QuestionHello. I have 3 children and have had one miscarriage between first and second child. My 2nd and 3rd deliver were c-sections. When completing my c-section with 3rd child it was discovered I had a tremendous amount of scar tissue. They had to make another incision, thus making it a t c-section to get baby out and complete the c-section. The doctors initially told us I should have no more children. We sought out opinion of high risk obgyn and another ob dr. They gave me the go ahead that I could have my 4th child. Now, the drs have made me very fearful for my life that I have serious risk to it while delivering this baby in Oct. I have been transferred to Highrisk OBGYN at another hospital. I know they will take baby early and hope to prevent me from contracting early. (I forgot to mention I have preterm labor issues and start contracting around 33-34 weeks). Previously, was treated with medication and hospitalization to get me to fullterm. What would you say my risks are for death. And complications? How grave do you think my situation is? This is our last pregnancy. Also, what would you predict this pregnancy care may look like? Should I be hospitalized from say 30 weeks on? I will be going to West penn hospital in Pittsburgh. I have lost 30 pounds and am trying to maintain best health possible for this pregnancy. Thank you for answering my questions.
AnswerHi Tammy,
First of all, I am not a doctor and can give you only general information.
Although a T-incision does carry with it a higher rate of uterine rupture than a bikini incision, here is some information I found.
There was a study done in 2004 called The Landon Study, which found that the rate of rupture for inverted t incisions is 1.9% for women who go into labor - if you are having a repeat cesarean, then it would stand to reason that your rate would be lower.
The American College of Obstetricians and Gynocologists generally reports a higher rate of 4-9%, but there is speculation that some of those aren't uterine rupture, but ulterine dehiscence - where the scar is compromised but does not rupture. And even that 4-9% rupture rate is WITH labor, not a planned cesarean.
In cases of uterine rupture, 1 in 18 babies die, and 1 in 23 women require a hysterectomy. With the high end figure of 9% uterine rupture, you are still looking at well under 1% chance of a poor outcome.
If the same doctors who told you that it was ok to get pregnant are now telling you that they are concerned, it sounds like there may be more going on in with your pregnancy that they are concerned about other than the T-incision and the pre-term labor issues. I would talk to your doctors and get answers from them - they are the ones most familiar with your exact condition. If their answers are unclear, don't be afraid to ask them to clarify or give you the information in a way that you will understand. I would ask them - what is making them concerned now when they weren't concerned before you got pregnant?
I am guessing that bedrest is probably in your future as well as probably an early delivery.
I wish you the best with the rest of your pregnancy and birth.
Sincerely,
Dorothy H, LCCE
