What is a cesarean section. Caesarean section: from preparation for surgery to discharge from the hospital By cesarean section

Date: 04.11.2019

Around the world, there is a clear trend towards gentle delivery, which helps preserve the health of both the mother and the baby. The tool to help achieve this is the caesarean section (CS) operation. A significant achievement was the widespread use of modern methods of pain relief.

The main disadvantage of this intervention is considered to be an increase in the frequency of postpartum infectious complications by 5-20 times. However, adequate antibiotic therapy significantly reduces the likelihood of their occurrence. Nevertheless, there is still debate about when a cesarean section is performed, and when a physiological delivery is permissible.

When operative delivery is indicated

Caesarean section is a major surgery that increases the risk of complications compared to a normal natural birth. It is carried out only on strict indications. At the request of the patient, CS can be performed in a private clinic, but not all obstetricians-gynecologists will undertake such an operation unnecessarily.

The operation is performed in the following situations:

1. Complete placenta previa is a condition in which the placenta is located in the lower part of the uterus and closes the internal pharynx, preventing the baby from being born. Incomplete presentation is an indication for surgery when bleeding occurs. The placenta is abundantly vascularized, and even a slight damage to it can cause blood loss, lack of oxygen and fetal death.

2. What happened ahead of time from the uterine wall is a condition that threatens the life of a woman and a child. The placenta detached from the uterus is a source of blood loss for the mother. The fetus ceases to receive oxygen and may die.

3. Previously postponed surgical interventions on the uterus, namely:

at least two cesarean sections;
a combination of one KS operation and at least one of the relative indications;
removal of intermuscular or on a solid basis;
correction of a defect in the structure of the uterus.

4. Transverse and oblique position of the child in the uterine cavity, breech presentation ("booty down") in combination with the expected fetal weight over 3.6 kg or with any relative indication for operative delivery: a situation when the child is located at the internal pharynx in a non-parietal region , and the forehead (frontal) or face (facial presentation), and other features of the location that contribute to the birth trauma in the child.

Pregnancy can occur even during the first weeks of the postpartum period. The calendar method of contraception in an irregular cycle is not applicable. The most commonly used condoms are mini-pills (gestagenic contraceptives that do not affect the baby while breastfeeding) or conventional (in the absence of lactation). Use should be excluded.

One of the most popular methods is. The installation of the spiral after a cesarean section can be performed in the first two days after it, however, this increases the risk of infection, and is also quite painful. Most often, the spiral is installed after about a month and a half, immediately after the onset of menstruation or on any day convenient for a woman.

If a woman is over 35 years old and has at least two children, at her request, during the operation, the surgeon can perform surgical sterilization, in other words, ligation of the fallopian tubes. This is an irreversible method, after which conception almost never occurs.

Subsequent pregnancy

Natural childbirth after cesarean section is allowed if the formed connective tissue on the uterus is wealthy, that is, strong, even, capable of withstanding muscle tension during childbirth. This issue should be discussed with the supervising doctor during the next pregnancy.

The likelihood of subsequent birth is normally increased in the following cases:

the woman gave birth to at least one child through natural means;
if the CS was performed due to the wrong position of the fetus.

On the other hand, if the patient is more than 35 years old at the time of the subsequent birth, she is overweight, concomitant diseases, inappropriate sizes of the fetus and pelvis, it is likely that she will undergo surgery again.

How many times can you have a caesarean section?

The number of such interventions is theoretically unlimited, however, in order to maintain health, it is recommended to do them no more than two times.

Usually, the tactics for repeated pregnancy are as follows: a woman is regularly observed by an obstetrician-gynecologist, and at the end of the gestation period, a choice is made - an operation or natural childbirth. In a routine delivery, doctors are ready to perform emergency surgery at any time.

Pregnancy after a caesarean section is best planned at intervals of three years or more. In this case, the risk of inconsistency of the suture on the uterus decreases, pregnancy and childbirth proceed without complications.

How long does it take to give birth after surgery?

It depends on the consistency of the scar, the age of the woman, concomitant diseases. Abortion after CS is detrimental to reproductive health. Therefore, if a woman nevertheless became pregnant almost immediately after the CS, then with the normal course of pregnancy and constant medical supervision, she can carry the child, but the delivery will most likely be prompt.

The main danger of early pregnancy after CS is suture failure. It is manifested by increasing intense pain in the abdomen, the appearance of bloody discharge from the vagina, then signs of internal bleeding may appear: dizziness, pallor, drop in blood pressure, loss of consciousness. In this case, it is necessary to urgently call an ambulance.

What is important to know about a second cesarean section?

Elective surgery is usually performed at 37-39 weeks. The incision is made along the old scar, which somewhat lengthens the operation time and requires stronger anesthesia. Recovery from CS may also be slower, as scar tissue and adhesions in the abdomen prevent the uterus from contracting well. However, with a positive attitude of the woman and her family, the help of relatives, these temporary difficulties are quite surmountable.

