Table of contents
Does cesarean section affect the onset of the next pregnancy?
- foot presentation of the fetus
- large fetus
- diseases of the mother in which it is impossible to give birth to a child naturally (for example, visual impairment in which there is a threat of detachment of the retina during exertion, varicose veins of the labia, hypertensive disease of the mother)
and emergency reasons, due to the immediate risk to the mother or the fetus:
- weakness of labor activity, which threatens the condition of the fetus.
After a cesarean section, the uterine wall becomes weaker, which is why it takes time to recover and adapt to the next pregnancy. During pregnancy, the size of the uterus increases almost tenfold, and it is important that the walls of the uterus and the scar itself after the previous caesarean section can withstand such a load. That is why it is important to understand the state of the scar after a previous cesarean section before planning a pregnancy. Its thickness can be estimated during pelvic ultrasound, recently 3D ultrasound has gained great value. When making a decision about delivery by caesarean section, it is important to know about the possible consequences for the onset and carrying of the next pregnancy. So there are data that the possibility of the next pregnancy after a previous cesarean section is somewhat lower. Usually, the incision on the uterus during a caesarean section is made horizontally, but there are cases when it is made vertically. The state of the scar on the uterus after cesarean section does not depend on the state of the postoperative scar on the mother’s skin.
When can I plan my next pregnancy after cesarean section?
The speed of healing for each woman is very individual and depends on the specifics of the operation, location of the incision, suture material, and loads in the postoperative period. Therefore, before planning the next pregnancy, it is very important to consult with an obstetrician-gynecologist and conduct a high-quality pelvic ultrasound, sometimes with sonohysterography (when fluid is injected during pelvic ultrasound) to assess the state of the uterine scar. Usually, one year should be enough for the scar on the uterus to become formed. When planning an embryo transfer in the IVF program after the previous KR, only one embryo should be transferred to safely carry the pregnancy.
What is a niche (isthmocele) after cesarean section?
This is a defect that forms in the area of the scar after cesarean section. Most often, it has a triangular or oval shape and is filled with liquid. This liquid is the remnants of menstrual secretions after previous menstruations, due to the fact that the uterus cannot contract in this place and ensure the output of this content. The niche is considered large if the depth is 50-80% of the thickness of the uterine wall, or if the thickness of the uterine wall at the site of the scar is 2.2-2.5 mm or less. If the thickness of the uterine wall is less than 0.2 mm, then this indicates the failure of the scar. The main symptoms of niche can be bleeding between periods, heavy or prolonged periods, pain in the lower abdomen during ovulation or menstruation, discomfort in the bladder. Sometimes there are no symptoms. Isthmocele affects the possibility of pregnancy, as it creates a violation of the microflora and serves as a possible cause of a chronic inflammatory process in the uterine cavity. Isthmocele also increases the risk of future placenta accreta (placenta accreta spectrum) in the area of the scar, increases the risk of uterine rupture in the area of the niche. There are situations when, in the presence of a deep isthmocele, only surgical treatment is possible for the onset and bearing of the next pregnancy
How many deliveries by caesarean section are possible?
With each subsequent operation, the wall of the uterus weakens, the risk of obstetric complications increases. Therefore, it is not advisable to perform more than three caesarean sections. But it is important to know that each situation is very individual, depends on the condition of the woman’s body and the experience of the obstetrician-gynecologist.
What are the risks of carrying a pregnancy after a previous caesarean section?
The risk associated with the fact that the wall of the uterus in the area of the scar after the previous cesarean section becomes weaker.
The shorter the time between operations, the greater the risk of uterine rupture:
- 5% in women who had less than 18 months between cesarean sections
- 2% between 18 and 23 months
- 1% if more than 24 months have passed.
There is an increased risk of placenta previa (a condition in which the placenta blocks the birth canal) and placenta accreta (the placenta grows too deeply into the uterine wall), premature birth. If the previous birth of the child was by caesarean section, the probability of the next operative delivery increases. But this is not always the development of events; it depends on the reasons and the situation. For example, if the cause of the first caesarean section was breech/leg presentation of the fetus, and in the next pregnancy the fetus is located in the main presentation – then the birth of a child is possible naturally. Also, this decision depends on the size of the fetus and the individual situation of each expectant mother.
It is important to note that at the stage of pregnancy planning, it is very important to consult an experienced obstetrician-gynecologist in order to understand your individual situation, the possibility of safe and calm planning, bearing and birth of a healthy child.