Recently, the Fifth Plenary Session of the 18th Party Central Committee resolved to fully implement the policy of allowing a couple to have two children. This is another population policy adjustment after the decision of the Third Plenary Session of the 18th Central Committee in 2013 to launch the implementation of the “separate two-child” policy. However, many women chose to have a cesarean section for their first child for various reasons, and now that they are going to have a second child, the scar on their uterus has become a hidden problem. Scarred uterus mainly occurs after obstetrical and gynecological surgeries such as cesarean section, uterine fibroid removal, repair of uterine perforation or rupture, and hysteroplasty, among which cesarean section is the most important cause of scarred uterus. So what do you need to pay attention to when you are pregnant with scarred uterus? 1, the current situation of delivery methods for pregnant women in China Medically, cesarean delivery should be the method used when the mother or fetus has abnormalities, such as maternal pelvic stenosis, oversized fetus, abnormal fetal position, placenta praevia, early placental abruption, hypertensive disease during pregnancy, acute fetal distress, etc. In recent years, the rate of cesarean delivery in China has soared wildly, with the proportion reaching as high as 33%, and in some hospitals even reaching 80-90%. In other words, one out of every three pregnant women in China takes a cesarean delivery, such a cesarean rate is as high as the third highest in the world, after Chile and Brazil. A considerable number of pregnant women in China use cesarean section for the sake of selecting auspicious time for delivery, fear of pain, higher commercial insurance coverage for cesarean section than natural delivery, and vaginal laxity caused by natural delivery, etc. Not all of them have cesarean section according to medical indications. 2.What are the risks of re-pregnancy in scarred uterus? Scarred pregnancy. In early pregnancy, the gestational sac does not settle in the normal cavity of the uterus, but in the scar of the uterus from the previous cesarean delivery, and the baby cannot grow to a normal size and will miscarry, or penetrate the mother’s uterus, causing uterine rupture and hemorrhage, and finally the uterus is removed to save the life of the pregnant woman. Even if the pregnancy is terminated early, the risk of bleeding in abortion is high, and the outcome of subsequent re-births is unpredictable. Uterine rupture. As the number of weeks of pregnancy increases, the uterus increases in size, the pressure in the uterine cavity increases, the muscle layer of the lower uterine segment becomes thinner, the muscle fibers elongate, and at this time the uterine scar is less elastic, there is a possibility of muscle fiber rupture and rupture of the uterine scar, which may lead to massive bleeding, shock and death in serious cases. It is especially common for those who have a short interval between previous cesarean deliveries and poor healing of the uterine incision. Postpartum hemorrhage. Lack of elasticity and poor contractility after scarring of the original uterine incision, which makes it easy for the lower uterine segment to contract poorly and may cause heavy bleeding during delivery or during another cesarean delivery. Increased difficulty in surgery and anesthesia. The chances of tissue adhesion, surgical damage and infection are greatly increased. 3. Is it necessary to have a cesarean section for the first child and a cesarean section for the second child? As more and more evidence shows that natural birth has many benefits for the mother and baby, the willingness of pregnant women to give birth naturally is gradually increasing. Is it possible to have a vaginal birth after a cesarean? This question is controversial, mainly because of concerns about the increased risk of uterine rupture. In a paper published in the New England Journal, over 20,000 women in Washington State who had a first cesarean and a second singleton birth over a 10-year period chose to have a cesarean, a natural painful birth, a prostaglandin, or no prostaglandin for their second birth. It is true that uterine rupture is higher after vaginal birth, especially since hypnobirthing may lead to an increased risk of uterine rupture. As medical technology has also become more advanced, various new research data have confirmed that the medical community has come back with evidence that vaginal trial of labor after cesarean delivery should not be equated with uterine rupture. If the previous fetus was delivered by cesarean section because of malposition, overweight, or placenta praevia, then this fetus can be carefully selected for vaginal trial of labor in consultation with the doctor, provided that it is in the correct position, of moderate weight, and without placenta praevia. Vaginal trial of labor must be done with care in selecting the mother and not trying to induce labor. Some women, including those with large fetuses, narrow pelvic cavity, and those who have had delayed labor, should avoid vaginal trial of labor. 4, the first cesarean birth again childbirth considerations after the cesarean birth if you want to have a second child, it is best to two years after the pregnancy. If a woman who has had a cesarean section in her first child has scars on her uterus from the surgery, if she gets pregnant again, the uterus may rupture in late pregnancy or even before delivery, thus endangering the safety of the fetus and the pregnant mother, which is very dangerous. If the cesarean incision is not so “strong”, if there was a hematoma or poor healing, the risk of another pregnancy will be higher. Therefore, if you want to have a second child after a cesarean section, it is best to have a pre-pregnancy examination in an obstetrics and gynecology department to fully assess the recovery of the cesarean scar and to consider transvaginal or laparoscopic or transabdominal scar repair if the cesarean scar is not healing well (whether this procedure reduces the risk of uterine rupture is still controversial in the medical community). In addition to the usual precautions for pregnant women, it is important to prevent abdominal compression in late pregnancy. To prevent the uterine scar from cracking, in late pregnancy, it is important to avoid crowding in cars and walking, to do appropriate housework, to sleep on your back or side, to have a moderate sex life, and to avoid pressure on the abdomen. Some scar uterus may rupture spontaneously in late pregnancy, and abdominal pain is the main manifestation. Therefore, you should seek medical attention immediately when abdominal pain occurs. 5.How many embryos do you transfer in IVF? IVF is the last “ace in the hole” if the second child has difficulties with natural birth. After entering the IVF process and getting several embryos successfully, it is a bit difficult when it comes to transferring embryos. Because IVF technology can transfer two embryos, the pregnancy rate can be more than 60%, but the rate of double pregnancy is as high as 30-40%. The risk of uterine rupture in late pregnancy is significantly increased if the scarred uterus is pregnant with a twin pregnancy, so it is advisable to choose to transfer one embryo. Having a second child is a wonderful family plan, but the risks of having a second child with a scarred uterus must be well considered. You should visit a medical professional before conception to seek counseling on having another baby and to develop personalized advice based on your actual situation.