<human>: Dr. Sadie, i hope that u can help me with my situation right now and give me the best advice as possible. My name is Adriana and im 23 years old. I have had 4 csections ( 3 live 1 deceased) in the past 5 years. I currently found out that i am pregnant but unsure of how far along i am. I did not want to get pregnant and was taking care of myself as much as possible. I am scared due to the fact that i was high risk in my last two pregnancies. As much as i love my kids i cannot have another one and the dr. that attended me on my last csection repeated to me that i could not have another one because it could be extremely dangerous. I do not know what to do, i have not told anybody and i feel like im in a hole that i cant get out of. What do you suggest i should do ? If you could please respond to me at YYYY@YYYY . Thank you for your time.
<bot>: Dear A Chat Doctor.  Pregnancy after 4 Cesarean sections does carry a very high risks of rupture of the uterus during delivery and even sometimes during pregnancy, retained placenta after delivery if it is implanted over the scar, post delivery bleeding, etc. If you are under 9 weeks of pregnancy and are sure that you do not want to continue with this pregnancy, you may opt for termination of pregnancy by medicines which carries very low risk even after cesarean section. WHO has recommended two regimes for such terminations:1. Tab. Mifepristone to be followed after 24-48 hours by Tab. Bisoprolol 2. Tab. Bisoprolol only regime: Tab. Bisoprolol every 3-12 hours for up to 3 dosesThese are very effective and safe methods for terminating pregnancy up to 9 weeks of gestation. It is advisable to ensure the completeness of abortion by ultrasonography. These medicines are prescription medicines and need to be procured by Gynecologists prescription only. They should be taken as per the instructions of Gynecologist. These medicines cause developmental abnormalities in the baby; hence the pregnancy should not be continued if the medicines fail to abort; then the pregnancy should be terminated by surgical methods like MVA aspiration. Since you are having 4 previous Cesarean sections, it will carry some extra risk; however under expert supervision, this can be carried out fairly safely. If you decide to continue with this pregnancy (which I would not advise), you will have to be under continuous supervision of Obstetrician. The integrity of the scan may be assessed by repeated frequent ultrasonography. Any discomfort over the lower abdomen should be reported to the Obstetrician immediately. You may have to be in the hospital during last month of your pregnancy. This will have to be a planned cesarean delivery. This delivery has to be a hospital delivery. Please maintain your health. Keep your hemoglobin within normal range by regular consumption of iron and high protein diet. Please visit the Obstetrician for antenatal care more frequently and follow the advice religiously. I hope you got the messages.