Uterine wall- once thin, always thin? - Mothering Forums

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Old 09-06-2008, 12:02 AM - Thread Starter
 
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Cross posted in Birth Professionals. I really need advice about whether the uterus can "heal" itself, or thicken again after being thinned out for a prolonged amount of time! I felt like both forums fit this thread. Hope that's alright!

This post is long. I apologize, but I wanted to give a clear picture of the situation.

My second dd was a cornual ectopic pregnancy. She implanted very high on the right side of my uterus, just outside the fallopian tube. It's truly a miracle that she made it, and I didn't rupture. I'm very thankful!! She was delivered by c/sec because the high risk specialist felt it was risky to labor and push. He felt that there was a high risk of rupture, since the upper sides of the uterus don't stretch out like the lower portion. I did go into labor on my own, which they were scared of. After they delivered her, the OB checked my uterus and said she could feel form the inside that the uterus was thinner in that spot. It wasn't noticeable from the outside. My medical report says she felt slight thinning.

So, now I am expecting again, I'm 31 weeks right now. When I delver this little guy it will have been 4 years since my c/sec. I've been having prenatal care with a homebirth midwife for this pregnancy.

About 2 months ago, I got a call from my old OB's office when I asked that the records to be transferred. He called me personally to beg me to not attempt a VBAC. He's not the one who did the c/sec, but my name was well known in the office of 5 OB's because of my special case. He was asking me not to have a VBAC because of the thinned area, he wasn't concerned too much about the actual c/sec scar.

I wanted to be completely honest with my midwife so I told her about this conversation. Of course she shared with her backup OB who then revoked the approval for my homebirth. Paraphrasing, she said she could not approve the homebirth because if something happened it would damage her reputation. She's a good OB, and very supportive of VBAC, so I might be phrasing that wrong. She wasn't being rude or saying she didn't care about safety. But that was the bottom line, obviously I was a well known case and she would look like a nut for approving me if something happened.

If there's a real concern about rupture, I do not want to risk the safety of my baby or myself. But, no one can seem to tell me if there is a real concern. I've tried to research whether or not the uterus can repair itself after being thinned out, and can't seem to find any reliable information. I was given the analogy of an innertube that gets a weak spot- it will always be weak and it's likely to blow if there's too much pressure. The old OB's office is the one who used this analogy, and my current OB backup says she would agree. She also said there just isn't any research on this to help us decide. Most women do not have this happen. Most cornual ectopic pregnancies do not result in a 9 month pregnancy with a live baby and healthy mom at the end. So, it's difficult to find any evidence about what happens to the uterus afterwards.

Now, I thought the uterus was a muscle, and this analogy doesn't quite sit well with me. I could be wrong, of course. The reason a VBAC is important to me, besides the obvious reason that it's important to most women- is we want a large family & I don't want repeat c/sec's to limit the size of our family.

At first, the backup OB, who will now handle my care instead of my midwife said she would consider a VBAC in the hospital. She said we would pursue getting an MRI to check on the thickness of the uterus in that area. Today she emailed me to let me know the radiologist said that an MRI would not work. I'm confused about this because they did an MRI during my cornual ectopic pregnancy to get a baseline thickness on my uterus, and I had lots of u/s to check as well. But she's done with the MRI option. She said bottom line, I need to have a c/sec because they cannot say everything will be alright.

There is one other OB here that would let me VBAC. He's in a very bad part of town at a very questionable hospital. It's the only teaching hospital in the area and he would be able to let me attempt a VBAC with notes in my medical record saying he doesn't advise it.

The thing is, you can search long enough and hard enough to find the answer you want to hear, but that doesn't make it the right answer. If I know that the uterus can thicken after being thinned out for 9 months, I would feel ok with attempting a VBAC. But if not, then I'm just not a good candidate and I need to accept that.

I'm hoping someone has some experience, or advice that can steer me in the right direction!
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Old 09-06-2008, 12:38 PM
 
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This is a tough one.

The uterine wall, as you know, thins during pregnancy. The wall of those of us who've had c-sections thins more. Apparently, they don't yet know for certain whether this increases the risk of rupture. (Check out this study for some fairly interesting, if dense, reading.) If the concern is that the thinning wall could lead to dehisence (sorry, misspelled the crap outta that one), it seems that that portion of the uterus doesn't change much in thickness, at least during the first and second trimesters. In fact, it doesn't seem to thin out at all.

So my first thought--that they're afraid thinning of the wall will lead to rupture--doesn't seem to bear out.

