In this article, we consider what kind of cesarean sections exist, as determined by the date of the operation, when to lie down in the maternity hospital, if you are planned for the loan section.
In addition, we will analyze the question in detail, is it possible to make a cesarean section at the request of a woman (without medical testimony), and is it worth it to do so.
Planned and Emergency Caesarean section
Briefly list, what is the difference between the planned and emergency cesarean cross section.
- The planned and emergency caesarean section is made in different medical testimony. Read more about the testimony for planned Cesarean in the article. On the testimony for emergency, in the article.
- As a rule, the testimony for the planned caesarean section and the woman in labor and the doctor know long before delivery, sometimes even before the start of pregnancy. Conversely, the readings to the emergency operation arise, as a rule, right in the process of childbirth or shortly before it.
- At the moment it happens more and less often, but sometimes it all happens. With a planned and emergency cesarean, the type of section (subsequently, the operational seam) may differ. Read more about this in the article.
A kind of anesthesia (anasthesia) may vary, more about this in the article.
How is the case of caesarean sections itself, you can read in the article .
When to lie down in the maternity hospital with a cesarean section
For sure you will answer this question only your doctor who fully knows your situation, testimony to the operation, and so on. If we consider a general case, then in the maternity hospital is laying 1-2 weeks before the expected date of delivery (PDR), with the fact that the operation date will try to appoint closer to this date. But this is a general option. And in each particular case may be different. In any case, at least 2 weeks before the PDR (and with certain testimony before), a woman must be examined. These directions are investigated (this is the minimum, there may be still surveys depending on the indications):
- General condition of pregnant (pressure, blood tests, urine);
- If there is already a scar in the uterus, then the state of the scar;
- The state of the cervix, evaluation of readiness for childbirth;
If the state of the woman and the course of pregnancy is good, then these studies can be held outpatient. After that, prescribe the date of the operation. Further, the woman can stay before surgery in the hospital, and maybe at home (if everything is good for analyzes, research and so on).
For example, in the first childbirth, the doctor recommended for two days before the operation date. And in the second birth, I myself asked to lie 2 weeks before childbirth, even the doctor resisted that early, and no testimony. And it seemed to me that I was supervised, and it was calmer. All tests and research passed, even the date of operation has not yet been appointed, they said "go for another week, let's see." And the same is good, which went before, because they suddenly moved the water, and had to quickly do the operation.
In general, you can say so. 2 weeks before the DTR, you need to go through all the necessary surveys (the mains are above) in the maternity hospital. Further - by results and your state. Either home and come to the maternity hospital before the operation or stay to the operation in the hospital.
How defined the date of operation with a planned caesarean section
There is a concept of DRD (alleged date of birth). This date is determined by such parameters:
- by date of last menstruation,
- according to the intended date of conception;
- according to the results of the first ultrasound;
- according to the first fixed fetal intrauterine movements.
More information about how the estimated date of birth is determined, one can read in the article.
Given this date, and at normal, doctors will try to conduct an operation as close as possible to the estimated. Most of the sources assures that the doctors "will definitely take into account the wishes of the Genovers itself relative to the date." Here you need to make clarity. Doctors, of course, will take into account your wishes, but only after they take into account all really important factors. The final date of the planned operation is raised on the basis of preliminary research in the hospital. As a rule, these studies are carried out 1-2 weeks before the DA. The following parameters listed below are studied (generally).
- The state of the health of the mother, which indications the cesarean section was planned. It depends on how much "close" to the PDR can be "approaching". In some cases, doctors can wait until the start of labor (but not before the departing of the waters), and only after that do the operation. In the case of multiple pregnancies, for example, its testimony, there may be an operation for a period of 36-37 weeks and even 32 weeks with monoamniotic double. HIV-infected women caesarean section is carried out at 38 weeks before the start of generic activity and disheavage.
- If there is already a scar on the uterus, then they look at the state of the scar.
- The state of the cervix, evaluation of readiness for childbirth.
- The state of the fetus (ultrasound, KTG, Dopplerometry in the vessels of the mother, placenta and fetus).
For these parameters, the doctor may assign a date. From experience we can say that one or two days of the difference is provided as a choice for a woman. That is: Do you want on Monday or on Tuesday? There is no particularly wide selection in this situation.
Is it possible to make Cesarean at will
In recent years, cases have increased when women are requested to make Cesarean, without medical testimony to surgery. The most common causes of such appeals are the following:
- Fear in front This is the fear of the process itself, pain, and fear of the consequences (, for example).
- Fear of what changes in the genital organs will occur (in the size of the vagina, sexual lips, for example), and this will adversely affect sexual life.
