There is always a special group of patients who come to the clinic, who do not have a disease, but just come for consultation – either 1-2 years, or 3-5 years, or a decade or two after the birth of their first child. But all of the first children were born by cesarean section. There are many concerns, some for the whole family. The high rate of cesarean births cannot be dismissed as a negative effect of the “one-child” policy. When a woman can only have one child, she often has very high expectations and does not want to have an accident during the birth, and from a layman’s point of view, she thinks that a C-section is safer (it is not), so she has a C-section. Now the second child policy is here. In October 2015, the full liberalization of the second child, in the face of this sudden, joyful and worrying news, many women of childbearing age into a tangle, the first child cesarean delivery, how to do the second child? Faced with the many problems that may arise when you get pregnant again after a cesarean section, it makes many women and families with ideas very worried. What are the possible scenarios for another pregnancy after cesarean delivery: medically speaking, there are the following risks: scarred uterine incision pregnancy, aggressive placenta praevia, etc., as well as the possible serious consequences of uterine rupture, hemorrhage, hysterectomy, surgical injury, preterm delivery, etc. These adverse pregnancy outcomes make those women doctors around me who are obstetricians and gynecologists need to carefully consider whether to continue with a second child. Let’s discuss these issues together. How long does it take to recover from a first cesarean to have a second child? As the rate of cesarean delivery increases, the proportion of scarred uterus after cesarean delivery increases, and women with scarred uterus are more complicated and dangerous to have a second child. It takes time for the uterine incision to heal after the previous cesarean delivery, and the scar is connective tissue, which is not as elastic as the myometrium, so the scar will not heal well after the surgery, and the scar will easily rupture when you get pregnant again. In late pregnancy, as the fetus grows, spontaneous rupture of the uterine scar may occur, and abdominal pain is the main manifestation. At the same time, it is important to prevent the abdomen from being squeezed by external forces in late pregnancy to prevent the uterine incision scar from splitting. If abnormal abdominal pain is found, it is important to go to the hospital in time. Currently, pregnancy ultrasound can measure the uterine scar pattern directly and also the thickness of the lower uterine segment, which can help predict the risk of uterine rupture in transvaginal delivery in scarred uterus, and is most significant in predicting uterine rupture when the thickness of the lower uterine muscular layer is less than 2.0 mm. If I had a cesarean delivery in the first child, can I only have a cesarean delivery in the second child? The number of cesarean deliveries and the time since the current pregnancy are important. If there is only a history of one cesarean delivery and the cesarean delivery is at or more than two years since the current pregnancy, there is a possibility of natural delivery. The previous cesarean delivery should also be chosen if the reason for the previous cesarean was an abnormality of the pelvis or if there is an oversized fetus, abnormal fetal position or abnormal placental position this time. If the previous operation was performed with a longitudinal incision in the body of the uterus or a poorly healed postoperative uterine incision, the risk of uterine rupture in another pregnancy is higher and natural delivery should not be considered. A scar on the uterus after a previous cesarean delivery requires close monitoring during another pregnancy and delivery, and prompt consultation if there is abnormal abdominal pain and vaginal bleeding. Pregnancy after previous cesarean delivery, be alert to hysterotomy scar pregnancy A cesarean scar pregnancy is a pregnancy in which the gestational sac or embryo sac is implanted in a previous hysterotomy scar, and as the rate of cesarean delivery increases, the incidence of pregnancy at the hysterotomy scar site gradually increases. The location of the lower uterine incision scar is equivalent to the uterine kip and is located outside the uterine cavity, making it a specific site of ectopic pregnancy. The etiology may be due to poor healing of the uterine incision after cesarean section, with the possibility that the fertilized egg may develop and grow after implanting in or near the fissure, and that the villi may invade directly into the myometrium or even penetrate it. The clinical presentation includes abdominal pain and vaginal bleeding, and the location of the gestational sac is found on ultrasound at the uterine incision scar. If the diagnosis is not confirmed in time, uterine perforation, uterine rupture and hemorrhage may occur, and in severe cases, hysterectomy may be required. In recent years, there has been a gradual increase in the understanding of the condition, and the diagnostic techniques have become more mature, allowing for early diagnosis and treatment and preserving the reproductive function of the patient. There are various modalities of treatment, such as medication, uterine artery embolization, aspiration under ultrasound monitoring, laparoscopy, transabdominal and transvaginal scar gestation removal. Pregnant women who have had a second pregnancy after a previous cesarean delivery are alerted to the occurrence of an aggressive placenta praevia. Placenta praevia that occurs in a second pregnancy after a cesarean delivery is called an aggressive placenta praevia, where the chorion and placenta easily invade the muscular layer or even the plasma layer, becoming an implanted placenta, often leading to complications such as hemorrhage and hysterectomy. If the ultrasound of pregnancy during pregnancy indicates that the placenta is in an anterior position and the placental blood flow invades the myometrium, placental implantation may be considered, and it is important for preoperative evaluation.