This article is professionally consulted by Specialist Doctor I Phạm Thị Yến - Obstetrics and Gynecology Department - Vinmec Hai Phong International General Hospital.
A cesarean section is a major surgical procedure performed on the lower abdomen and uterus to deliver a baby. The healing process of the cesarean scar depends on the woman's health, and typically the scar will fully heal within 3 months after childbirth. However, this scar is closely related to future pregnancies and deliveries. Especially when undergoing a third cesarean, the risks increase.
1. When Should the Third Cesarean Be Performed?
If a mother decides to have a third cesarean, she should consult thoroughly with obstetricians and ensure the gap between pregnancies should be 3-5 years to allow the body to fully recover and ensure the pregnancy is completed optimally.
At this point, the doctor will recommend performing the cesarean without waiting for other signs because the mother’s body is more prone to unwanted complications if attempting vaginal delivery. However, the cesarean should be performed carefully, with close monitoring to ensure safe labor for both mother and baby.
When the pregnancy reaches maturity (approximately 38-39 weeks), doctors will proceed with the cesarean (to prevent preterm complications such as respiratory distress or respiratory membrane disease), unless signs of labor occur earlier. It is advised that the mother should visit the doctor by 37.5 weeks to be monitored, counseled, and better prepared for the cesarean delivery.
2. Is a Third Cesarean Dangerous?
The risks increase with each subsequent cesarean, and they become more severe. With a third cesarean, the following dangers may occur:
- Uterine rupture or tearing: This is the most dangerous risk during the third cesarean. After two previous cesareans, the cervix has a scar. This area becomes weaker, and as the uterus contracts, the scar may rupture, leading to uterine rupture, which directly threatens the life of both the mother and the baby. The risk of scar rupture is higher if the gap between the second and third pregnancy is short (less than 18 months).
- Adhesion of intestines: The more cesareans a woman has, the higher the likelihood that her intestines may adhere to the abdominal wall, bladder, or other organs.
- Placenta abnormalities: The scar tissue on the uterus increases the chances of complications such as placental abruption or placenta previa. These require the doctor to carefully manage the cesarean, particularly in cases of placenta accreta, a highly dangerous condition that can affect surrounding organs (bladder, intestines), potentially leading to postpartum hemorrhage and the need for a hysterectomy.
- Infection: The risk of infection at the cesarean site, on the uterine wall, abdominal wall, and even near the bladder, may lead to extended hospital stays and treatment.
- Slow recovery: As the body has already undergone two cesareans, recovery during the third cesarean will be slower. The mother may experience more pain, and which need for antibiotics and painkillers, those factors may affect milk production.
3. Things to Consider for a Third Cesarean Delivery
- The gap between cesareans should be 3-5 years: This time frame allows the cesarean scar to heal fully, reducing the risk of rupture as the uterus grows larger and minimizing abnormal placental conditions.
- Choose an early cesarean (around 37-38.5 weeks): The third cesarean should not wait for spontaneous labor or the due date. It's better to opt for early intervention when the fetus is between 37-38.5 weeks to reduce the risks of potential complications.
- Regular prenatal check-ups: A third cesarean increases the risk of placental complications, so regular, careful monitoring of the pregnancy is essential to detect and manage any abnormalities early.
- Extended recovery time: A third cesarean requires more time for the mother to recover, so it is important to give her enough time to rest and regain strength.
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