K-section involves surgical intervention - an incision in the mother's abdomen and uterus, which allows the newborn to be taken directly from the uterus without passing through the birth canal.
Most often, a caesarean section is done in the case of a previous birth by caesarean section or when, in the opinion of the obstetrician, vaginal delivery is dangerous to the health of the child. Typically, an obstetrician will perform an emergency caesarean section when the fetal heart rate is severely reduced or uneven and is not at risk of continuing with a normal birth.
If the fetus is in the gluteal position (buttocks or feet forward), a caesarean section is also recommended as the best method of delivery. With breech presentation of the fetus, vaginal delivery is difficult and the likelihood of complications increases. In most cases, the fetus is head down, but in three out of a hundred newborns, the buttocks or legs come out first, and sometimes both together (breech presentation). The doctor determines the position of the fetus by palpating certain areas of the mother's lower abdomen; ultrasound or other tests may be ordered to confirm breech presentation.
The process of giving birth by caesarean section is significantly different from vaginal delivery. Firstly, the entire operation takes no more than an hour, and depending on the circumstances, you may not feel the pangs at all. An important difference is the need to use drugs that affect both the mother and the child. When choosing anesthesia, most women in labor prefer regional (local) anesthesia. Here, injecting a pain reliever into the back causes an epidural, or spinal, nerve blockage, so that pain is not felt. With regional anesthesia, the lower body becomes numb. It has relatively few side effects and allows you to monitor the birth process. But sometimes, especially in the case
emergency K-section, general anesthesia is required, in which the woman in labor is unconscious. With the current level of development of medicine and as a result of the examination, the obstetrician and anesthesiologist will tell you the best choice.
Because of the effects of anesthesia, babies born with caesarean section sometimes have difficulty breathing and need extra help. When a caesarean section is performed, a pediatrician or other doctor who is familiar with the problems of newborns is usually present. Immediately after giving birth, they examine the baby and, if necessary, provide assistance.
If you were conscious during the operation, you can see your child immediately after he is examined and declared healthy. Then he will be taken to the children's ward, where he will spend several hours in a sealed bed with a controlled air temperature. This allows doctors to monitor him as the drug wears off and he adapts to his new environment.
With general anesthesia, you can sleep for several hours and wake up with a heavy head and confusion. In addition, you may feel pain at the incision site. But pretty soon you will be able to pick up your baby and quickly make up for lost time.

Even if you have seen pictures of newborns, the first look at your own baby will amaze you.

Babies born with a K-section may appear prettier than those born by vaginal delivery, as they do not have to squeeze through the birth canal. As a result, their head does not become elongated, but retains its rounded shape.
Don't be surprised if your baby is still under anesthesia for six to twelve hours after giving birth and looks a little sleepy. If you are going to breastfeed him, try to do so as soon as he wakes up. Even if the baby is sleepy, the first feed will push him to wake up and face the new world - and with you.
As already mentioned, many obstetricians believe that women who give birth using K-section should have all subsequent labor in the same way. If you are a father-to-be, discuss your role and presence in the labor ward and how best to support your partner during labor.

It is believed that the name of the operation is associated with the name of the Roman emperor Gaius Julius Caesar, whose mother died during childbirth, and he was removed from her womb through surgery. There is information that under Caesar a law was passed indicating that in the event of a woman's death in childbirth, an attempt must be made to save the child by dissecting the abdominal wall and uterus with the extraction of the fetus. For a long time, caesarean section was performed only when the mother died during childbirth. And only in the 16th century there were reports of the first cases when the operation allowed not only the child, but also the mother to survive.

When is the operation performed?

In many cases, a caesarean section is performed by absolute readings... These are conditions or diseases that are fatal to the life of the mother and child, for example placenta previa- a situation when the placenta closes the exit from the uterus. Most often, this condition occurs in re-pregnant women, especially after previous abortions or postpartum diseases. In these cases, during childbirth or in the last stages of pregnancy, bright spotting appears from the genital tract, which is not accompanied by pain and is most often observed at night. The location of the placenta in the uterus is clarified by ultrasound. Pregnant women with placenta previa are observed and treated only in an obstetric hospital.

Absolute indications also include:

Premature detachment of a normally located placenta. Normally, the placenta is separated from the wall of the uterus only after the baby is born. If the placenta or a significant part of it is separated before the baby is born, then there are sharp abdominal pains, which can be accompanied by severe bleeding and even the development of a state of shock. At the same time, the supply of oxygen to the fetus is sharply disrupted, it is necessary to urgently take measures to save the life of the mother and baby.

Transverse position of the fetus... A baby can be born through the vaginal birth canal if he is in a longitudinal (parallel to the axis of the uterus) position with the head or pelvic end down to the entrance to the pelvis. The transverse position of the fetus is more common in multiparous women due to a decrease in the tone of the uterus and the anterior abdominal wall, with polyhydramnios, placenta previa. Usually, with the onset of labor, a spontaneous rotation of the fetus occurs to the correct longitudinal position. If this does not happen and with external methods it is not possible to turn the fetus into a longitudinal position, and also if the water leaves, then childbirth through the natural birth canal is impossible.

Prolapsed umbilical cord... This situation occurs during the outpouring of amniotic fluid during polyhydramnios in cases when the head is not inserted into the entrance of the small pelvis for a long time (narrow pelvis, large fetus). With the current of water, the loop of the umbilical cord slips into the vagina and may even end up outside the genital slit, especially if the umbilical cord is long. The umbilical cord is compressed between the walls of the pelvis and the head of the fetus, which leads to impaired circulation between the mother and the fetus. In order to diagnose such a complication in a timely manner, after the discharge of amniotic fluid, a vaginal examination is performed.

