Uterine Healing Post C-Section
Did you know that a little over 1/3 of all deliveries in the U.S. are cesarean? What you don’t know is, although it's thought to be uncommon, after having a c-section you have an increased risk of your uterus not healing correctly. The poor healing after c-section may leave a woman with a low grade contained infection, or a gap in the wall, or just a thinning of the wall of the uterus itself.
How well your uterus heals after a c-section can help determine the health of your next pregnancy, as it will affect where a new pregnancy can implant within the uterus. There is no specific of numbers of c-sections a woman can have and the risks rise slightly after more than just one previous c-section. However, if you have healed well, you are more likely to be healthier and have a lower risk in any future pregnancies should you want them. There is no set "number of total c-sections that is safe." Women often will have a third or 4th safely, but what is important is how the uterus heals each time. One way is to perform ultrasound assessment of your uterine scar. But: what can an ultrasound of your uterus really tell you about how well you healed after a c-section?
The site where the incision was at the time of a previous c-section is not a healthy place for a pregnancy to grow. In fact, it may lead to potentially dangerous growth of placenta into the wall of the uterus where it will be very difficult to remove at the time of delivery. Yet it is not uncommon to find an early pregnancy discovered within the uterus implanted in the previous c-section site, and as a gyno we do see these types of pregnancy on ultrasound. And the more carefully a gyno looks at the placenta at the time of ultrasound in early pregnancy, the more cases we are finding.
A study was done and reported in the March 2011 issue of Obstetrics and Gynecology that was designed to understand the healing of one's uterus, the chances for abnormal placenta location, and the likelihood that uterine scar is separated or ruptured after the C-section. Women in this study had their uterus evaluated after their most recent c-sections; 6-9 month post partum by transvaginal ultrasounds. Out of 162 women with prior c-sections, 20% had an intact scar, 58% showed a small defect while 22% revealed a large defect.
We suggest any patient with prior cesarean delivery with irregular bleeding, pain or pregnancy planning now think about this as a possible diagnosis or cause and we are suggest they come in for a consultation, and as part of the consultation, to consider having an ultrasound and Saline Infused Sonohysterography to evaluate the c-section scar more completely.