- The conviction is that natural childbirth is harmful to the child.
What can be said about this. A few moments.
If you decide that you only need a cesarean section, and you categorically do not want to give birth naturally, then you are guaranteed to find a doctor who will do it. Despite the fact that everywhere it is written that the decision on the need for the operation is taken by doctors. Doctors have a lot, and I will definitely find a doctor who will make an operation without testimony to it for the agreed amount. Especially to perform Cesarevo, if all the testimony for natural delivery is most likely it will not work. But find a doctor, and agree on a planned operation - most likely it will work out. This is all I write to the fact that no matter how much do not write that "only doctors make a decision on a planned operation," you still achieve your own, if you want too much.
Another question is whether to insist on a cesarean section, if there is no need for it. Our opinion is not worth it. I will explain what we are based on (specifically the authors of these materials have experience and natural genera, and childbirth through cesarean section).
- Yes, natural childbirth, it's a painful thing, no one argues. But, women who survived and Cesarean, and natural childbirth, they say that according to pain, it is quite comparable. Only in natural genus it hurts during childbirth, and in Cesarian childbirth, it hurts after childbirth.
Mama store has for healing and restoring tissues after cesarean section.
Note. Return of food and cosmetics is possible only with intact packaging.
In general, in our opinion, such a comparison is correct here. If we compare natural labor without complications, medium duration, without "surprises" and the average cesarean section, then most of the opinions (women who experienced both) are better and easier than natural childbirth. As an argument, in most cases the following leads:
- After the normally past natural genera are much easier to restore.
- In the first days after giving birth, you need strength. You are mastering the new role (especially when the child is the first). You and so hard. So, these first days can even be remembered as a solid pain (in comparison with the first days after the normally past natural genera).
- After natural genera, milk comes faster, and it greatly facilitates the first days. After the cesarean section, the milk comes later, and the first three or four days it can be quite small, and the child can behave very restlessly. A hungry child is crying, mom is nervous, and it also hurts. What can be done in this situation, we will consider in detail in the article.
Prepare thrasher and pastime from several days to a week in the maternity hospital. Buy in the mother's store:
- (according to the testimony of the doctor);
- And for comfortable feeding.
Regarding whether your genitals are "former" after natural genera. Now let's stop at this briefly, and we will analyze this question in more detail in a separate article. It can be said that with normal natural labor, your genitals have all the chances to recover by 80-95% (with respect to the previous sizes).
In general, you can say the following. If you have all the testimony of natural childbirth, then Caesarean "just so," is not worth it.
In the same connection, another question arises. It often happens that the woman is so bothering so much with the thought that she will give birth naturally, which simply cannot accept the need for Cesarean (if it suddenly arises).
For example, one friend my friend even ran away from the maternity hospital when she was told that they would have to operate. Far, of course, she did not run away, she became bad on the street, and at the ambulance returned to the same hospital, and plunged. Everything cost, and mom and child are healthy. But, is the question exactly how to give birth to that way risks? In my opinion, it is not worth it.
In addition, after childbirth, a woman (except for postoperative discomfort) is faced with the fact that it is beginning to be assessed by her childbirth, no matter how ridiculously sounded. It turns out something like this: she gave birth to himself, - well done, real woman and mother, and so on. And fed, - Well, well .. and it happens .. Well, the second time, let's herself .., Well, you're not guilty, and so on. So, dear girls. I want to tell you that it is categorically impossible to let all this nonsense. You go to the goal of the child. And how exactly you give it, - it does not matter.
Your goal is to give birth without prejudice to health, your own and child. You go to give birth not to get a "good assessment for the process of childbirth." Therefore, you gave birth to naturally or with cesarean, - in any case you are a real woman and mother. And believe me, your child's life is just beginning with childbirth. This is just the starting point. And the child himself, and you with the child, still so much ahead that the features of his birth do not really have such a meaning which they can come immediately after delivery. In general, we would advise not to tune in categorically to the fact that "I am a face myself." Anyone can occur. Much more correct installation: I will face a healthy child and everything will be fine with us.
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Now artificial childbirth is not uncommon. Therefore, very many women ask themselves the question is whether the cesarean cross section should do. But unfortunately, the baby cannot be born independently and in such cases it's just not to do without surgical intervention. And of course, pregnant will experience that this operation can somehow adversely affect the health of the child or on it. Caesarean section is an operation, and the operation always scares a little. Although doctors argue that this is done exclusively in order to save the life of the child.
Translated from Latin Caesarean cross-section denotes a "royal incision", and the people themselves are in the people themselves dubbed the royal. Some of the scientists and historians say that it was with the help of Cesarean sections, Julius Caesar was born. One more prove that he issued a law that forced the doctors to cut the belly after the death of a woman so that the kid also did not die.