Gestosis. This is a serious complication of the second half of pregnancy, manifested by high blood pressure, the appearance of protein in the urine, edema, headache, visual impairment in the form of flashing "flies" in front of the eyes, pain in the upper abdomen and even cramps, which requires immediate delivery, so how with this complication both the condition of the mother and the condition of the fetus suffers.

However, most operations are carried out by relative indications- such clinical situations in which the birth of a fetus through the vaginal birth canal is associated with a significantly greater risk for the mother and fetus than with a caesarean section, and by combination of indications- a set of several complications of pregnancy or childbirth, which individually may not be significant, but in general pose a threat to the condition of the fetus during vaginal delivery. An example is breech presentation fetus. Breech delivery is a pathological birth. there is a high risk of injury and oxygen starvation of the fetus during labor through the vaginal birth canal. The likelihood of these complications especially increases with a combination of a breech presentation of the fetus with its large size (more than 3600 g), overmaturity, excessive extension of the fetal head, with anatomical narrowing of the pelvis.

Primiparous age over 30 years. Age itself is not an indication for a cesarean section, but in this age group, gynecological pathology is often found - chronic diseases of the genital organs, leading to prolonged infertility, miscarriage. Non-gynecological diseases accumulate - hypertension, diabetes mellitus, obesity, heart disease. Pregnancy and childbirth in such patients proceed with a large number of complications, with a great risk for the child and mother. The indications for cesarean section in women in late reproductive age with breech presentation of the fetus, chronic fetal hypoxia are expanding.

A scar on the uterus. It remains after removal of myomatous nodes or suturing of the uterine wall after perforation during an induced abortion, after a previous cesarean section. Previously, this indication was absolute, but now it is taken into account only in cases of defective scar on the uterus, in the presence of two or more scars on the uterus after cesarean section, reconstructive surgery for uterine malformations and in some other cases. To clarify the condition of the scar on the uterus, ultrasound diagnostics allows, the study is necessarily carried out from 36-37 weeks of pregnancy. At the present stage, the technique of performing the operation using high-quality suture material contributes to the formation of a wealthy scar on the uterus and gives a chance for subsequent births through the natural birth canal.

There are also indications for caesarean section that occur during pregnancy and childbirth.

According to the urgency of performing a cesarean section, it can be planned and emergency. Caesarean section during pregnancy is usually performed routinely, less often in emergency cases (bleeding with placenta previa or with premature detachment of a normally located placenta and other situations).

A planned operation allows you to prepare, decide on the technique of its implementation, anesthesia, as well as carefully assess the state of a woman's health, and, if necessary, carry out corrective therapy. In childbirth, a caesarean section is performed on an emergency basis.

Clinically narrow pelvis. This complication occurs during childbirth when the size of the fetal head exceeds the internal size of the mother's pelvis. The complication is manifested by the lack of progressive advancement of the fetal head through the birth canal with full disclosure of the cervix, despite vigorous labor activity. In this case, there may be a threat of rupture of the uterus, acute hypoxia of the fetus (oxygen starvation) and even its death. Such a complication can occur both with an anatomically narrow pelvis, and with normal pelvic sizes, if the fetus is large, especially with prolonged gestation, with incorrect insertion of the fetal head. It is possible to correctly estimate the size of the mother's pelvis and the size of the fetal head in advance by additional research methods: ultrasound diagnostics and X-ray pelvimetry (study of an X-ray of the pelvic bones), which allow predicting the outcome of childbirth. With significant degrees of narrowing of the pelvis, it is considered absolutely narrow and is an absolute indication for a cesarean section, as well as in the presence of bone tumors, gross deformities in the small pelvis, representing an obstacle to the passage of the fetus. Incorrect insertion of the head (frontal, facial) diagnosed in childbirth during vaginal examination is also an absolute indication for caesarean section. In these cases, the fetal head is inserted into the pelvis with its largest size, significantly exceeding the size of the pelvis, and childbirth cannot occur.

Acute fetal hypoxia(oxygen starvation). This condition occurs due to insufficient oxygen supply to the fetus through the placenta and umbilical cord vessels. The reasons can be very different: placental abruption, umbilical cord prolapse, protracted labor, excessive labor, etc. To diagnose the threatening condition of the fetus along with auscultation (listening) using an obstetric stethoscope, modern diagnostic methods help: cardiotocography (registration of fetal heartbeats using a special apparatus), ultrasound examination with Doppler (studying the movement of blood through the vessels of the placenta, fetus, uterus), amnioscopy (examination of amniotic fluid, carried out using a special optical device inserted into the cervical canal with a whole fetal bladder). If signs of threatening fetal hypoxia are detected and there is no effect of treatment, an urgent surgical intervention is performed.

Weakness of labor... The complication is characterized by the fact that the frequency, intensity and duration of contractions are insufficient to complete labor naturally, despite the use of corrective drug therapy. As a result, there is no progress in the opening of the cervix and the advancement of the presenting part of the fetus along the birth canal. Childbirth can take a protracted nature, there is a risk of infection with an increase in the anhydrous gap and fetal hypoxia.

Operation progress

The incision of the anterior abdominal wall is usually made in the transverse direction above the pubis. In this place, the layer of subcutaneous fat is less pronounced, wound healing is better with a minimal risk of incisional hernias, patients after surgery are more active, get up earlier. The aesthetic side is also taken into account, when a small, almost invisible scar in the pubic area remains. A longitudinal incision between the pubis and the umbilicus is performed if there was already a longitudinal scar on the anterior abdominal wall after a previous operation, or in case of massive blood loss, when an examination of the upper abdomen is required, with an unclear volume of surgery with a possible extension of the incision upwards.

