Tears/perforations/c onception/pregnancy/ labour.. Not sure what to do, not sure where to post this?

[podmumlet]

Hello all,

I am seeking some comments/experiences from Mumsnetters but unsure where to post this. So apologies for the reposting!

I had a very rapid first labour and birth of my DS 2.5 yrs ago which resulted in a 3C degree tear leaving me rather fearful of a second natural delivery.

For whatever reason, I am still very keen on a natural delivery, and thought I would look into the risks of tearing ago and incontinence closer to any second pregnancy.

In the interim, I have had a disastrous (to put it VERY mildly) time with the Mirena coil which has resulted in me having TWO perforations and scars in the upper fundal area of my uterus. One probably caused when trying to remove the coil that had embedded itself into the uterine walls, and one caused when inserting the hysteroscope to try see what was going on (and resulted in a laparoscopy too!!). The coil had also broken into pieces while inside. Sigh.

My gynae has suggested a future caesarean due to the risks of rupturing due to the small scars. He explained that the upper location of the two small scars will bear greater pressure with any contractions than a lower scar from a CSection incision...

Anyhoo - just wondering...
-- Has anybody had any fundal perforations and gone on to have a natural birth?
-- Has anybody had any fundal perforations and scarring and had difficulty conceiving?
-- Has anybody has perforations and/or a 3C tear and gone on to have a natural delivery?
-- Has anybody had a 3C tear, delivered naturally second time round and experienced problems??

While I would like another natural birth, if it really is medically unsound, I would not do so. My gynae has said that this is such a rare occurrence (both the Mirena perforating my uterus, the perforation in the hysteroscopy) that there are no statistics he can cite me as this is so rare and he certainly hasn't come across this.

Which makes me hope that someone out there has had some similar experiences or has a gynae with more experience or knowledge on this exceptional cases.

So looking forward to any replies.

PS: Happy for the moderators to move this to any more appropriate section of the forums (pregnancy, childbirth, conception, family planning???)

Lord, what a time you've had. Can't help I'm afraid but bumping for you.

If you don't mind my asking, were you aware that things had gone wrong with the Mirena or was it a scan that revealed it had become embedded? I've got a copper coil and wondering how you know if something has gone awry.

Thanks for the reply and the bump kalidasa.

While it hasn't been great, I know of many women who have had a rougher time of it, so I certainly don't want to come across as moaning :).

To answer your question: The insertion was more painful than I was led to believe it would be, and from that point on I would get shooting pains and twinges in my uterus area. I also spotted for a lot longer than many of the reviews from other women that I had read. I can only assume that this was the point at which the coil had embedded itself in my uterus wall.

When eventually the GP agreed to removal and couldn't find the strings, this could possibly also have been a red flag. I then went to the sexual health clinic and had two specialists attempt to locate and then remove my coil.

By this point, the shooting pains were far less frequent. When they located it and tried to remove it, I actually burst into tears. Think of the most intense contraction at 9/10cm dilated without any warning or buildup. I suspect this was the point that the coil was tugged and tore a hole in my uterus and probably broke into pieces. I bled continuously for three more months from that point (during which this perforation started healing) while I waited for my laparoscopy referral (which led to the second perforation by the camera!). Ah well.

So, in short, I guess the shooting pains and excessive bleeding should have been the cues that things were very much not well. I brushed off my intuition and when I raised concerns of a perforations, was assured that it takes time for the coil to settle, bleeding was perfectly normal and that perforations were incredibly rare.

Hope your coil experience is/will be better than mine (and thankfully you don't have the hormonal element of the Mirena to contend with!)

I had a serious uterine infection after my first LSCS. Unbeknown to me it weakened the stitching in the uterine layers. Six years later I planned another CS but went into labour the day before. The midwife encouraged me to labour on rather than have a CS immediately. I had an EP put in though and thank goodness I did because my uterus and urinary bladder ruptured. I started bleeding heavily but the MW kept insisting it was a show (which i'd had days earlier) despite the fact that the pain was now punching through my EP. I insisted on seeing a Dr and he took one horrified look and carted me off in my bed to theatre.

They saved my son and myself but I was left unable to have any more children. It took units and units of blood plus several units of plasma to save me. The scar was so weak it tore my bladder when it gave way (adhesions from the infection had adhered uterus/bladder together). My consultant (Richard Smith then of the Chelsea & Westminster) said that should I seek to become pregnant, he could not guarantee my pregnancy lasting beyond 24 weeks such was the damage and it took 7 years before I became relatively free of urinary retention-I have the opposite situation to most women post delivery-i have such 'good' bladder control that I can last all day and night without realising bladder is full and still have trouble voiding. Richard Smith advised me to be sterilised asap and I was aged 28.

My advice? They never know what the true situation is internally until they get in there. I personally wouldn't take the risk. I know I am speaking from a position of the worst happening and also, being a nurse can skew one towards caution. But, you have had significant trauma, will have scar tissue and a scar is only as strong as the surrounding tissue. If that has suffered any loss of collagen/increase in collagen fibres because of infection or trauma it may give way more easily.

Either way, your experience will help contribute towards future knowledge and training so at least some good will come of it.

mignonette - thank you for your detailed response.

And, oh my word! What a time you had of it!!

I am so pleased to hear that you and your son were safe after what must have been a terrifying experience.

I think you are right, and the number of risk factors I have really are tipping me in the direction of a planned ELCS.

When you spontaneously started labour, could they have rushed you in at that point for an EMCS?

Thanks again for sharing - I am sure your case has been a remarkable contribution to medical learning and certainly wouldn't wish your experience on another mother.

I asked my consultant jokingly if he was going to write a paper on my multiple perforations and disintegrating coil? He smiled wryly. :)

Pod

They could have taken me for a ELCS yes but decided to let me trial. I have CPD so the chances of my delivering anything larger than a medium sized puppy was minimal and that was their first error. My eldest was born in a different HA, no notes were available so they 'only' had my word for the pelvimetry results that was carried out after I had that first child. T'was all a complete balls up really. And they lost my notes regarding the rupture. Conveniently...............

You deserve your own paper. It definitely qualifies as a new area of research/awareness.

And the best of luck!

Hello ladies -

Just reviving this earlier thread (under a new username) with an update, and still equal amounts of confusion!

I am pleased to say, I am now 14 weeks pg with DC2. The future birth is still worrying me and while all the consultants I have seen have recommended an ELCS at 39 weeks, I am terrified that I go into labour sooner.

I am deeply worried that due to my precipitous/speedy first birth and the uterine perforations and the bit of coil still lodged in my myometrium/womb muscle wall, that I will rupture before I even have time to get to any emergency help.

When is the earliest that you have been able to schedule your cesarean without risk to baby?

Thanks for any advice/comments/experiences.
Slightly petrified.

Hello stardustshaper. Came across these old threads and just wondering if you can give me an update on what decisions were made for the birth of your second little one? I am in a similar situation. Have had one forceps delivery (2008) and one planned CS (placenta previa January 2011) then a perforated merina coil (March 2011). So I have a CS scar and a weakspot from the coil. I am 34 weeks pregnant with number 3 and living in Spain. The docs here are happy for me to try for a VBAC but I am doing my own research because I want to make sure it's the right (and safest) decision. Did you have a planned CS in the end? Hope it all went well either way. Thanks.