What is a scarred diverticulum? With the full liberalization of the second child, many women are eager to try, including many with a history of cesarean delivery. For women who have had one or more cesarean deliveries, what additional risks will they encounter when they get pregnant and give birth again? 1. Pregnancy in the scar of the uterus after cesarean delivery Pregnancy in the scar of the uterus after cesarean delivery is a special type of ectopic pregnancy in which the gestational sac, chorionic villi or placenta is laid in the scar of the uterine incision of previous cesarean delivery and the pregnancy is completely or partially located outside the uterine cavity, surrounded by the myometrium or fibrous connective tissue. Due to the thinness of the myometrium at the scar and the proliferation of connective tissue and blood vessels, as the pregnancy progresses, the chorionic villi adhere to the myometrium, implant, and in severe cases, penetrate the uterus causing uterine rupture. As shown in the picture above: the hole seen outside is the diverticulum, and the cavity inside is the real uterine cavity. A normal uterus does not have this hole, so if the villi are implanted in this area, it is more dangerous. 2, uterine rupture uterine rupture refers to the rupture of the body of the uterus or the lower part of the uterus, can occur in all stages of pregnancy, but commonly in labor or at the end of pregnancy, a serious obstetric complication, a serious threat to the lives of mothers and babies. Rupture of the uterus occurs in women who have had a difficult delivery, multiple births at an advanced age, and women who have had surgery or damage to the uterus. Among them, scar uterine rupture occurs when the uterus has been incised, such as previous cesarean delivery or hysterotomy, myomectomy trauma close to or reaching the endometrial layer. Uterine rupture is most common with cesarean scar rupture. In late pregnancy, the uterus expands, especially during delivery, the original scar is poorly healed and cannot withstand the increased pressure in the uterus, the scar cracks and ruptures naturally; in classical cesarean section, because the incision is less aligned and poorly healed than the lower segment, the uterine body incision scar is more prone to rupture than the lower segment scar, and its incidence is several times that of the lower segment scar rupture. There are specific risk factors for rupture of the scarred uterus after cesarean delivery, including: the type of suture used in the previous cesarean delivery; a cohort study in the United States in 2002, which included nearly 3000 patients, showed that the incidence of rupture of the uterus in a second pregnancy increased fourfold to 3.1% in pregnant women with single-layer sutures compared to double-layer sutures; whereas the incidence of rupture of the uterus in pregnant women with double-layer sutures was only 0.5%. The incidence of uterine rupture in women with double sutures was only 0.5%. The incidence of rupture of the uterus was 1.7% in a study of more than 1,000 women who had two or more cesarean deliveries. The incidence of uterine rupture in pregnant women who had only one cesarean section was 0.6%. It is related to the length of time between pregnancies: if the time between a second pregnancy after a cesarean delivery and the previous pregnancy is too short, the uterine incision does not heal completely, increasing the risk of uterine rupture. Despite the controversial findings, most scholars generally agree that it is safer to have a second pregnancy 2-3 years after a cesarean delivery. If the uterine scar is particularly thin and fragile, the consequences of rupture of such an inelastic and overstretched uterus will be unimaginable. 3, postpartum hemorrhage The first of the four causes of postpartum hemorrhage is weak uterine contraction, and the risk factors for weak uterine contraction are uterine muscle wall damage such as a history of cesarean delivery. Poor healing of the uterine incision after cesarean section can even lead to hemorrhagic shock in severe cases. Among the placental factors that lead to postpartum hemorrhage, placenta praevia, placental adhesions and placental implantation, which are prone to re-pregnancy in scarred uterus, can lead to postpartum hemorrhage. 4. Postpartum uterine infection The mode of delivery is one of the most meaningful correlates of the occurrence of uterine infection. In France, the mortality rate associated with infection is nearly 25 times higher for cesarean delivery than for vaginal delivery. The rate of readmission for incisional complications and endometritis is much higher for planned cesarean deliveries than for planned vaginal deliveries. 5. Placenta praevia Among the possible factors of this disease are impaired or defective growth of the uterine metaplastic vessels, and uterine scarring (history of cesarean delivery, history of myoma removal) increases the risk of placenta praevia. 6, amniotic fluid embolism Cesarean delivery, the uterine incision venous blood sinus a large number of open, if the amniotic fluid is not aspirated in time, after delivery of the fetus uterine contraction, the amniotic fluid is easy to squeeze into the open blood sinus into the maternal circulation and amniotic fluid embolism, the typical performance of amniotic fluid embolism to sudden onset of hypotension, hypoxemia and coagulation disorders, is also one of the important causes of maternal death. In addition to the regular examination items, pelvic ultrasound is also essential to assess the healing of the uterine scar; in the early stages of pregnancy, the purpose of pelvic ultrasound is not only to assess the size and shape of the uterus, the presence or absence of the fetal sac and fetal heart; to determine the gestation The purpose of pelvic ultrasound is not only to assess the size and shape of the uterus, the presence or absence of the fetal sac and fetal heart; to determine the number of sacs and embryos, the chorionicity of twin fetuses; to observe the embryonic condition and determine whether there is embryonic arrest; to determine whether there is ectopic pregnancy; to determine whether there are gynecological complications (e.g. uterine malformations, myomas, adnexal cysts), but also to determine the location of the pregnancy and whether it is a scar pregnancy. Avoid excessive and rapid weight gain in the middle and late pregnancy; do strict obstetric examinations during pregnancy and terminate the pregnancy in time once abnormalities are detected; near the due date, seek medical consultation in time when abdominal pain occurs to avoid uterine rupture after strong contractions; pregnant women with a history of cesarean delivery with abnormal fetal position should be admitted to the hospital 1~2 weeks before the due date and end the delivery by elective cesarean delivery; women with a history of cesarean delivery should be closely observed during trial of labor. If you have a history of cesarean section, you should perform elective cesarean section; you should be accurate and gentle during cesarean section, and aspirate the amniotic fluid in time after the uterine incision before delivering the fetus to avoid amniotic fluid embolism when the amniotic fluid enters the open blood sinus of the uterine incision.