it is necessary to sustain time after Cesarean section, KME or perforation of a uterus. The optimum term of rest - is not less than 2 years. In order to avoid uterus vyskablivaniye in the postoperative period protection is obligatory; it can be both hormonal contraception, and mechanical (a condom in a combination to spermitsida). Early application of intrauterine contraception (spiral) is not welcomed.
If there passed 2 years after uterus operation and you plan pregnancy, it is desirable to make sure even before its approach of full value of a hem on a uterus.
At not pregnant women a hem solvency on a uterus is estimated by means of the following methods:
of of ultrasonography - hysteroscopy (research at which enter the optical device which allows to estimate uterus walls into a cavity of a uterus); thus development and degree of expressiveness of connecting fabric in a hem is estimated.
of Gisterosalpingografiya - x-ray research of a uterus and uterine tubes after introduction to a cavity of a uterus of X-ray contrast substance.
If do not have
objective signs of insolvency of a hem and there passed not less than 2 years after the previous uterus operation, the woman with quiet conscience can become pregnant, but it is worth to remember, as during pregnancy control of a condition of a hem will be necessary.
On what signs doctors judge
inferiority of a hem at pregnant women?
during ultrasonography thinning of the lower uterine segment in the field of a hem (less than 3 mm), dense inclusions in a significant amount in the field of a hem is defined by
that specifies on soyedinitelno - a woven component in the field of a hem.
At a palpation (palpation) by the obstetrician - the gynecologist of area of a hem on a uterus after shift towards a hem on skin, the uterus is usually reduced evenly at a full-fledged hem and unevenly - at defective, forming deepenings in a forward wall of a uterus. Also local (local) morbidity in the field of a hem on a uterus is defined.
pains in the field of a postoperative hem Can arise. If the woman with a hem on a uterus complains of pains, it is necessary to understand in what their reason. Most often they are connected with threat of an abortion, solderings in a small basin or hem stretching on a uterus. The pains connected with solderings in a small basin pass with change of position of a body. They are not connected with a tone of a uterus and do not pass at reception of spazmolitik. The pains connected with threat of an abortion arise at a uterus tension that is felt also by the pregnant woman. These pains pass in the weakened state. Point out the local pains in the field of a hem which are not connected with a tone of a uterus and not passing at reception of spazmolitichesky preparations inferiority of a hem.
At inferiority of a hem in the x-ray pictures received after introduction to a cavity of a uterus of contrast substance niches, change of contours of a uterus etc. are defined by
Pink color of a hem at hysteroscopy tells
about its full value and a solvency as it indicates muscular tissue, and a large number of inclusions of white color, deformation in the field of a hem force to think of its inferiority.
the Hem on a uterus can cause some complications during pregnancy. Among them - threat of interruption of pregnancy in different terms (occurs at every third pregnant woman) and placentary insufficiency at a placenta attachment in the field of a postoperative hem. This state appears because the placenta is attached not in the field of full-fledged muscular tissue, and in the field of cicatricial fabric, on placenta vessels to a fruit the insufficient amount of oxygen and nutrients arrives. At 20% of women with a hem on a uterus with a placenta attachment in the field of a hem (in the main ambassador of Cesarean section) the fruit hypotrophy is observed (it lags behind in the sizes, does not correspond to pregnancy term). Most often the hypotrophy of a fruit is observed when thinning a hem.
of Feature of conducting childbirth
At suspicion on inferiority of a hem the pregnant woman has to be hospitalized by
long before childbirth, in 34 - 35 weeks of pregnancy, and at a full-fledged hem - in 2 - 3 weeks prior to the forthcoming childbirth, for supervision, definition of tactics of conducting childbirth (operation or spontaneous childbirth) and solutions of terms of a rodorazresheniye. If any signs indicate
inferiority of a hem on a uterus, there are no doubts that childbirth has to be quick - the doctor determines rodorazresheniye only terms depending on a condition of a fruit and mother. At a full-fledged hem spontaneous childbirth at a satisfactory condition of mother and a fruit is admissible, at readiness of patrimonial ways to the forthcoming childbirth (a mature neck of a uterus) and the pregnant woman`s consent to spontaneous childbirth.
If the hem on a uterus is formed by
as a result of Cesarean section in the previous labor, often there are same indications to operation that were at the previous childbirth. It can be, for example, anatomic the narrow basin, cicatricial deformations of a vagina and neck of a uterus etc. Often I arise indications to operation at this pregnancy, irrespective of the postponed earlier Cesarean section, for example prelying of a placenta, pelvic prelying of a fruit (at the same time to an exit from a uterus predlezhit the pelvic end), clinically narrow basin at a large fruit etc. In such cases, undoubtedly, despite a hem solvency, operation of Cesarean section is performed (it would be carried out even if the woman would have no hem on a uterus).
Absolute indications to repeated Cesarean section are:
the Hem on a uterus after korporalny Cesarean section (in this case it is located along a uterus body).
the Hem after two and more operations.
the Insolvency of a hem determined by the shown symptoms and data of ultrasonography.
a placenta Arrangement in the field of a hem on a uterus. If the placenta settles down in the field of a postoperative hem, then its elements deeply take root into a muscular layer of a uterus that increases risk of a rupture of a uterus at its reduction and stretching.