The opening of the uterus is performed in its lower segment in the transverse direction.In late pregnancy, the isthmus (part of the uterus between the cervix and the body) significantly increases in size, forming the lower segment of the uterus. Muscle layers and blood vessels are located here in the horizontal direction, the thickness of the wall of the lower segment is much smaller compared to the body of the uterus. Therefore, the opening of the uterus in the transverse direction in this place along the vessels and muscle bundles occurs almost bloodlessly. It is extremely rare to resort to the longitudinal method of opening the uterus in its body in cases where access to the lower segment of the uterus is difficult, for example, due to scars after past operations, or it becomes necessary to remove it after a cesarean section. This approach was practiced earlier, it is accompanied by increased bleeding due to the intersection of a large number of blood vessels and the formation of a less complete scar, as well as a large number of postoperative complications.

The fetus is removed by the head or by the pelvic end (by the inguinal fold or by the leg) in the pelvic position of the fetus, the umbilical cord is cut between the clamps, and the child is handed over to the midwife and neonatologist. After removing the child, the afterbirth is removed.

The uterine incision is sutured to ensure proper alignment of the wound edges with minimal suture use. For suturing, modern synthetic absorbable sutures are used, which are sterile, durable, and do not cause allergic reactions. All this contributes to the optimal healing process and the formation of a well-to-do scar on the uterus, which is extremely important for subsequent pregnancies and childbirth.

When suturing the anterior abdominal wall, separate sutures or surgical staples are usually applied to the skin. Sometimes an intradermal "cosmetic" suture is used with absorbable sutures, in this case there are no external removable sutures.

Complications of cesarean section and their prevention

Caesarean section is a serious abdominal operation and, like any surgical intervention, should be performed only if indicated, but not at the request of the woman. Before the operation with a pregnant (parturient) woman, the scope of the planned operation and possible complications are discussed. A mandatory written consent of the patient for the operation is required. In vital conditions - for example, if a woman is unconscious, - the operation is carried out for health reasons or with the consent of relatives, if they accompany her.

And although a cesarean section at the present stage is considered a reliable and safe operation, complications of the surgical plan are possible: vascular injury due to a prolonged incision in the uterus and associated bleeding; injury of the bladder and intestines (more common with re-entry due to adhesions), injury to the fetus. There are complications associated with anesthetic treatment. In the postoperative period, there is a possible risk of uterine bleeding due to impaired contractility of the uterus caused by surgical trauma and the effects of drugs. Due to a change in the physicochemical properties of blood, an increase in its viscosity, blood clots may form and clog various vessels with them.

Purulent-septic complications during cesarean section are more common than after vaginal delivery. Prevention of these complications begins during surgery by administering highly effective broad-spectrum antibiotics immediately after the umbilical cord is transected to reduce their negative impact on the child. In the future, if necessary, antibiotic therapy continues in the postoperative period with a short course. Most often, there are wound infections (suppuration and divergence of the seams of the anterior abdominal wall), endometritis (inflammation of the inner lining of the uterus), adnexitis (inflammation of the appendages), parametritis (inflammation of the peri-uterine tissue).

Before and after surgery

The very procedure of preparing for the operation, as well as the postoperative period, promise some discomfort, some restrictions, will require effort, work on oneself.

With a planned operation the night before and 2 hours before the operation, a cleansing enema is done, which will be repeated again on the 2nd day after the operation in order to activate the peristalsis (motor activity) of the intestine. To cope with anxiety and fear, taking tranquilizers at night, which the doctor will prescribe. Immediately before the operation, a urinary catheter is installed, which remains in the bladder for 24 hours.

After an abdominal delivery, a woman is both a postoperative woman and a postoperative patient. During the first day, she will be in the intensive care unit under the close supervision of an anesthesiologist and obstetrician-gynecologist. Discomfort is possible during recovery from general anesthesia: sore throat, nausea, vomiting, after epidural anesthesia, there may be dizziness, headache, back pain. Within 2-3 days after the operation, infusion therapy with intravenous infusion of solutions is carried out in order to compensate for blood loss, which during the operation is 600-800 ml, i.e. 2-3 times more than during vaginal delivery. The operating wound will be a source of pain in the stitches and in the lower abdomen, which will require the administration of pain medications.

In order to prevent postoperative complications, it is practiced to get up early after 10-12 hours, conduct breathing exercises and self-massage 6 hours after the operation. Compliance with the diet is mandatory for the first 3 days. On the first day, it is recommended to starve, you can drink mineral water without gas, tea without sugar with lemon in small portions. On the second day, a low-calorie diet is followed: meat broth, liquid cereals, jelly. You can return to normal nutrition after activating intestinal motility and independent stool. We'll have to come to terms with some limitations of the hygiene plan: washing the body in parts is carried out from 2 days, it will be possible to take a full shower after removing the stitches on the 5-7th day and discharge from the maternity hospital (as a rule, on the 7-8th day after operation). Gradual restoration of muscle tissue in the area of the uterine scar occurs within 1-2 years after surgery.

