Concerns About Pregnancy After Multiple C-Sections: A Mother's Questions

My doubts and concerns?

Hello Dr.
Tian,
I am a mother who has undergone three cesarean sections (the first was an emergency, so all were done vertically).
Due to certain reasons, my children are not with me, and I have recently remarried.
My current husband has no children, so we would like to have a child of our own.
I have a few questions:
1.
After three cesarean sections, is it still possible to have a fourth cesarean?
2.
My menstrual cycle is somewhat irregular; for example, my periods were on 10/14, 11/12, and 12/15, lasting only two days each time but with heavy flow, requiring a pad change every hour.
Is this menstrual flow considered normal? Does this indicate ovulation? My periods often end after two days; what should I do? Could this affect my chances of conception?
3.
On 11/12 and 12/15, I took ovulation medication for five consecutive days, one pill in the morning and one in the evening, to facilitate conception.
I also monitored my follicles and followed the doctor's recommendations for timing.
However, I did not conceive on 11/12.
For the 12/15 cycle, I took the ovulation medication again starting on 12/18 for five days (but my period still only lasted two days).
On 12/29, I had a follow-up ultrasound, and the doctor said my follicles were very mature and advised me to try to conceive that day.
We attempted on 12/29 and 12/31.
Between 1/4 and 1/6, I experienced some abdominal bloating, which was not very painful but uncomfortable.
Starting on 1/5, I began to feel breast engorgement and pain, which felt different from my usual premenstrual symptoms; it was softer and occurred earlier than usual.
I would like to know if this could be a sign of pregnancy or if my period is about to start.
4.
If I do not conceive this month, can I try to conceive after taking ovulation medication for two cycles? I am 38 years old, which is considered advanced maternal age.
Is this approach appropriate? Is it likely to succeed?
Thank you for your assistance, Dr.
Tian.

Yu Yu, 30~39 year old female. Ask Date: 2016/01/08

Dr. Tian Yiwen reply Obstetrics and Gynecology

1.
The more cesarean sections a woman has, the higher the associated risks.
There is no specific limit on the number of cesarean deliveries, but it is important to understand the related risks, including the potential for intraoperative hemorrhage due to placenta previa or placental implantation issues.
Additionally, adhesions from multiple surgeries may increase the difficulty of the procedure and raise the risk of injury to the intestines or bladder during surgery.
Although the risk of uterine rupture during pregnancy is low, it is still a possibility.

2.
Having a menstrual period does not necessarily indicate ovulation, but if menstruation occurs approximately once a month, it is usually a sign of ovulation.
The volume and duration of menstrual bleeding can vary due to individual physiological differences or the presence of uterine lesions.
It is advisable to consult with the physician who performed your ultrasound for further evaluation.
3.
Symptoms of breast engorgement cannot be used to determine pregnancy.
A pregnancy test should be taken if menstruation is expected but has not occurred.
4.
There is no set standard for the number of times ovulation induction medications should be taken before proceeding with artificial insemination or in vitro fertilization in older women.
Typically, a consensus is reached through discussion between the physician and the patient.
You should feel free to express your thoughts and discuss them with your physician.

Reply Date: 2016/01/08

More Info

When considering pregnancy after multiple cesarean sections (C-sections), there are several important factors to take into account. As a mother who has undergone three C-sections, your concerns are valid and warrant careful consideration. Here are the answers to your questions based on medical knowledge and practice.

1. Can I have a fourth C-section?
Yes, it is generally possible to have a fourth C-section, but it is crucial to consult with your obstetrician or a maternal-fetal medicine specialist. The risks associated with multiple C-sections include increased chances of complications such as uterine rupture, placenta previa, and adhesions. Your healthcare provider will assess your individual situation, including your overall health, the reasons for your previous C-sections, and any complications you may have experienced. They will also monitor your pregnancy closely to ensure the safety of both you and your baby.

2. Is my menstrual cycle normal?
A menstrual cycle that lasts only two days with heavy bleeding can be considered abnormal, especially if it consistently occurs. Normal menstrual cycles typically last between three to seven days. The heavy flow you describe, requiring frequent changes of sanitary products, could indicate an underlying issue such as hormonal imbalances, fibroids, or polyps. It's essential to consult with a gynecologist to evaluate your menstrual health and determine if ovulation is occurring. Irregular cycles can affect fertility, so understanding the cause is crucial for your plans to conceive.

3. Could my symptoms indicate pregnancy?
The symptoms you describe, such as breast tenderness and abdominal discomfort, can be indicative of early pregnancy, but they can also be related to hormonal changes associated with your menstrual cycle. Since you have been taking ovulation medications, it is possible that these symptoms are a result of hormonal fluctuations rather than a definitive sign of pregnancy. A home pregnancy test or a blood test at your doctor's office can provide clarity. If you suspect you might be pregnant, it is advisable to take a test after a missed period for the most accurate result.

4. Is it safe to continue trying to conceive after two cycles of ovulation medication?
Yes, it is generally safe to continue trying to conceive after taking ovulation medications for two cycles, but it is essential to do so under the guidance of your healthcare provider. Given your age (38 years), it is considered a higher-risk pregnancy, and your doctor may recommend additional monitoring. The use of ovulation medications can increase your chances of conception, but they should be used judiciously. Your doctor will likely want to monitor your response to the medication and any potential side effects.

In summary, while it is possible to have a fourth C-section, it is essential to have a thorough evaluation by your healthcare provider. Addressing your menstrual irregularities is crucial for understanding your fertility status. If you suspect pregnancy, confirm it with a test, and continue to work closely with your doctor regarding your fertility treatments. Your health and the health of your future child should always be the top priority.

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