Uterine Window: What is It and How to Deal With It

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Tubal ligation reproduction

Pregnancy brings with it many joys, but it can also bring forth some pretty troubling and scary realities. For women who suffer from complications that have either arisen in a current pregnancy or plague them from past ones, it can be trying to move forward carrying a baby knowing there are impending risks at hand. Uterine windows are one of those risks.

What It Is

At first glance, even the most pregnancy-proficient momma may not be aware of what a uterine window is. This condition actually occurs as a result of being pregnant. In some cases it may become a complication during the later stages of a pregnancy, but sometimes it won’t make itself known until the end. Nonetheless, it can complicate matters in future pregnancies. It happens when the uterus is stretched very thin — so thin that it pulls apart slightly and creates an opening or a very thin and opaque area where the tissue has been stretched to capacity. This often happens as a result of a previous C-section that left scarring which gets stretched.Woman with a tablet screening the reproductive organs

A good example of this is the blowing of a bubble when chewing gum. The more air that is blown into the interior of the gum bubble, the thinner the gum stretches. This occurs with the uterus just the same. The larger that the uterus grows as a result of the developing baby growing, the thinner the tissues comprising it will be stretched. That gum bubble sometimes ends up with very thin patches on it from being stretched so far and wide.

Uterine windows may also be termed as dehiscence, asymptomatic separations or incomplete ruptures. Most of the time, uterine windows are actually unnoticed. They aren’t purposely ignored, but they aren’t visible in all cases either from the view that a doctor would have during a routine Cesarean. Usually, they are caught in later Cesareans. Obviously they cannot be detected during a vaginal delivery. However, in a study of women who had previously diagnosed uterine windows and ruptures, just six percent had windows at the time of a repeat Cesarean section, per Tubal Reversal.

What It Isn’t

Uterine windows are not uterine ruptures. Unfortunately, medical professionals often mislabel uterine windows as being uterine ruptures. This is problematic for women who hope to deliver vaginally. They are frequently misled to believe their situation is more dire than it really is. In fact, some women may even be persuaded to believe they have to have a repeat Cesarean section when they don’t.

Doctor checking pregnancy woman's belly
Source: http://circ.ahajournals.org/

There are three layers that combine to make the uterine wall. In cases of uterine rupture, tears occur through all three of those layers. In cases of uterine windows, the separation only occurs in two layers. The remaining layer — known as the perimetrium — remains intact creating that opaque window that the condition garnered its name for.

Although the uterus can rupture along any part of its surface, it’s most likely to happen across the scar line from a previous Cesarean section. While this may lead some people to believe uterine rupture only happens in women who have had C-sections, this isn’t actually the case. They can occur in anyone, though it is generally women who’ve had some kind of uterine surgery or multiple pregnancies that have weakened the uterine muscles over time. Using Pitocin can also increase the risk of uterine rupture.

Tubal Ligation and HysterectomyTubal ligation reproduction

A big question looming in the minds of many women when they have a uterine window is whether or not they will need to have their tubes tied. This procedure normally involves cutting the fallopian tubes and in some cases burning the cut ends so they cannot easily be fused back together. The likelihood of pregnancy after a tubal ligation is one to 1.8 percent, Baby Center states. In some cases hysterectomy may be necessary as a result of a uterine window. While the Journal of Obstetrics and Gynecology notes that this was a routine procedure in years gone by, it is far less likely to be necessary in today’s age of medical advancements.

[Read more about Tubal Ligation]

Confusion

There is constant confusion over what a uterine window is among both members of the medical community and their patients. Women are often told by one doctor that they have a uterine window only to have another tell her it’s a rupture later on. The additional names that uterine windows go by have only aided in further complicating this matter. The confusion continues to grow among patients diagnosed with this condition as to why there isn’t one reliable name for it. No one truly seems to understand why so many terms describing the condition came to be, either. It is likely that the overlapping exchange of rupture and windows has more to do with doctors who are being overly precautious than anything else.

Future Pregnancies

When a uterine window occurs, women may be concerned with whether or not they can go on to have a successful pregnancy or birth. The answer to both of those worries is yes. Women with classical incisions from a Cesarean that extend downward on the abdomen in a vertical direction are more likely to suffer from a uterine window than women who have transverse low-lying incisions, according to the Agency for Healthcare Research and Quality. While there have been suggestions that the likelihood of a uterine window leading to rupture could be assessed by using ultrasound to measure the thickness of the scarring, there is little evidence that this practice is widely beneficial. Another theory posits that tracking the intensity and pattern of contractions during labor could be helpful in ruling on rupture’s likelihood, but again it’s just a theory with little evidence to back it up.Embryo in the doctor's hand

Vaginal birth after cesarean — often referred to as a VBAC — is definitely possible with a uterine window. However, these cases may be considered more of a risk and as a result must be followed closely by your midwife or doctor. This is because even with a typical cesarean that doesn’t produce a uterine window, there is risk of rupture. When a uterine window is present, the risk of rupture is greater, but by only a slight margin. There are VBAC risks, but they are not nearly as detrimental or prominent as most mothers-to-be are led to believe.

No woman wants to undergo surgery if she doesn’t have to, and for many women, Cesareans leave them feeling robbed of the birth experience they so desperately wanted. Only 1.9 percent of women with uterine scars from previous surgeries like Cesareans go on to have a uterine rupture in future pregnancies, per Special Scars. What may be even more important to acknowledge is that only six percent of those ruptures that do occur result in the mother’s death, according to the National Institutes of Health Consensus Development Program.

The Journal of Obstetrics and Gynecology also reports that the risk of uterine rupture is lower with each subsequent VBAC a women with cesarean scarring undergoes than it is for those with no previous vaginal births at all. The risk is 0.87 percent for women with no previous vaginal births, 0.45 percent for those with one previous VBAC, 0.38 percent for those with two previous VBACs, 0.54 percent for those with three previous VBACs, and 0.52 percent for those with four previous VBACs. Knowing the facts about uterine windows and what your particular circumstance involves can make a world of difference when planning future pregnancies and births.

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