Spontaneous childbirth at a well-founded hem is conducted by
in an obstetric hospital where the round-the-clock highly skilled surgical help is possible, there are anesteziologichesky and neonatal services. The possibility of spontaneous childbirth is defined finally already at the end of pregnancy. Childbirth is carried out at continuous cardiomonitoring (warm activity of a fruit for timely detection of oxygen insufficiency of a fruit is traced).
Only 30% of women with a hem on a uterus can get to this group as at other 70% either insolvency of a hem is observed, or stable (which already were at the first operation of Cesarean section and remained) or passing (arisen during this pregnancy) indications to Cesarean section. And only at full confidence that in case of threat of a rupture of a uterus or at a rupture of a uterus on a hem it can be timely, within 10 - 15 minutes, surgical help is given, it is possible to allow spontaneous childbirth.
If at women with a well-founded hem on a uterus in labor observes weakness of patrimonial forces, then operation of Cesarean section is performed.
Often women after a rodorazresheniye by operation of Cesarean section ask
a question: how many times it is possible to give birth still? Quite often already during repeated Cesarean section there is a question of sterilization (bandaging of uterine tubes) as danger of inferiority of a hem with each pregnancy grows. Most often already at the third Cesarean section offer the woman sterilization, but without its consent the doctor has no right to take such step.
After the delivery if the woman gave birth in natural patrimonial ways, manual inspection of walls of a postnatal uterus for an exception of an incomplete rupture of a uterus on a hem is obligatory for
. This operation is performed under a short-term intravenous anesthesia. The obstetrician - the gynecologist after surgical processing of hands and the woman in childbirth crotch, one hand in a sterile glove enters a cavity of a uterus and feels uterus walls, in this case - especially carefully area of a postoperative hem on a uterus. At detection of defect in the field of a hem if it partially or completely dispersed, required urgent operation for an ushivaniye of area of a gap, otherwise there can be intra belly bleeding, life-endangering swear.
the Rupture of a uterus on a hem
Among all ruptures of a uterus during pregnancy and childbirth the leading place is taken by a rupture of a uterus on an old hem. It is necessary to emphasize that ruptures of a uterus in the presence of a hem often proceed without the expressed symptoms.
are Distinguished by three stages of a rupture of a uterus:
of the Menacing rupture of a uterus - a stage at which integrity of body is not broken yet, but the gap here - here will occur. During pregnancy nausea, vomiting, pains in a stomach which then are displaced in the lower departments of a stomach, more often to the right are characteristic. At palpation of a stomach and uterus are defined morbidity in the field of a hem, sometimes - deepenings, roughnesses. In labor violations of sokratitelny activity of a uterus are added to above-mentioned symptoms: weakness of patrimonial activity, uneasy behavior of the woman with painful, but weak contractions which are unproductive do not lead to disclosure of a neck of a uterus.
the Begun rupture of a uterus on a hem . During pregnancy in the field of a gap the hematoma (a blood congestion) as a result of internal bleeding is formed. There can be also external bleeding from a genital tract. Nausea, vomiting, dizziness, pains in the field of a hem, the raised uterus tone are characteristic. When listening heartbeat of a fruit there can be signs of sharp oxygen insufficiency. In the first period of childbirth the uterus between fights does not relax, is strained constantly. From - for the raised uterus tone the fruit experiences oxygen starvation. In the second period of childbirth the woman in labor is uneasy, complains of pains in the bottom of a stomach, in a sacrum. Attempts are weak, but painful. The fruit experiences oxygen starvation. From a genital tract bloody allocations appear.
the Made rupture of a uterus on an old hem . Generally it is shock symptoms as a result of big loss of blood. Classical symptoms at a rupture of a uterus: sharp belly-ache at the height of one from fights, sudden “calm“ after “storm“ (the sudden termination of fights), symptoms of internal bleeding - pale skin, expanded pupils, the sunk-down eyes, the speeded-up pulse, superficial breath, dizziness up to loss of consciousness, nausea, vomiting. At a complete separation of a uterus the fruit and an afterbirth can move to an abdominal cavity, at the same time through a forward belly wall parts of a fruit are distinctly probed.
Unlike a classical rupture of a uterus, at a rupture of a uterus on a hem symptoms develop gradually, are not brightly expressed.
the Fruit can be born
live spontaneously in natural patrimonial ways as defect in the field of a hem develops gradually.
At the menacing rupture of a uterus during pregnancy performs the emergency operation of Cesarean section, in labor - removal of patrimonial activity by means of a deep anesthesia and Cesarean section.
At the begun or come true rupture of a uterus during pregnancy or in labor, regardless of a condition of a fruit, performs operation and extraction of a fruit and afterbirth, a gap ushivaniye. After operation the woman is in intensive care unit. If injury of a uterus considerable, is not possible to take in a wall, make removal of a uterus. Both at begun, and at the come true gap the fruit suffers. Consequences can be deplorable.
Thus, at the woman with a hem on a uterus after Cesarean section or KME with opening of a cavity of a uterus the probability of operational childbirth is very high. Childbirth through a natural genital tract is admissible only at a hem solvency, a normal state of mother and a fruit in the large specialized centers where they at any time will be able to give to the woman in labor highly skilled help.