The woman may have to deal with some of the difficulties in breastfeeding, which are more common after a planned caesarean section. Surgical stress, blood loss, late attachment of the baby to the breast due to impaired adaptation or drowsiness of the newborn are the reason for the late development of lactation; in addition, it is difficult for a young mother to find a position for feeding.

If she is sitting, then the baby presses on the seam, but this problem can be dealt with by using the lying position for feeding.

During delivery by cesarean section, the process of launching adaptive mechanisms that ensure the transition of the newborn to extrauterine existence is disrupted. Respiratory dysfunctions in a newborn occur much more often with a planned caesarean section performed before the onset of labor than with vaginal delivery and with a cesarean section during labor. Therefore, a planned caesarean section should be performed as close as possible to the date of the expected birth.

After a caesarean section, the baby's heart functions differently, the glucose level and the level of hormones that regulate the activity of the thyroid gland are lower, the body temperature is usually lower in the first 1.5 hours. Lethargy increases, muscle tone and physiological reflexes decrease, the healing of the umbilical wound is sluggish, the immune system works worse, But now medicine has all the necessary resources in order to minimize the difficulties that the baby is experiencing. Usually, at discharge, the indicators of the physical development of the newborn return to normal, and after a month the baby is no different from children born through the natural birth canal.

Caesarean section: choosing anesthesia

In modern obstetrics, the following types of anesthesia are used during caesarean section: regional (epidural, cerebral) and general (intravenous, mask and endotracheal anesthesia). Regional anesthesia is the most popular because with her, the woman remains conscious during the operation, which ensures early contact with the child in the first minutes of life. The good condition of the newborn is noted, because he is less susceptible to the influence of medications that inhibit his vital activity. With spinal anesthesia, an anesthetic drug is injected through a thin catheter tube directly into the spinal cord canal, and with epidural anesthesia, it is injected more superficially under the dura mater, thus blocking pain sensitivity and motor nerves that control the muscles of the lower body (during the duration of the anesthesia, the woman cannot move her legs). For general anesthesia, as a rule, endotracheal anesthesia is used. An anesthetic drug is administered intravenously, and as soon as the muscles relax, a tube is inserted into the trachea, and artificial ventilation is performed. This type of pain relief is often used in emergency operations.

When natural childbirth is not possible for medical reasons, an alternative delivery option is used - a cesarean section. It should be borne in mind that this is a difficult path that allows you to bypass the pain of natural childbirth, and a serious procedure that has a number of negative consequences.

In contact with

CS is a surgical procedure to remove a fetus from the uterus through an abdominal incision. Depending on the development of the pregnancy, the procedure may be scheduled as planned. If during the development of pregnancy no complications were observed, but complications arose during the birth process, then an emergency operation is performed.

According to statistics, every ninth baby in Russia is born with help. Despite the fact that the operation is considered simple and often practiced, the likelihood of complications increases more than 12 times.

Indications for elective caesarean section

Planned COP is shown in the following cases:

diabetes mellitus and Rh-conflict;
detachment of the retina and myopia;
physiological characteristics of the mother: a narrow pelvis, malformations of the uterus or vagina;
the presence of scars on the uterus, remaining;
breech presentation of the fetus or other abnormal position - frequent indications for a cesarean section;
with post-term pregnancy, in which the size of the fetus is above normal;
at ;
the presence or exacerbation of genital herpes;
with placenta previa.

Anyway, the operation is performed with the consent of the woman in labor... This consent must be recorded in writing.

In the practice of doctors, there are cases when a woman in labor without medical indications for surgery decides to give birth by caesarean section. The reasons are psychological: fear of pain or physiological changes in the genitals. However, the World Health Organization recommends giving preference to natural childbirth, since the operation lays certain imprints on the health of the baby and mother.

An emergency caesarean section is indicated in the following cases:

A long labor process leading to oxygen starvation of the fetus. In this case, there is a real threat to the baby's life;
The loss of the strength of the woman in labor. For the normal development of the birth process, physical strength and psychological determination are required.;
Wrong position of babies with multiple pregnancies;
Childbirth that came before the natural time;
Premature rupture of amniotic fluid. In this case, there is a high risk of contracting infections.;
Placental abruption in a woman in labor. This is fraught with bleeding;
Presentation or prolapse of the fetal loop. Threatens with hypoxia and death for the baby;
At ;
Rarely, but still there are cases of uterine rupture.

Each generic process is individual. Therefore, this list does not reflect all the complications that may require urgent action. A woman in labor should always be under the close supervision of an obstetrician to prevent certain deviations from the birth process.

Algorithm for preparation in the hospital

When carrying out a planned operation, a woman in labor should prepare in advance for the procedure. What week is the planned cesarean section done? In practice, the operation is prescribed at the end - 38–39 weeks of pregnancy. 8-10 days before the appointed date, the gynecologist writes out a referral to the clinic where the operation is planned. A woman should be hospitalized in advance with everyone, as she:

General analysis of blood and urine;
Rh factor analysis;
Cytological smear;
Doppler vessels.

These tests help assess the degree of preparation of the body for delivery.

What is the best anesthesia for CS?

general and regional. General anesthesia has a number of negative consequences., among which, respiratory failure of the mother and child or the ingress of fluid from the gastrointestinal tract into the respiratory tract can be noted. The very substances contained in the composition of anesthesia can have a depressing effect on the neurological system of the baby. The "gold standard" for cesarean section in this case is the spinal and epidural type of pain relief.

