THinning of the uterus after C-section, fixable??
A very, very thin uterus (you may hear descriptions of "windows", where you can almost see through the tissue) is a problem and a risk factor for rupture, though there's no way to predict it reliably. They did do a study that showed that a thin uterus was more likely to rupture than a thick one, but it wasn't good enough to be predictive of who would rupture.
I would want more information and a 2nd opinion before making any decisions.
Hi! Im am researching this myself, as I was told pretty much the same thing. I also have had three c sections, and after my third (5.5 months ago) suffered from terrible complications afterwards. When I was in surgery my dr. reported being able to see my daughters hair floating around in my uterus through the "tissue thin" walls. Shen said that my uterus was literally falling apart and thats what caused my internal bleeding. It was a miserable and painful recovery, I also recieved several transfusions. They couldnt give me pain meds because They were afraid of any heaving nausea may cause, would cause a rupture in my uterus. My Dr. told me no more kids, and explained that she would have done a complete hysterectomy then and there had the risk for my complete bleeding out not been so high. When I asked at my 6 week appt, what could I expect if I were to get pregnant again, she restated I could die, that I possibly would lose the baby, but that If i did make it to the operating table they would do a verticle incision from my naval to pubic bone. So in conclusion sweetie I think you and I are faced with the same issue, another baby for us is a roll of the dice. I have finally begun accepting it, My other children need me and I cant risk it all on such a huge gamble. It has been a really rough thing to accept for me, but I am glad to have survived the last close call.
I've been told I have a thin uterus twice - once during a 10w loss (early 2008) that resulted in heavy bleeding and an emergent curetage, and most recently during a term cesarean for double footling breech twins (mid 2009). I have also been told my uterus is just fine (mid 2009) - by a RE doing a hysteroscopic procedure to remove adenomyosis. The OB during the 2009 c/s didn't give me any reason for the thin uterus or explanation of what that might mean.
I asked a new-to-me OB (mid/late 2008) what a thin uterus really means, and he said probably nothing. He recalled "back in the day" when they used to palpate c/s scars internally after VBACs that sometimes he'd reach up there and feel a complete dehiscence (scar separation). They never repaired them; the uterus repairs itself, he said.
I asked my OB (6 week post-partum, 2009) what a thin uterus really means, and he said probably nothing. OTOH, very few OBs here in town will touch VBAmC, including him. How convenient.
If my experiences with "thin uterus" diagnoses have told me anything . . . it's that perhaps my uterus naturally thins during labor, and that it would be reasonable for my uterus to be fairly thin at term while having over 12.5 lbs of babies cut out of me! My baby didn't break my uterus when she so violently broke her amniotic sac. My uterus didn't rupture during labor. My uterus didn't rupture during the cesarean . . . though the OB did puncture my bladder.
I don't mean to make light of your concerns at all. I'm still concerned about my diagnoses and what that might mean come June/July of this year as I labor my fourth child at home. However, I have NOT read anything that leads me to believe that uterine thickness is predictive of who will rupture. If anything it may help identify who is less likely to rupture (but not the other way around). You can always ask an experienced ultrasonographer to guestimate your uterine wall thickness in late pregnancy, if you think that would be helpful information for you.
I agree with meatloafkend that thin doesn't necessarily mean weak or compromised. I've been told that silk analogy before, and I like it. Thanks for the reminder!
It's been a while since doing the research but IIRC, the (scant) research I found said that a thick uterine wall was a good predictor of a uterus that will not rupture. However, a thin uterus was not a good predictor either way.
When I was in the hospital for PTL w/ DD (after having 2 c/s), the doctors said that my uterus was so thin that they couldn't distinguish between it and my bladder. I went on to have a wonderful VBA2C (against doctors wishes).
You have to be a little careful with that kind of statement anyway , I don´t mean to discredit anyone , but I´ve heard of many circumstances , when anti-vbac people will tell you just about anything to scare you away from even attempting to try a vbac .
And what better way to do that , than by saying "your uterus is thin" , after all , it´s not like you can unzip your stomach , to check yourself .
I don´t mean , that those cases don´t exist ! However , I was told after my second c/s , that I have too much scar tissue and all kinds of other issues , and I shouldn´t have any more kids at all and I went on to have two vbacs without any complications and when I asked the doctor after my surgery for the third c/s due to fetal heart problems , he said "what scar tissue , I didn´t see anything abnormal in there?"
If you look at the stats on uterine rupture, a thinning or "window" is actually considered a form of rupture. That being said, I wouldn't let that stop me from having more kids. Like the PP said, the uterus heals itself. There are parts that are thinner than other parts. I had a doula client who had a "window" who went on to have 3 more kids (7 c/sections in all)...and I don't think they are done.
I think you should get a 2nd...or 3rd opinion.
I can understand why you are scared. I am about 4 weeks along now, I have had 6 c-sections and after my 4th they said I had a dehicence "window" then my 5th my lower uterine segment was thin, then my 6th the same thing, doc said she could see the amniotic fluid through the lower uterine segment. I am going for my first Vaginal Birth after C-Section around December and am confident yet scared. The body is an amazing form and is very strong if you take care of yourself, you are not over weight, you get adequate prenatal care, and are confident in believing in your body everything is going to be fine. Find a doc you can trust in and that will make you completely comfortable in whatever you decide, but remember it is your decision, not their's because they are just worried about a law suit and there "at home time".
I am currently 5 weeks pregnant and got my surgical report (last section in 2008) and it indicates a thin lower uterine segment, omental adhesions to anterior uterus, and my bladder was densely adhered to my uterus (hence the bladder cut).
Has anyone had these adhesions and gone onto have aanother safe section? I am trying desperately to get in with my perinatologist for an emergency consult, but it is like pulling teeth!