Questioni am 29 weeks pregnant with my 6th baby. i have had 5 previous c/s and have been told at 24 weeks that my uterus was 2mm. i am wondering if this is normal, and should i be worried? i had the ultrasound due to scar pain which i am still getting, they were not able to get a good look at the scar only the uterine wall.i would really appreciate your opinion as my ob is not sure how thick it should be but is concerned as he noted that my lower segment was thin when he delivered number 5. Thankyou!
AnswerHi Sarah,
The risk of uterine rupture, although uncommon, does increase with each subsequent C Section. Having more than 3 previous C Sections puts you at higher risk for uterine rupture. Since you have had 5 previous and are experiencing pain at site of the scar is concerning to me. You will need to be monitored closely, especially with your last uterine wall measurement. There have been studies on this but there still is no definite standard "normal" measurement for the lower uterine wall. However, most go with 3mm as the limit of normal. So you really do not want to see a measurement less than that. So again, given your history, you really need to be careful with this and be monitored closely for risk of uterine dehiscence and rupture.
Uterine dehiscence is a more common scenario with previous C Sections and involves separation of the already existing scar from the uterine wall but can cause pain and even bleeding. The baby, placenta and umbilical cord are still contained within the uterus. Uterine rupture is much more serious and is defined as full separation of the uterine wall and causes significant bleeding and expulsion of all or some of the baby, placenta or both into the abdominal cavitiy, creating a need for emergency delivery and repair to save both your lives.
Most cases of separation involve uterine dehiscence, not rupture (even for those considered high risk) but my advice is to be very cautious and pay attention to your body; any abnormal pain and/or bleeding needs to be evaluated IMMEDIATELY, no matter how many times you need to go in between now and delivery, because if uterine rupture should happen outside the hospital setting, results are disastrous due
to the very short amount of time given to save your baby's and your own life. I am not saying this will happen to you but just in case I do want to put down what you are at risk for (you probably already know!). I wish you the best and any other questions just let me know.
Take care
Sara