The spinal method is carried out by a single injection injected into the cerebrospinal fluid. Epidural anesthesia is administered through a catheter into the spinal cord area. Both types of injections are given in a horizontal or seated position. The procedures are painless, sometimes accompanied by discomfort in the lower part of the peritoneum.

Each of these types has its own characteristics. The analgesic effect in the first case occurs within 10-15 minutes, for an epidural it will take 20-30 minutes.

Sometimes, regional anesthesia may not provide the appropriate level of pain relief. In such cases, if spinal anesthesia is initially administered, then general anesthesia is administered. If initially there was an epidural, the operation will be continued by increasing the dose of the drug through the inserted catheter.

According to the consequences, the advantages of spinal anesthesia can be noted. With her, in the postoperative period, mild headaches are possible. are extremely rare, but can be more tangible.

On the eve of the operation

The COP is usually done in the morning. The night before, a woman in labor should prepare for her. In particular, the anesthesiologist conducts an explanatory conversation. As a result, he must find out the previous facts of taking anesthetics, past illnesses, the woman's weight and other factors. The data obtained will help you choose an individual dose of painkillers.

Hygienic preparation is also carried out: taking a shower and epilation of the genitals. Lunch on this day should be limited to the first course, and dinner should consist of kefir or tea, drunk before 18:00.

On the day of surgery, be sure to refrain from eating and drinking fluids. A couple of hours before the caesarean section, the intestines are cleansed with an enema.

How is the operation going?

The woman in labor lays down on the operating table in shoe covers and a hygienic cap. The legs of the woman in labor are tied with an elastic bandage. This measure is necessary as prevention of thrombosis.... The operating area and the woman's face are separated by a screen. It should be borne in mind that in the absence of other indications, local anesthesia is practiced. After the anesthetic procedure, a dropper is inserted to compensate for the loss of blood. Cuffs are put on the arms to control pressure and pulse. A catheter is placed in the urinary tract. The peritoneum is sterilized and covered with a sterile sheet. The doctor proceeds to the procedure.

How long does a cesarean section take? Itself the operation takes about an hour on average, if there are no additional difficulties during its implementation. And here the process of removing the fetus with a cesarean section takes no more than 10 minutes... The umbilical cord is cut and the baby is handed over for postpartum procedures. The process ends with the extraction of the placenta and suturing of the incision.

After the operation, the woman in labor spends about a day in the intensive care unit, then transferred to the postpartum department. During the day, a number of measures are taken to restore the woman in labor:

measures to reduce the muscles of the uterus;
stopping bleeding;
compensation of fluid in the body;
anesthesia.

Despite its apparent simplicity, a cesarean section has a number of risks for both the mother and the baby.

The consequences for a woman in labor are divided into two types according to the duration of manifestation:

Late;
Postoperative.

Late consequences are expressed:

The formation of ligature fistulas is an inflammatory process around the seams;
Hernia of the vertebra;
Keloid scar is a scar after surgery. Rather, it plays an aesthetic role. The scar is absolutely safe for health.

Postoperative complications include the following factors:

Pain syndrome after surgery. The process of discharge may be accompanied by headaches, dizziness, intense thirst and general weakness;
During the operation, the woman in labor loses 4 times more blood than during natural childbirth;
Adhesions may form in internal organs;
Upon contact with air, there is a risk of developing endometritis - inflammation of the uterine cavity;
Hematomas may form on the seams or purulent processes may develop;
Rarely, but there may be cases of seam divergence;
Impossibility of caring for a child for several days.

The consequences for the child are also significant.

In the process of natural childbirth, the baby's body must be rebuilt to a new form of life. In this regard, at the beginning of the birth process in his body, the concentration of the hormone catecholamine sharply increases. It is necessary in order to throw fluid out of the lungs and start the baby's respiratory system as soon as he “comes out”. During the operation, the baby's body will not have time to collect the required amount of hormones. The lungs are not ready to breathe, and the heart bears significant stress. This can cause degenerative phenomena in the heart.

In addition, before the baby enters a period of hibernation, in which all physiological processes slow down. This phenomenon is a preparation for the transition to a new environment. Surgical intervention involves a sharp change in pressure drop. This grossly disrupts the natural process of preparing the baby for life and is fraught with minor hemorrhages in the brain. These children often have evidence of minimal brain dysfunction.

It has been noticed that children born by cesarean section also have psychological characteristics. This can be expressed in apathy of character, increased dependence on the mother and a pronounced desire to manipulate adults.

Let's summarize:

With an adequate assessment of the risks of surgery, even women in labor with indications may decide to give birth naturally. The doctor in this case can only warn about the possible development of events. However, the task of medicine is to preserve the life of the baby and the mother. If natural childbirth is impossible for objective reasons, then one should not persist, thereby endangering two lives.

Pregnancy planning, a healthy lifestyle, and adequate physical activity and a positive attitude towards childbirth help to minimize the risks of complications and may help to avoid surgery and give new life in a natural way.
Read some feedback from women who have had CS:

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Childbirth is a process to which a woman's body is fully adapted. But sometimes, for one reason or another, natural childbirth can pose a danger to the health or even the life of both the child and the mother. In such cases, an operative delivery is performed - a cesarean section operation.

Caesarean section can be planned and urgent... A planned cesarean section is prescribed even during pregnancy: according to indications or at the request of the expectant mother. The decision on an urgent caesarean section is made if complications arise already during childbirth, or dangerous situations requiring urgent intervention (acute fetal hypoxia, placental abruption, etc.).