To date, the cesarean cross section becomes a very popular method of roostening. It is often used in relation to the famous "star" mammy. If earlier the cesarean section was rare, now the percentage of these operations has increased to 27, and in some countries and at all to 80%. And this means that almost every 4 child is born artificially. This was the reason why WHO practically forbid the cesarean section in cases where a woman can give birth on their own.
Indicators for cesarean section
Usually, the cesarean section is customary to do only on the recommendation of the doctor. And this may exist several reasons.- Great weight of the fetus;
- Inconsistency of pelvic bones (narrow pelvis or there is a deformation);
- Disease heart or nervous system;
- Poor eyesight;
- Diseases of internal and external genital organs;
- Transverse preservation of the fetus;
- Several scars on the uterus who remained from previous pregnancies.
What to do on the day of the cesarean sections
If the cesarean cross-section was planned, then first of all the day before this day costs to sleep well. From the evening and in the morning it is advisable to completely abandon meals. Plus, this woman still put the enema to completely clean the intestines. Before proceeding with the operation in the bladder, the cathetter is introduced, which pump up urine and anesthesia is made.But there are such cases when the cesarean section is not scheduled. The following indicators can be given to this: the hypoxia of the child, the reasons that threaten the life of a child and mother, bleeding, placenta dryers, the complete absence of contractions.
Anesthesia with cesarean sections
There are several anesthesia methods with cesarean sections: general and regional (spinal and epidural anesthesia). With the general anesthesia, the woman in labor is completely unconscious. This method is dangerous in that when using multiple drugs, it may adversely affect the child. With regional anesthesia, a woman is conscious and can observe the operation. To date, such types of anesthesia have more applied as they are less dangerous for the mother and child. The prohibition of their application may occur only if there are certain contraindications. Such as, for example, high blood pressure.Period after surgery
After the operation is completed, the woman is transferred to the ward, where it is for at least a week, is under the supervision of doctors. In order for a woman to be discharged from the maternity hospital, you need to spend several inspections and make an ultrasound. When information is about the fact that the healing of the scar on the uterus goes well, mom together with the child is released home. In most cases, for applying seams, threads are used, which are solicitated themselves after a few weeks, so there is no need to see the doctor about this.Consequences of Cesarean section
After the cesarean section, it is necessary to monitor personal hygiene, change the diet. To do this, follow the advice of a doctor. And do not be upset, because most women who have made a cesarean cross section for the first pregnancy almost always give birth on their own.In anticipation of the touching moment of acquaintance with his baby, every woman wants to know the date of birth in advance. This will make it possible to prepare, collect the "alarming suitcase" in the maternity hospital and tune in psychologically. Let's deal with how how many weeks caesarean do.
Cesarean section is planned and emergency. The testimony for it occurs both during pregnancy and during childbirth.
The operation date will depend not only on you, but also from the maternity hospital in which you gathered to give birth. After all, in each clinic its own rules. One completely accurate, make a planned operation with a dead pregnancy or as close as possible to this deadline.
The perfect option, if you have a planned operation. At the same time, mom and kid feel good, nothing threatens their condition. In such a situation, it is possible to perform a cesarean section with the beginning of bouts.
For the baby, this is very good, as the childbirth will begin only when your child is ready for birth and completely matures.
In addition, it will affect positively on breastfeeding.
Such a situation is possible, for example, with eye diseases, the bone system, if the sizes of the mother's pelvis are less than the circumference of the child's head, if the mother in the previous births there were gaps of the rectum, there are tumors of the uterus (mioma), vagina, pelvic bones preventing natural breeds.
In these situations, the planned caesarean section can be performed with the beginning of generic activities for a period of 38-41 weeks. But the female consultation doctor will send you to the hospital in advance, in the period of 38-39 weeks.
It is necessary to pass tests and perform additional surveys if necessary.
In most maternity hospitals, it is preferred not to wait for the start of labor activity, but to schedule the Date Cesarean after the hospitalization of the patient. In this case, you will try to perform an operation closer to 40 week.
By the way, if you like some number, you can ask the doctor to assign an operation for that day. Your wishes will definitely take into account if it is possible.
What week do surgery?
It depends on a specific obstetric situation.
- With a pelvic prevention of the fetus. You are hospitalized in advance, by 38-39 weeks. Weighing everything and against, will take a decision: Cesarean or natural childbirth. If you make a cesarean section, then it is better to wait for the fights. Of course, if there are no other readings so that you do not hesitate with the operation. A child can turn over the head at the last moment and the need for an operation will disappear. Especially if the pregnancy is repeated.
