Treatment of pregnancy at the old caesarean section

This is an automatically translated article.

The article was professionally consulted by Specialist Doctor I Le Thi Phuong - Department of Obstetrics and Gynecology - Vinmec Ha Long International Hospital.
Pregnancy at the old caesarean section is a phenomenon where the fetus implants near the old cesarean. If not treated early, it can cause some dangerous complications such as uterine rupture, miscarriage, difficult to stop bleeding. Treatment methods vary depending on the size of the fetus, the degree of uterine compression.

1. What is an old cesarean birth?

Pregnancy at the old C-section is a condition in which the egg implants near the old C-section. Over time, as the fetus develops, it can put pressure on the old incision, causing the incision to open, leading to uterine rupture, which is life-threatening for the woman.

2. What are the dangerous complications of pregnancy at the old incision?

For pregnant women who have had one or more previous cesarean births, in this pregnancy, pregnancy was diagnosed at the old incision, it is necessary to have surgery to remove the pregnancy mass immediately. If left for a long time, the size of the fetus becomes larger, causing pressure on the bladder to damage the bladder. In particular, the fetal mass presses on the uterine wall, at the old incision, causing dangerous complications such as miscarriage, bleeding, uterine rupture, dangerous to the patient's life.
Therefore, for those who have had a history of giving birth by cesarean section, it is necessary to pay attention to regular pregnancy health checks, especially to locate the fetal mass, if abnormalities such as fetal mass are detected. develop in the isthmus of the uterus, close to the incision site, it is necessary to take timely measures to avoid complications.

3. Suspected sign of pregnancy at the old caesarean section

Women who have given birth by cesarean section should pay attention to the following symptoms to go to the doctor to identify and prevent pregnancy complications at the old cesarean:
Abnormal vaginal bleeding Dull abdominal pain in the pelvis

When coming to the doctor, pregnant women are assigned to do an ultrasound. If the pregnancy is at the old cesarean section, the ultrasound results will have abnormalities such as:
No amniotic sac in the uterine cavity The fetal heart is located in the anterior wall of the isthmus. There is a uterine muscle separating the gestational sac from the bladder. Distribution of blood vessels around the gestational sac, combined with Doppler ultrasound showing increased vascularity around the gestational sac Loss or lack of muscle layer between the bladder and the gestational sac

4. Treatment of pregnancy at the old caesarean section

During the treatment, the doctor will prioritize taking the pregnancy out to avoid uterine rupture, preserving the woman's fertility, depending on the specific clinical case to give the treatment methods and appropriate combination therapy.
Some commonly used treatment methods include:
Aborting the pregnancy in the amniotic sac Removing the pregnancy mass by: Abortion: This is a method of management with a high risk of bleeding. out: Surgery is performed to remove the pregnancy mass, preserving the uterus when medical treatments do not work or the placenta is heavily invasive to the incision and bladder. Indications for hysterectomy can be done when the bleeding is difficult to stop or the pregnancy mass is too large. Cervical balloon catheterization: A procedure performed to stop bleeding after aspiration. The person performing the procedure uses a Foley catheter to gently place it on the cervix and then inflate the balloon with 30ml of physiological saline inserted in place for 12 hours. Systemic chemotherapy: The method is used to reduce the distribution of blood vessels in the fetal mass and destroy the placental cells. The drug used is Methotrexate 1 mg/kg, intramuscular dose Causing blood vessel occlusion: This is a combination treatment in preparation for surgery or in combination with chemotherapy. The procedure is performed by vaginal ligation of the uterine artery or an internal iliac artery ligation to prevent bleeding during surgery or to make chemotherapy more effective.

Prenatal screening helps pregnant women detect pregnancy at the old incision for timely intervention. Faculty of Fetal Medicine - Vinmec International General Hospital is the first unit in the North to deploy a one-stop prenatal clinic (OSCAR) providing a comprehensive screening package for pregnant women at 12 weeks. The clinic gives quick results on the same day of examination and screening.
Faculty of Fetal Medicine has successfully implemented advanced prenatal screening methods, helping to screen for complications for pregnant women; Timely detection and intervention of some abnormalities in the fetus from very early weeks of pregnancy.

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