What organs can be damaged during Csection?
Asherman’s syndrome is an acquired condition where scar tissue (adhesions) form inside your uterus. The scar tissue can build up, decreasing the amount of open space inside your uterus. This condition can be a complication of medical procedures or cancer treatments. Women with Asherman’s syndrome may experience light or no periods, pelvic pain or infertility.
What is Asherman’s syndrome?
Asherman’s syndrome is a rare condition where scar tissue, also called adhesions or intrauterine adhesions, builds up inside your uterus. This extra tissue creates less space inside your uterus. Think of the walls of a room getting thicker and thicker, making the space in the middle of the room smaller and smaller.
This condition can cause pelvic pain and abnormal uterine bleeding and can lead to fertility issues. Asherman’s syndrome can be treated and treatment often helps relieve your symptoms.
How common is Asherman’s syndrome?
Asherman’s syndrome is considered a rare disease. It’s hard to know exactly how many people have Asherman’s syndrome because it can go undiagnosed. Some people may not experience any symptoms from this condition. If you don’t experience symptoms, you may never see a healthcare provider.
Who gets Asherman’s syndrome?
Asherman’s syndrome is an acquired condition, which means that something usually happens that causes you to develop scar tissue. You can acquire Asherman’s syndrome in several ways, including surgery, infections and cancer treatments.
Your risk of developing Asherman’s syndrome can increase if you’ve:
- Had surgery on your uterus in the past, including operative hysteroscopy, complicated dilation and curettage (D&C) or cesarean section (c-section).
- Had a history of pelvic infections.
- Been treated for cancer.
Is Asherman’s syndrome genetic?
Asherman’s syndrome is generally not a genetic condition. This means that you get this condition through something that happens (as a side effect of surgery, treatment or infection) and not passed down through your family.
Symptoms and Causes
What are the symptoms of Asherman’s syndrome?
If you have Asherman’s syndrome, you can experience a variety of symptoms. These symptoms can include:
- Having very light periods (hypomenorrhea).
- Not having a period (amenorrhea) or having abnormal uterine bleeding.
- Feeling severe cramping or pelvic pain.
- Having difficulty getting pregnant or staying pregnant.
In some cases, you may not experience any symptoms of Asherman’s syndrome. You may also still experience normal periods. If you feel any discomfort in your pelvis or have unusual periods, reach out to your healthcare provider.
What causes Asherman’s syndrome?
Asherman’s syndrome happens when scar tissue (adhesions) build up inside your uterus, limiting the space inside your uterus and sometimes blocking your cervix. This can happen for several reasons, but one of the main causes is often surgery of your uterus or cervix.
The causes of Asherman’s syndrome can include:
- Operative hysteroscopy: A surgery where your provider places a camera into your uterus and then cuts off and removes fibroids using an electric instrument.
- Dilation and curettage (D&C): A type of surgery, dilation and curettage (D&C) is used to open your cervix (dilate) and then remove tissue from your uterus. This tissue can be the lining of your uterus (endometrium) or tissue from a miscarriage or abortion. During the procedure, a tool is used to scrape away the extra tissue. This typically doesn’t cause scarring unless you have an underlying infection.
- Cesarean section(c-section): This surgery is used to deliver a baby. In some cases, a c-section can cause scar tissue to form. This can happen where the stitches (sutures) were used to stop bleeding (hemorrhages) during the c-section and you have an infection at the time of the procedure. Otherwise, it’s very rare for a c-section to cause Asherman’s syndrome.
- Infections: Infections alone don’t typically cause Asherman’s syndrome. But, when you have an infection while you undergo uterine surgery, like a D&C or a c-section, you can develop Asherman’s syndrome. Some infections that could lead to Asherman’s syndrome include cervicitis and pelvic inflammatory disease (PID).
- Radiation treatment: Sometimes, a treatment option can cause scar tissue to develop in your uterus. Radiation therapy can be used on conditions like cervical cancer, but this can cause adhesions (scar tissue) that lead to Asherman’s syndrome.
Can an IUD cause Asherman’s syndrome?
An intrauterine device (IUD) is a type of long-term birth control that’s placed inside your uterus and left there for a period of time (often several years). When this device is placed in your body, there’s always the risk of infection and the development of scar tissue. However, this isn’t a proven cause of Asherman’s syndrome and IUDs are not commonly linked to the condition.
Diagnosis and Tests
How is Asherman’s syndrome diagnosed?