Indications for caesarean section are divided into absolute and relative... Absolute are those on the basis of which the doctor unconditionally prescribes an operation, and natural childbirth is out of the question. These indications include the following.

Absolute indications for caesarean section

Narrow pelvis of a woman in labor... Because of this anatomical feature, a woman simply cannot give birth on her own, as there will be problems with the passage of the child through the birth canal. This feature is revealed immediately upon registration, and the woman from the very beginning prepares and tunes in for an operative delivery.

Mechanical obstacle preventing the fetus from passing naturally. This could be:

defragmentation of the pelvic bones;
ovarian tumors;
placenta previa (the placenta is not located where it should, blocking the fetus's path to the cervix);
isolated cases of uterine fibroids.

The likelihood of uterine rupture... This indication for childbirth through a cesarean section occurs if there are any stitches and scars on the uterus, for example, after previous cesarean section and abdominal operations.

Premature placental abruption... Pathology is expressed in the fact that the placenta, even before the onset of labor, is separated from the uterus, depriving the child of nutrition and access to oxygen.

Relative indications for caesarean section

Relative indications for a caesarean section suggest the possibility of natural childbirth, but at risk for the baby or mother. In such a situation, all individual factors are carefully weighed and considered. Relative indications include:

visual impairment in the mother (this is due to the high load on the eyes when the woman in labor is pushing);
malfunctioning of the kidneys;
cardiovascular diseases;
pathology of the nervous system;
oncological diseases, etc.

As you can see, these diseases are not related to pregnancy, but the intense stress on the mother's body during childbirth can cause various complications.

In addition, an indication for caesarean section is preeclampsia- violation in the blood flow and vascular system.

To the testimony, threatening the health of the child carry various genital infections in the mother, since the child can become infected by passing through the birth canal.

As for an urgent caesarean section, it is prescribed if the labor activity is very weak or has stopped altogether.

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By urgency, a cesarean section can be of the following types:

planned;
emergency.

According to the technique of execution, they are distinguished:

abdominal cesarean section - the incision is made through the anterior abdominal wall;
vaginal cesarean section - an incision through the anterior fornix of the vagina.

How is the operation of a cesarean section, what happens before and after it

How is a cesarean section

How long do I have to have a planned cesarean section? The date of the operation is assigned on an individual basis and depends on the condition of the woman and the child. If there are no special indications, then a cesarean section is prescribed on the day closest to the expected date of birth. It also happens that the operation is carried out with the onset of contractions.

How to prepare for a caesarean section

Usually, the expectant mother awaiting a planned cesarean section is placed in the hospital in advance in order to conduct an examination - to determine that the baby is full-term and ready for birth, and to monitor the woman's condition. As a rule, a caesarean section is scheduled in the morning, and the last meal and drink is possible no later than 6 pm the night before. The stomach of the operated patient must be empty to prevent its contents from entering the respiratory tract. In the morning, on the day of the operation, they carry out hygienic procedures to prepare for a caesarean section: they do an enema, shave their pubis. Then the woman changes into a shirt, and she is taken away or taken on a gurney to the operating room.

Immediately before the operation, anesthesia is performed, a catheter is inserted into the bladder (it will be removed a couple of hours after the operation), and the abdomen is treated with a disinfectant. Further, in the area of the woman's chest, a small screen is installed so that she cannot see the course of the operation.

Anesthesia

There are 2 types of anesthesia available today: epidural and general anesthesia. Epidural anesthesia involves inserting a thin tube through a needle into the exit site of the nerve roots of the spinal cord. It sounds pretty scary, but in fact, the woman experiences discomfort for only a few seconds when the puncture is performed. Further, she ceases to feel pain and tactile sensations in the lower body.

General anesthesia. This type of anesthesia is used for emergency caesarean section, when there is no time to wait for epidural anesthesia. First, a drug of the so-called preliminary anesthesia is injected intravenously, then a mixture of anesthetic gas and oxygen enters the trachea through a tube, and the last drug is injected to relax the muscles.

The course of the caesarean section

After the anesthesia has worked, the operation begins. How is caesarean section performed? First, an incision is made in the abdominal wall. During the operation, 2 types of incisions are possible: longitudinal (vertical from the bosom to the navel; done with an emergency caesarean section, since it is faster to get the baby through it) and transverse (above the bosom).

Next, the surgeon spreads the muscles, makes an incision in the uterus and opens the fetal bladder. After the baby is removed, the placenta is removed. Then the doctor first sews up the uterus with threads, which dissolve after a few months - after the tissues grow together, and then the abdominal wall. A sterile bandage is applied, ice is placed on the abdomen so that the uterus contracts intensively, as well as in order to reduce blood loss.

The duration of a cesarean section usually takes from 20 to 40 minutes, while the child is removed into the light already at 10 minutes, or even earlier.

Postoperative period

Another day after the caesarean section, the woman is in the intensive care unit or intensive care unit so that doctors can monitor her condition. Then the newly-made mother is transferred to a regular ward. To reduce pain, she is assigned pain relievers, drugs to reduce the uterus and normalize the state of the gastrointestinal tract. Sometimes antibiotics are prescribed, but this is decided on an individual basis. Gradually, the doses of drugs are reduced, and they are completely abandoned.