The only thing I can suggest right now is that you really should get ahold of your medical records. See if you can get them from your pregnancy as well as your birth. Might be cost-prohibitive, though, so see if they'll let you look at them on site. That should give you some idea of what their issue is.

Because you're right. Without knowing exactly what they're afraid of, and why, you cannot make an informed decision.

Sabra: Mama to Bobbie (3/02), Linda (1/04), Esther (10/05), Marie (11/10), & Douglas (11/12)

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Old 09-06-2008, 06:42 PM
 
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I agree with the above poster. I had to research your past pregnancy condition and think about this all night long.

I still am not sure I understand why a "thin" spot in the uterus way up high by your fallopian tubes would interfer with a c-section scar and possible VBAC.

If they have okayed your uterus for another pregnancy I would think that your uterus would hold up fine. Once labor begins the uterine muscles do thin but at the BOTTOM and get thicker at the top. They do this cuz all the top muscles do all the work pulling the cervix open and pushing the baby down.

I'm just not sure what I would do. I would need to research more and look at my records, and talk with more OB's and possibly midwives
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Old 09-06-2008, 11:10 PM - Thread Starter
 
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Thank you for your responses!

My records from the previous pregnancy just talk about how my dd was positioned just outside the falopian tube & how this thinned out the uterus through the course of the nine months. Then the notes from the c/sec itself say that the OB noted when she felt inside my uterus there was slight thinning up there. She told me at the time it felt like a little pocket.

Right now, the confusing part is, will this thin spot my dd created always be there? Because I thought it would sort of "bounce back". The OB's are using the inner tube analogy & saying it won't bounce back. Though they admit they do not know for sure.

The current OB backup who I'm now seeing is very VBAC supportive & the prior OB that called me with concerns is also supportive of VBAC's. Neither of them is concerned about my c/sec scar during a VBAC.

They are both concerned that the thin spot at the top of my uterus would rupture. They say there's not enough research about it to know if it's a big risk.

The explanation of the top of the uterus getting thicker during labor is very helpful, I did not know that.

I really appreciate your help ladies, thanks SO much! I would appreciate any additional insight you might have.
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Old 09-06-2008, 11:34 PM
 
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The first study I linked to indicated that the deepness of the pocket formed by a c-section scar might have some bearing on risk of rupture, but that the research isn't there to be certain. Again, though, this is a slightly different injury we're talking about. I'm just basing conjecture off what we do know about uterine scars, and most of those are from surgical births.

In poking around, it seems that laparoscopic surgery of the uterus might be a risk factor for uterine rupture (this is in non-c-section mamas), but without being able to determine where these incisions are usually made, I can't even guess if those cases have any impact on your case.

As far as expecting it to bounce back...I wouldn't. Surgical repair is possible, at least of thinning as a result of a c-section, but in the normal course of things there will be some improvement but not a perfect regeneration. With a normal muscle, one of the reasons you're able to repair it to no small extent is that you are able to exercise it. But the uterus doesn't get much exercise outside of childbirth. (Well, orgasm is exercise too, I think, and go ahead and tell your husband you need a daily dose as physical therapy. ) And even with normal muscles, there is a point of injury where there will always be a weakness. Perhaps this is analogous; I don't honestly know.

It sounds as if the obstetricians you've been dealing with are recommending a very conservative course of action, and that's understandable. They've a duty to protect their patients, and they see this as minimizing the risk to you and especially to your child. This is why they're saying that the research doesn't exist to prove the safety of a VBAC in your circumstances. Chances are, it doesn't exist to prove the risk, either.

I honestly don't know what I'd do in your shoes. I'm comfortable with risks, but only if I am able to quantify them. If you do have a VBAC, though, make certain your obstetrician writes you up as a case study for publication. Maybe it will help women in your position in the future.

Sabra: Mama to Bobbie (3/02), Linda (1/04), Esther (10/05), Marie (11/10), & Douglas (11/12)

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Old 03-21-2014, 06:20 PM
 
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Hi, 

 

I just came back from my doctors office and was told that my uterus is too thin near the left tube to carry a pregnancy.  it is a very small area but it seems that I have a high prob of uterine rupture.  I wanted to ask, do you know how thin your wall was when you conceived or at any point during the pregnancy?

 

I really want to carry my own child but everyone is telling me no!  I miscarried recently and they sent me into an emergency surgery because the uterus was at 3mm. I'm 37 and desperately wanting a child.

 

Help!  Any input would be appreciated.

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