Asherman’s syndrome is typically diagnosed when you either experience symptoms of the condition like pelvic pain, amenorrhea (lack of menstruation), abnormal uterine bleeding or an inability to get and stay pregnant. Your medical history can also lead to a diagnosis of Asherman’s syndrome. If you have had a dilation and curettage (D&C) procedure, c-section, radiation therapy or pelvic infection, you may be tested for Asherman’s syndrome. All of these procedures and conditions can lead to Asherman’s syndrome.
During an appointment, your healthcare provider will go over your medical history. If you have had any kind of pelvic surgery that isn’t included in your medical history, make sure to tell your provider. That information can be very important in diagnosing Asherman’s syndrome. Your provider will then do a physical exam, but to detect scar tissue inside your uterus, your provider will perform a sonohysterogram. For a sonohysterogram, your provider injects a little saline solution inside your uterine cavity through a small catheter. Then, they use transvaginal ultrasound to see if any tissue is blocking the cavity or cervix.
What imaging tests can be used to diagnose Asherman’s syndrome?
Imaging tests allow your healthcare provider to see your internal organs. Different tests provide various amounts of detail. These tests can be done on top of your skin and involve little to no preparation, or they can be more complicated procedures.
Imaging tests that can be used to diagnose Asherman’s syndrome include:
- Ultrasound: This type of imaging test uses sound waves to create a picture of your internal organs. An ultrasound can be done externally on your skin or internally with a transvaginal ultrasound. A thin wand is inserted into the vaginal during this version of the test.
- Hysteroscopy: During this procedure, your healthcare provider uses a thin tool with a camera on the end to look inside your uterus. This is inserted in your vagina and moved up through your cervix and into your uterus. Hysteroscopy allows your provider a very detailed look at the inside of your uterus. It can also be used to treat Asherman’s syndrome.
- Saline infusion sonography: This imaging test uses ultrasound along with a saline (a mixture of salt and water) solution to create a clear image of the inside of your uterus. The fluid expands your uterus so that your provider can see details of the shape and defects of your uterine cavity. This gives your provider a very detailed look at the inside and outside of your reproductive organs.
Management and Treatment
How is Asherman’s syndrome treated?
There are several ways to treat Asherman’s syndrome. During a conversation with your healthcare provider, it’s good to discuss how this condition makes you feel — including any pain you may experience — as well as your goals for future fertility. In some cases where a woman isn’t experiencing symptoms, a treatment option can actually be no treatment. However, if your plan includes future pregnancies, there are treatment options that can remove the scar tissue. Treatment can also help if you’re experiencing cramps or pelvic pain.
The main goal of treatment is to remove the scar tissue and restore your uterus to its original size and shape. Treatment for Asherman’s syndrome can help:
- Relieve pain.
- Restore your normal menstrual cycle (periods).
- Allow for the possibility of pregnancy if you’re pre-menopausal.
Your healthcare provider may use hysteroscopy to remove the adhesions in your uterus. During a hysteroscopy, your provider uses a thin tool called a hysteroscope to look inside your uterus. This tool can also be used to remove scar tissue. The hysteroscope is inserted into your vagina, through your cervix and into your uterus. Scar tissue is very carefully removed during this procedure. A possible risk of this procedure is damaging healthy tissue inside your uterus while removing the scar tissue.
Hormonal treatments (estrogen) may be paired with a small intrauterine catheter left inside your uterus for a few days after the hysteroscopy. This will reduce the risk of recurring scar tissue formation after the procedure. In fact, estrogen promotes healing of your endometrium (inner lining of the cavity) and the catheter provides a physical barrier between your anterior and posterior uterine walls, so that they don’t adhere to each other in the few days following the procedure for scar tissue removal. When an intrauterine catheter is inserted, you’ll be given antibiotics to prevent possible infections.
C-Section Surgery: What Happens During and When It’s Necessary
Here’s what to know about one of the most frequently performed surgery in the U.S.
Jessica Migala has been a health, fitness, and nutrition writer for almost 15 years. She has contributed to more than 40 print and digital publications, including EatingWell, Real Simple, and Runner’s World. Jessica had her first editing role at Prevention magazine and, later, Michigan Avenue magazine in Chicago. She currently lives in the suburbs with her husband, two young sons, and beagle. When not reporting, Jessica likes runs, bike rides, and glasses of wine (in moderation, of course). Find her @jlmigala or on LinkedIn.
Updated on January 20, 2023
Medically reviewed by
Kiarra King, MD, FACOG, is a board-certified gynecologist from Oak Park, Illinois.
Childbirth either happens vaginally or via a Cesarean section, also known as a C-section. An obstetrician performs a C-section by an incision in the abdomen and uterus. They deliver the newborn directly from the uterus instead of through the birth canal.