If the operation went without complications, get up for the first time the woman is allowed after at least 6 hours. First you need to sit down on the couch, and then stand for a while. In no case should you strain yourself, experience at least minimal physical activity, as this threatens with seam discrepancies.

It is highly advisable to purchase in advance postoperative bandage, wearing it will greatly facilitate movement and discomfort in the first days after the caesarean section, especially when you need to lie down or get out of bed.

Grooming, diet and stool

On the first day after the operation, it is recommended to drink only water without gas, and you will need to drink a lot to replenish the loss of fluid. You will also need to empty your bladder on time. A full bladder is believed to prevent the uterus from contracting.

On the second day, liquid food is allowed (cereals, broths, etc.). If everything is in order, then from the third after the operation, you can return to the normal diet recommended for lactating women, however, after childbirth, many mothers complain of constipation, and in order to mitigate the situation, it is advisable not to eat solid food for several days.

Also, this problem is solved by enemas, candles (usually candles with glycerin are used; when you put such a candle, try to lie down for a while) and eating foods that have a laxative effect (kefir, dried fruits, etc.).

After discharge from the hospital

For the first month and a half after the caesarean section, you will not be allowed to take a bath, swim in the pool and ponds, you can only wash in the shower.

Active physical exercise should be postponed for at least two months. At this time, you will need the help of relatives and husband. Although it is impossible to completely abandon physical activity. Ideally, the doctor after surgery should tell you about exercises that will speed up the body's recovery, at least you can ask about it yourself.

To renew sex life recommended not earlier than a month and a half after the operation. Be sure to take care of contraception. Experts advise planning the next pregnancy only after 2 years, during which time the body will fully recover and will be able to ensure the full development of the unborn baby.

Is natural childbirth possible after cesarean?

Contrary to popular belief, a woman can give birth to a child herself if a previous pregnancy ended with a caesarean section. If the stitches have healed, no complications have arisen, the reproductive system has recovered successfully and there is no indication for another cesarean section.

Pros and cons of caesarean section

Surgical delivery is possible both for medical reasons and at the woman's own request. However, doctors usually oppose such a decision, discouraging the expectant mother from surgery. If you are also considering the possibility of an operation, provided that normal childbirth is not contraindicated for you, carefully weigh all the positive and negative aspects of the issue.

Pros of a cesarean section:

during the operation, injuries to the genital organs, such as tears and incisions, are not possible;
Delivery by caesarean section takes a maximum of 40 minutes, while in vaginal delivery a woman often has to endure contractions for several hours.

Cons of Caesarean section:

psychological aspect: mothers complain that at first they do not feel connection with the child, they do not have the feeling that they gave birth to him themselves;
limitation of physical activity and pain at the suture site;
scar. Read more about this in the article.

Consequences of a caesarean section

The consequences can be divided into 2 types: for the mother, in connection with surgery, and for a child, due to unnatural birth.

Consequences for mom:

pain in the seams, resulting in a scar on the abdomen;
restrictions on physical activity, inability to take a bath and restore intimate relationships for several months;
psychological condition.

Consequences for the child:

psychological; there is an opinion that children born through surgery are less adaptable to the world around them. It is worth noting that the opinions of scientists on this matter differ, and the experience of mothers shows that in most cases, fears about the mental retardation of children are far-fetched, and one should not worry about this. However, it cannot be denied that the child does not follow the path prepared for him by nature, and that helps prepare for the new environment of existence;
the possibility of a residual amniotic fluid in the lungs of a newborn;
getting into the child's blood of drugs of anesthesia. Read more about the consequences of a cesarean section and watch the video in

Complications after a cesarean section

Complications after anesthesia. If you are about to have a caesarean section with an epidural, you need to remember the following point. After the operation, a catheter with an anesthetic is left in the back for some time, and drugs are injected through it to anesthetize the stitches. Therefore, after the operation is over, the woman may not feel both or one of the legs, and is unable to move.

There are times when, when the woman is shifted to the couch, her legs twist, and since the operated woman does not feel anything, this fact can go unnoticed for a long time.

What is the threat? Due to finding a limb in an unnatural position, it develops prolonged positional compression syndrome... In other words, soft tissues are without blood supply for a long time. After neutralization of the compression, shock, severe edema, impaired motor activity of the limb and, not always, but quite often, renal failure develop, all this is accompanied by severe pain lasting for several months.

Be sure to ask the hospital staff to check if you have been properly laid on the couch. Remember that sometimes the pinch syndrome is fatal.

In addition, anesthesia is often accompanied by headaches and back pain.

One of the most common complications is adhesions... Bowel loops or other abdominal organs grow together. Treatment depends on the individual characteristics of the woman: the matter may be limited to the usual physiotherapy or come to the need for surgical intervention.

Endometritis- an inflammatory process in the uterus. To prevent it, a course of antibiotics is prescribed immediately after the operation.

Bleeding also refer to complications after a cesarean section and, in rare cases, lead to the need to remove the uterus.

Complications can arise in the process healing stitches, up to their discrepancy.

So, a caesarean section is a guarantee of life for mother and child in cases where natural childbirth is impossible or dangerous. Every year this operation is being improved, and the number of complications is decreasing. However, the human factor cannot be excluded, therefore, if you know about the main features of the operation and postoperative care, this will help you avoid complications and enjoy the joys of motherhood without unnecessary distress.

Video, how is a cesarean section

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