You mentioned that you had 3 C-sections in the past, and on your last one, your doctor said you had quite a bit of scar tissue and seemed concerned about it. And now you're pregnant with baby number 4, and you're wondering what implications that might have. First of all, it is best for you to talk with your doctor, who knows all the specifics of your history, and they'll be able to give you the best advice. But I can give you some general information about things that we are concerned about, or watch for, when a woman has had multiple C-sections in the past.
One of the things we think about is uterine rupture. Every time in the past when you've delivered a baby, the doctors made an incision on the uterus, pulled the baby out, stitched it up, and then it's healed nicely, but there's still weak points forever more. So in future pregnancies like this one, that incision can be tested. It's just like if I were to make an incision down my bicep, and then I started lifting heavy weights, there's a possibility that it could burst open. And when this happens, it's life-threatening to mothers and babies. But the chance of it happening is very slim, although it's still something we definitely keep in the back of our minds.
Another thing to consider is abnormal placental attachment. The placenta is more likely to attach over the cervix, and this is called a placenta previa. And this is bad, because a large amount of your blood is going to that point to feed your baby during pregnancy, and so if your cervix starts to open up at all, or if you start to contract or dilate, then you could have massive bleeding episodes. And so we check for this at your 20 week ultrasound. They'll look to see where the placenta is attached to, and if it's on or near the cervix, they'll do repeat ultrasounds to check its progress over the course of the pregnancy, and see if it moves away from the cervical opening. The placenta doesn't grow legs and move up the uterine wall, but it's like a balloon that has words on it. They look like they're close to the base of the balloon when it's not blown up, but as the balloon is blown up, the words are pulled to the top. That's exactly what happens with the placenta and the uterus as it grows. It might be attached near the base of the uterus, but as it grows then it moves up with it. So they check its progress over the course of the pregnancy and see if it's a risk by the time you're close to delivery or not.
Along with abnormal placental attachment, there's something called a placenta accreta, or percreta, or increta. This is where the placenta attaches deeper than it should. It usually just attaches to certain layers of the uterine wall, and then the placenta is easy to deliver after the baby comes. But if it attaches more deeply than it should, it becomes very difficult to detach the placenta and get it out. This increases your risk of postpartum hemorrhage and the need for a hysterectomy after delivery.
So again, I do recommend talking with your doctor about the specifics of your circumstances, and they'll be able to give you the best advice about the scar tissue and about these risks that we just keep in the back of our minds when someone's had multiple C-sections in the past. I hope the very best for you during this pregnancy, and if you have any other questions for me in the future, feel free to ask them on our Facebook page at / intermountainmoms , and recommend us to your friends and family too.
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