Obstetricians may perform C-sections when a vaginal delivery isn’t going as anticipated. Other times, people know ahead of time that they will need one.
Here’s what to know about when someone might need a C-section and how obstetricians perform the surgery.
When Are C-Sections Necessary?
There are several possible reasons why you may need a C-section. A healthcare provider may recommend a C-section if you’re in labor or still pregnant in cases such as:
- You have a disease like heart disease or human immunodeficiency virus (HIV).
- The fetus is in a breech position, with the feet or butt facing downward instead of the head.
- You have placenta previa, which happens when the placenta fully or partially blocks the opening to the cervix.
- You have placental abruption, which happens when the placenta separates from the uterus.
- The fetus has a known congenital abnormality.
- You’re having twins or triplets.
Other times, a healthcare provider recommends a C-section while you’re in labor in cases such as:
- Your cervix has stopped dilating.
- The fetus is in distress.
- The cervix is dilated, but the fetus isn’t coming down the birth canal.
- You’re too tired to keep pushing, also known as maternal exhaustion.
Also, a healthcare provider will likely schedule people who’ve already had two or more C-sections for another with future pregnancies.
If you’ve previously had only one or two C-sections, you may be a candidate for a trial of labor after cesarean (TOLAC). An obstetrician or midwife will discuss if you are an appropriate candidate for a TOLAC. A vaginal birth after a C-section occurs once you have delivered vaginally.
Hospitals and healthcare providers have different policies about who is eligible for a TOLAC. Generally, large teaching hospitals are better equipped to handle TOLACs and VBACs than small hospitals.
What to Expect When You Have a C-Section
Commonly, an anesthesiologist gives an epidural or spinal anesthesia before the C-section. The medications used in those forms of regional anesthesia numb the body from the waist down. So, you can be awake for the birth of your newborn. Healthcare providers rarely administer general anesthesia if you require an emergency C-section.
The idea that the obstetrician takes out your organs and places them on the operating table is a myth, Michael Cackovic, MD, an OB-GYN at the Ohio State University Wexner Medical Center, told Health. Realistically, the obstetrician will cut through the skin and layers of connective tissue in your abdominal area. Then, they will move aside the organs surrounding the uterus, like the bladder and intestines.
The obstetrician will then manually separate the rectus abdominus muscles, the vertical muscles that run along your abdomen. From there, they make a vertical or horizontal incision on your uterus.
The obstetrician gently lifts the head through the incision and, at times, applies pressure on the uterus to facilitate delivery. The movement is similar to how the fetus travels through the vagina. Many people report feeling pressure and tugging as the newborn is born.
«While pain receptors are blocked with anesthesia, they deal with pain only, not the sensations of pressure. That can be anxiety-provoking or feel weird for the woman,» said Dr. Cackovic.
After the surgery, the obstetrician stitches up the incisions in your uterus, fascia, and skin. Most people will have a horizontal scar on their bikini lines. Sometimes, the scar runs up and down underneath the belly button.
The surgery takes about 25 to 30 minutes, added Dr. Cackovic. But sometimes, a C-section can last up to an hour or more, depending on how complicated the surgery is.
Once the obstetrician delivers your newborn, you should be able to hold them right away. But if you had general anesthesia, you would have to wake up and become alert before holding your newborn.
After the obstetrician stitches you up, you will move to a recovery room. There, healthcare providers will monitor your vital signs and pain level.
You may stay in the hospital for two to four days after a C-section. The length of your stay depends on several factors, including how your in-hospital recovery is going.
C-sections are generally safe for both the parent and newborn. But there are risks of complications associated with the procedure, regardless of if it’s planned, which include:
- Bladder or bowel injuries
- Issues with urinating and urinary tract infection (UTI)
- Blood clots
- Adverse reactions to medications
Repeat C-sections come with potential complications, as well. For example, a person might have a placenta accreta, which happens when the placenta remains attached to the uterine wall after delivery. Placenta accreta may cause severe bleeding.
Ideally, a healthcare provider can diagnose placenta accreta during a prenatal ultrasound, but in some cases, they cannot.
So, the American College of Obstetricians and Gynecologists advises that healthcare providers only perform C-sections if the benefits outweigh the risks. An OB-GYN should carefully discuss the decision with you.
Going Home After a C-Section
Once you are home, you will need to take it easy for a few weeks until you heal. It may take up to eight weeks to return to your normal self. You’ll likely experience some symptoms during your recovery, most of which also occur after a vaginal delivery. Those symptoms include:
- Mild cramping
- Bleeding from the vagina for four to six weeks
- Passing clots
- Pain at the incision site
If you’re bleeding, the blood will slowly become less red and then pink. Later, the blood will become a yellow or white color. Bleeding and discharge after delivery is called lochia.
