Question-------------------------
WOW! So you don't believe the risk of spontaneous rupture (rupture that is NOT labor induced) is as high as my OB mentioned? 40% chance of rupture seemed to be a fairly high risk! Another question, is the thinning generally associated with the scar tissue, or is it the entire uterus? Is it the scar tissue that is at risk for rupturing? What are windows in the uterus -- is this the same as thinning? Does the fact that I usually have very large babies have any impact on the risk of rupture? My babies were 9.2 lbs, 8.12 (2 weeks early) and 8.4 (2 weeks early). I really appreciate the time you are taking to answer these questions for me.
Emily
Followup To
Question -
Hi,
I am a 35 year old woman in very good health. I have had 3 c-sections due to the size of my babies(labored for 8 hours before having the first, the other two were scheduled. During my 3rd one, my OBGYN found that my uterus was quite thin. She said that if I were to get pregnant again, there would be a 40% chance of sponaeous rupture. This was more than 4 1/2 years ago. I would LOVE the chance to have one more baby, but I am bit concerned about the strength of my uterus. I do want to mention that the hospital that this OB is affiliated with doen't allow VBAC because of rupture that resulted in death a number of years ago. I'm mentioning this not because I want to try a VBAC, but because I'm not sure if my OB is slanted more towards the cautious because of this policy. Anyways, I would love to know more about the risk of rupture due to a thin unterus; does the uterus rejuvinate/strengthen over time? Is there anything that can be done to strengthen the uterus or help prevent rupture in the event of pregnancy? What is the REAL risk of rupture? Please, help me to answer these questions. I am going for my yearly exam with my OB on Monday, and I would like to bring up this topic, but I would like to be better informed when I bring it up to her. Thanks so much for you help.
Emily
Answer -
The risk of rupture of a uterus following one cesarean section is 1%. This is due to the integrity of the uterine incision. Since you have had two more cesareans, this risk is somewhat increased. Your uterus does not rejuvinate or become stronger over time. With each successive cesarean, there are more adhesions and it is more difficult to open the abdominal cavity. In addition, your bladder is tacked higher and higher with each operation, causing a higher risk of bladder injury. Usually, the uterus becomes thin around the time if delivery and, as long as you do not go into labor, there should not be any problem with another pregnancy. However, you should schedule a repeat cesarean no later than 38 weeks gestation to make sure that you do not go into labor and risk rupture.
AnswerThe risk of rupture of the uterus after cesarean section is 1% not 40% even if the wall was found to be thin. (Usually, the entire uterine wall is thin around the time of delivery) Sometimes it is so thin that it is a "window". In other words, we can see right through the wall of the uterus and see the baby. As long as you are not allowed to go into labor (regular contractions more than 10 minutes apart), it should not rupture. That is why we recommend having a repeat section PRIOR TO going into labor. The weakest part of the uterus is at the site of the previous scar. With each successive section, there are more areas of weakness. Of course, larbe babies put more pressure on the uterus, but usually will not cause spontaneous rupture unless you are in labor (having contractions). Of course, I did not see your uterus during your last operation, and you have to weight the advice of your doctor heavily because your doctor did, indeed, see the thin tissue and is in a position to advise you.
