Caesarean section in the old days was considered a desperate operation. It was done when it was no longer possible to save the woman, only in order to try to save the child. Modern medicine has in its arsenal new technologies for performing an operation, a qualitatively new suture material, as well as antibiotics, and therefore a cesarean section is practiced more often, and the list of indications for it is increasing. In all cases, when natural childbirth can be dangerous for the child and his mother, a cesarean section is performed. And this is not a verdict, because after the first such operation, a woman can become a mother for the second, third and even subsequent times.
In this article we will talk about what constitutes the third caesarean section, what risks it is associated with, and how the operation proceeds.
Dangers and risks
If a woman already has two children, and both were born by caesarean section, the third pregnancy will always be considered risky. It's all about the presence of a scar on the uterus. During gestation, the female reproductive organ grows, stretches, in total, the uterus grows 500 times compared to its size before pregnancy.
In the area of the scar, connective tissue predominates. It does not differ in elasticity, and therefore it is less susceptible to stretching. The third pregnancy, thus, automatically "records" the woman after the first two in the risk group for the likelihood of pregnancy complications, the most formidable of which is the rupture of the uterus along the scar. A break can theoretically occur at any time, and this is what doctors of antenatal clinics fear most of all, because in most cases, a rupture along the scar is fatal for the baby and his mother.
In addition, a scar on the uterus increases the likelihood of low placentation, fetoplacental insufficiency, placental abruption, and intrauterine growth retardation.
That is why, in the eyes of the obstetrician-gynecologist, there is no great joy and enthusiasm in the consultation when a woman comes to him to register for pregnancy, who is about to undergo the third cesarean section. This is understandable - no doctor needs corrupted statistics. The question of the danger of a third pregnancy is largely exaggerated.
And it is often exaggerated by the doctors themselves, who will have to bear responsibility for the expectant mother and possible complications.
In practice, rupture of the scar at the onset of labor occurs in about 5-9% of cases, and during pregnancy, this probability is below 1%. Nevertheless, there are risks, and you need to know about them.
Pregnancy that occurs within a short period of time after the previous operation can be dangerous (if 2 years have not passed, it is better to abstain from pregnancy).
Not too good and the break between births for more than 5 years. The older the scar becomes, the less elastic it is. The initial thickness of the scar before pregnancy is also important (it should not be less than 7 mm). The scar should be uniform, without “niches”.
A woman will need discipline in the process of carrying a third pregnancy. She will have to come to the doctor more often than other pregnant women, she will have an ultrasound scan more often, including in order to examine the scarring area during the growth of the uterus.
From the end of the second trimester, it is recommended to do an ultrasound scan 2 times a month, and in the third trimester - once every 10 days.
Much depends on the state of health of the pregnant woman, on her age, on the place of attachment of the placenta. The tactics of managing such a pregnancy is determined purely individually. Only one issue is not discussed - about delivery. There can be no natural birth after two KS operations. It is deadly for a woman and a child. Delivery is always performed surgically.
How is the third operation going?
The operation is carried out as planned. A woman can choose the date herself, provided that the doctor agrees with the choice.
Usually, the third cesarean section is performed at a period of 38-39 weeks, in order to exclude the likelihood of the onset of spontaneous labor due to the danger of rupture of the uterus along the scar during labor. They also operate at 36-37 weeks, if the doctor has reason to suspect that the woman may begin labor. But until the expected date of birth (PDD), the pregnancy is not allowed to carry on.
The operation, like the previous two, is carried out using anesthesia.
Most of these deliveries are now performed using epidural or spinal anesthesia, which make it possible to "participate" in the process, to see the baby immediately after his birth.
Also, a woman can refuse to inject an anesthetic drug into the spinal canal and ask for general anesthesia, in which she will be “absent” at her own birth, and will meet with the child only after a few hours.
The operation is performed on the old scar, which means that the doctor makes an incision where the incision was during the previous operation. Adhesions and old scar are excised.
The incision is made horizontally today in the lower uterine segment. In this place, the tissue is scarred better, healing is faster, and the lower segment of the genital organ is less stretched during subsequent pregnancy (if the woman wants a fourth child).
After the incision, the muscles are pulled apart, and the bladder is also pulled aside. Then an incision is made in the uterus, the fetal bladder is pierced. The child is removed, the umbilical cord is cut off. The baby is handed over for processing and weighing, and the surgeon manually separates the placenta.
After that, the uterus is sutured, the position of the muscles of the peritoneum is restored, external sutures are applied.
The operation usually takes about half an hour. But in the case of the third operation, the duration of the surgical intervention may be longer, because additional time is required to excise the old connective tissue.
After the operation, it is recommended to closely monitor the woman in labor for 24 hours a day. If necessary, a woman is injected with contraction drugs so that the uterus contracts better. Antibiotics are sometimes indicated. Pain relievers are almost always recommended for 1–2 days after surgery. It is believed that the sooner the baby is attached to the breast, the better and faster the uterus will contract, the less postoperative complications can occur.
A woman can get up in a day. Long lying in bed is not encouraged.
How to Prepare?
Preparation should start from the pregnancy planning stage. Many difficulties, both when carrying a child and during the operation, can be avoided if the risks are calculated as much as possible in advance. To do this, you need to protect yourself after the previous cesarean section and exclude the possibility of abortion, curettage, and operations on the uterus.
After a two-year break, you should definitely visit a gynecologist. It is recommended to do not only an ultrasound scan with an assessment of the state of the scar (outside of pregnancy it is not very informative), but also hysteroscopy and hysterography with contrast. These diagnostic studies allow to reveal the consistency of scar tissue, its homogeneity, possible notches and thinned areas.
Reviews of patients and doctors
According to women's reviews, the third cesarean section passed, like the previous ones, the subjective sensations were not much different. The period after the operation, according to the mothers, proceeded a little faster than in previous times, since I already had the skill and understanding of how to change the position of the body after the operation, how to sit down, get up, take steps. There was no fear of standing upright after surgery.
The opinion of doctors in recent years has become more favorable, but they continue to insist on a preliminary thorough examination of the scar. If the scar tissue is less than 2.5 mm thick, if there are heterogeneous fragments, thinning, then the woman is advised to abandon plans to become a mother for the third time.
Reviews of women show that the efforts of doctors and the possibilities of modern medicine make it possible to carry a child with both a thin scar and niches in scar tissue, but it is very, very difficult to find a clinic that would undertake the management of such a pregnancy.
There are not so many doctors and clinics that specialize in this. But they do exist, which means there is a chance for motherhood for the third time, even for those whose scars were declared insolvent in the consultation at the place of residence.
Experts tell about the consistency of scars on the uterus in the following video.