You must clean the incision site by washing it gently with mild soap and water. You can take showers but should avoid taking a bath or swimming pools until a healthcare provider tells you it’s OK.
After four to eight weeks, you should be able to resume most of your regular activities. But before then, you should not place anything inside your vagina, such as tampons, or have sex.
Other things to keep in mind after C-section include:
- Do not lift anything heavier than your baby.
- Rest when you need to.
- Avoid heavy housecleaning, jogging, exercising, or any other strenuous activity.
Over time, you can gradually increase your activity level until you are back to normal.
Seek medical attention right away if you notice any of the following while you are recovering from a C-section:
- Severe pain
- Heavy vaginal bleeding
- Redness, swelling, or excessive pain at the incision site
- Discharge from incision
- Cough or trouble breathing
- Swelling in your lower leg
- Pain while urinating or difficulty holding urine
A Quick Review
There are many reasons that it may not be possible to give birth vaginally, so you may need a C-section. With a C-section, an obstetrician makes an incision through the abdomen and into the uterus to deliver the newborn. It can take several weeks to recover after having a C-section.
Talk with a healthcare provider if you have questions or concerns about having a C-section. They can tell you what to expect if you end up needing one.
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Uterine rupture is when your uterine wall tears open. It’s more common in people who try a vaginal delivery after having had a cesarean delivery. It’s a rare but life-threatening complication that requires immediate treatment.
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What is uterine rupture?
A uterine rupture is a serious complication where your uterus tears or breaks open. It’s most common in people who’ve had a previous C-section delivery and then try for a vaginal delivery, or vaginal birth after cesarean (VBAC).
Your uterus is a muscular organ that can grow to support a developing fetus. It’s made of several layers of tissue. In a uterine rupture, these layers tear open. It’s most common for uterine rupture to occur along the scar line of a prior C-section incision. In a C-section delivery, your obstetrician cuts into your uterus to deliver your baby, leaving a scar. Ideally, this scar stays put and is strong enough to withstand the pressure of future pregnancies and labor. However, with a uterine rupture, this scar rips open.
A uterine rupture can be complete or incomplete:
- Complete uterine rupture: The tear goes through all three layers of your uterine wall. This is very serious and requires immediate treatment.
- Incomplete uterine rupture: The tear doesn’t go through all three layers of your uterine wall.
Most uterine ruptures occur when a pregnant person is in labor, but it can happen during pregnancy. There are cases of uterine rupture in people who aren’t pregnant, but this is rare.
What happens when your uterus ruptures?
Uterine rupture is considered a medical emergency as it can have life-threatening consequences for both you and the fetus. It essentially leaves a hole in your uterus and abdomen. This can be very dangerous and cause severe blood loss. When your uterus ruptures, the fetus is left without the protection of your uterus. It can cause the fetus’s heart rate to slow down and leave it without oxygen. Without oxygen, the fetus is at risk for brain damage or suffocation. Pregnancy care providers must act quickly to remove your baby and repair your uterus.
How common is a ruptured uterus?
Uterine rupture is rare. In people who’ve had one cesarean delivery, it happens in about 1 in 300 deliveries. Among people who’ve had more than one C-section, uterine rupture is more common, affecting up to 9 in 300 deliveries.
Who is most at risk for uterine rupture?
Uterine rupture is most likely to occur along the scar line in people who attempt a vaginal delivery after having a previous C-section delivery. Your risk for uterine rupture increases each time you have a C-section delivery.
Other risk factors include:
- History of uterine surgery.
- Previous uterine rupture.
- Uterine trauma.
- Congenital uterine anomalies such as septate uterus or bicornuate uterus.
- Your uterus is stretched, such as when you’re pregnant with multiples or have too much amniotic fluid.
- Your baby is breech and requires manual turning before delivery (external cephalic version).
- Prolonged labor.
Symptoms and Causes
What are the warning signs of a ruptured uterus?
You may not notice any signs of uterine rupture. Your pregnancy care provider will look for symptoms of complications during delivery and take action if they suspect something is wrong.
Symptoms of uterine rupture could include:
- Non-reassuring fetal heart rate (fetal distress).
- Fast heart rate or low blood pressure in the pregnant person.
- Sudden and severe abdominal pain.
- Vaginal bleeding.
- Contractions that don’t stop or let up.
- Labor that stops or slows down.
If your provider knows you’re at risk for uterine rupture, they can take precautions before delivery. It’s important to share your complete medical history with your provider for this reason.
What causes uterine rupture?
