C-Section Scar

Definition - What does C-Section Scar mean?

A C-section scar is a scar on the lower abdominal skin left after a Cesarean delivery. A Cesarean delivery is a delivery that takes place through an incision (or cut) in the abdominal skin and the uterus rather than through the vagina. Just like any other surgery wound, a C-section wound takes time to heal. The healing process generates a scar. Excess scar formation results in the formation of adhesions that bind organs. These adhesions are the cause of chronic pelvic pain that a woman usually experiences after a Cesarean delivery. Sometimes, an embryo attatches to the uterine scar, causing a pregnancy to implant outside its normal location, which is referred to as an ectopic pregnancy. Both the pelvic adhesions and ectopic pregnancy have a negative impact on fertility.

FertilitySmarts explains C-Section Scar

There are two major types of C-section scars:

  1. Horizontal incision scar: Most commonly, a horizontal incision is made just above the pubic bone or the hairline. It is also called as the “bikini cut,” because it becomes less apparent than a vertical incision scar. This low horizontal (or transverse) scar is much more cosmetically acceptable and carries fewer risks. Moreover, it makes vaginal birth after Cesarean (VBAC) in the next pregnancy much easier than a vertical scar.
  2. Vertical incision scar: A vertical incision runs from the navel to the pubic area in the midline and is made during an emergency C-section.This facilitates immediate delivery of the baby in an emergency situation such as fetal distress or low-lying placenta. A vertical scar has a potential to burst and it makes VBAC much more difficult in the next pregnancy. It is also cosmetically not as appealing. Although it is referred to as a "classical" incision, doctors reserve vertical incision for complicated cases such as placental problems, babies with abnormalities, or other emergencies.

What are the potential consequences of a C-section scar?

  • They can be considered cosmetically unappealing to some
  • If a woman lacks good postoperative care, the scar can rupture causing massive bleeding
  • Adhesions can form as a result of disproportionate scarring
  • An embryo can invade the uterine muscle and attach to the C-section scar leading to an ectopic pregnancy. This type of pregnancy also carries a risk for life-threatening bleeding. Risk factors associated with a cesarean scar ectopic pregnancy are trauma to the uterus caused by dilatation and curettage (or D&C), prior C-section, preexisting pelvic inflammatory disease, use of assisted reproduction, and a history of previous placental abnormalities
  • Inflammation of endometrium, known as endometritis: Usually occurs after a vertical incision

Pelvic adhesions, endometritis, and ectopic pregnancy can all interfere with a woman’s ability to get pregnant again.

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