Most uterine ruptures occur at the site of a previous C-section scar during labor in a subsequent vaginal delivery. This is because the pressure and stress of contractions weaken the scar tissue, causing it to tear open. Once your uterus ruptures, the fetus has nowhere to go but into your abdomen.
If you’ve had a C-section, this puts you at higher risk for a uterine rupture. Your risk is slightly lower if your surgeon made a low-transverse uterine incision as compared to a vertical incision. However, other surgeries, such as surgery to fix a uterine anomaly, also put you at risk. Your pregnancy care provider may automatically schedule you for a C-section if they feel you’re at high risk for a uterine rupture to avoid potential complications.
Just because you’ve had a C-section doesn’t mean you can’t have a vaginal delivery. Be sure to discuss your previous deliveries with your provider so they can evaluate if you’re a good candidate for VBAC. In some cases, VBAC is too risky and your provider will recommend a C-section to avoid uterine rupture.
What does a uterine rupture feel like?
Not everyone feels a uterine rupture. If you do, you may feel like your abdomen is ripping open or you may feel a sudden surge of pressure. You may also feel symptoms of low blood pressure or rapid heart rate such as dizziness and shortness of breath.
Can uterine rupture cause death?
Yes, uterine rupture can cause death. The rate of morbidity for the birth parent is less than 1%.
Can a fetus survive uterine rupture?
Yes. The rate of morbidity for the fetus is slightly higher than that of the birth parent (6%). Providers must act quickly to deliver the baby and provide life-saving treatment.
Diagnosis and Tests
How is uterine rupture diagnosed?
Diagnosis can happen during labor and delivery when your pregnancy care provider notices:
- Your baby’s head was very low in your pelvis, but now its head can’t be felt during a vaginal exam.
- Your baby’s heart rate goes down and you’re having lots of uterine contractions.
Pregnancy care providers confirm a uterine rupture by making an incision (cut) in your abdomen so they can see if your uterus has torn. If they confirm a uterine rupture, they’ll perform surgery to remove your baby as quickly and safely as possible.
Management and Treatment
How is a uterine rupture treated?
If your uterus ruptures, your provider will deliver your baby right away. Then, they’ll repair your uterus with surgery. Sometimes, a hysterectomy (removing your uterus) is necessary if you’re losing a lot of blood. Healthcare providers must pull your baby from your abdomen quickly and be prepared to administer emergency care to both of you.
How long does it take for uterine rupture to heal?
You can expect at least four to six weeks to recover from a ruptured uterus. It’s important to get lots of rest and follow your provider’s instructions on what to avoid until you’ve healed. Things your provider may ask you to avoid during your recovery include:
- Lifting objects more than a few pounds.
- Placing anything inside your vagina. This includes tampons and having sex.
- Exercise, stairs or strenuous movements.
- Taking a bath or sitting in water.
What are complications of a uterine rupture?
Uterine rupture can cause life-threatening complications. With quick treatment, there’s less risk of serious complications.
Complications for the fetus:
- Brain damage due to lack of oxygen.
Complications for you:
- Excessive blood loss (hemorrhage).
- Losing the ability to get pregnant due to hysterectomy.
How can I reduce my risk of uterine rupture?
You can reduce your risk by sharing your complete medical history with your provider and discussing risk factors for uterine rupture. Knowing that you’re at risk for uterine rupture helps your provider make preparations to prevent it.
Since your risk of uterine rupture is higher if you’ve had cesarean deliveries, your provider may decide it’s safer to schedule a C-section. This prevents you from going into labor and placing additional pressure on your uterus.
Outlook / Prognosis
Can I have another baby after uterine rupture?
Yes, many people have subsequent pregnancies and deliveries after a uterine rupture. You typically will require a C-section delivery if you’ve had a previous uterine rupture.
Frequently Asked Questions
What’s the difference between uterine rupture and placental abruption?
A placental abruption is when the placenta separates from your uterus before delivery. In a placental abruption, your uterine wall doesn’t rip or tear. It’s similar to uterine rupture in that it can cause severe complications for you and your baby. Certain risk factors, like uterine trauma and expecting multiples, are common in both conditions. They also share some of the same symptoms like abdominal pain and vaginal bleeding.
A note from Cleveland Clinic
Uterine rupture is a rare but serious complication that occurs most often in people who attempt a vaginal delivery after having had a C-section or other surgery on their uterus. It’s important to discuss your medical history with your pregnancy care provider so they can make the best decision on how to proceed with your delivery. It’s possible to have a vaginal birth after a previous cesarean (VBAC) if certain criteria are met. Talk to your provider about your options for delivery and if you’re at risk for uterine rupture.