- With the transverse position of the fetus, Cesarean will be made to the appointed date before the start of childbirth. The fact is that when pleasing waters, small parts of the child can fall out - the umbilical cord, handles.
- Full preview of the placenta. The placenta fully overlaps the generic paths. This pregnancy is very difficult to make bleeding due to the danger. With the beginning of the bouts, the neck opens and the bleeding can begin due to the pair of placenta. Therefore, such women operate for 38 weeks. But if the bleeding starts, you will have to perform an emergency operation earlier
- If you have the second caesarean or third and subsequent, then the date of the operation will depend on the state of the scar in the uterus. In the third trimester, the fruit is growing rapidly, and the scar may not withstand the load. If the scar is thinned and overwhelmed, the pain is bolted at the bottom of the abdomen, then wait long will not be. Come on 37 weeks, especially if the third or fourth operation.
- Do not many know that multiple pregnancy It is considered to be dodged in the period of 36-38 weeks. Twin can be given birth through the natural generic paths. But one-time twins, as well as bilayers, when the first child lies booty or across, twins after eco - born by cesarean sections. If the fruits are three or more - only Cesarean. Ease twins are much harder and complications occurs during pregnancy more. Trying to perform a scheduled operation closer to 38 weeks. But, if something goes wrong, one of the children lags behind the other in growth and development, Cesarean can do it earlier, on the 34-35 week, especially if the twin is single.
- HIV-infected Women are closed in a planned manner for 38 week.
- After cervical operations You are also waiting for a planned caesarean section, before the start of childbirth. It is necessary that the neck is not damaged when the contractions begin.
When do Emergency Caesarean?
Indications for emergency cesarean cross section may occur on any period, even with premature pregnancy, i.e. Earlier 37 weeks. If, in the period from 28 to 34 weeks, childbirth begin, or indications for the birth of a child before the deadline, then the cesarean section is performed. The child is not mature and childbirth through natural generic paths for him too complicated test.
Emergency Caesarean section performs up to 37 weeks, if:
- Bleeding begged due to premature placental detachment.
- Bleeding in the preservation of the placenta.
- With the appearance of signs of breaking the uterus in the head. Especially if the scar in the uterus is not alone.
- Another reason is the hypoxia of the fetus. The child is missing nutrition and oxygen from the mother. If such a state continues for a long time, the baby may die. To save the child, and it is necessary to give birth and nail it in a cuvez, even if the pregnancy term is still small.
- If from 22 weeks of pregnancy you are tormented by swelling, high pressure, bad urine tests are precipation. With an increase in the term of pregnancy, heal him becomes more difficult, the child also suffers from mom's edema and lags behind in growth. If the state of the woman and the fetus deteriorates sharply, they perform caesarean on any time.
Caesarean section can do in childbirth that will begin on their own.
- Clinically narrow pelvis - When the sizes of the mother's pelvis and the size of the preserving part of the child do not correspond to each other and the childbirth is impossible. This is clearly becoming only in childbirth.
- Frontal prediction - When the head enters the small pelvis the largest size. Her birth through natural generic paths becomes impossible.
- Pupli loop loss After influencing the accumulating waters.
- Hypoxia The fetus can develop during childbirth. In this case, childbirth must be completed immediately so that the child does not suffer.
There is also a small caesarean section. It is performed on the period of pregnancy 13-22 weeks to interrupt its purpose. It is performed if the placenta fully overlaps the entrance to the uterus. Or there is a detachment of placenta and bleeding, which requires emergency assistance to a woman.
As you can see, the testimony for the cesarean section can be the most different and arise on any time and at any time. Therefore, as soon as you leave on the decret, collect an "alarming suitcase", which will have everything you need for you and baby.
Fetal passport and your passport, shirt, bathrobe, spoon, mug, personal care products: calcination, gaskets, toothpaste and brush, toilet paper, gel for intimate hygiene or soap. For kid diapers, powder, pelleys, suites.
What time it would not be done by Cesarean, the main thing is that this is done according to the testimony and retained the health of the future mother and the child.
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In recent decades, more and more often, kids are born with the help of a cesarean section (COP). In some Roadmas CIS countries, the COP frequency indicators reach 50% of all kinds. In 2005, WHO conducted studies that showed that the frequency of antibiotics prescribes in the postpartum period increases with an increase in the CS frequency, the level of maternal morbidity and mortality increases. On average, the cesarean operation surgery accounts for 15 genera from 100, while further increase in the frequency of the COP does not lead to a decrease in perinatal morbidity and mortality in children.
Considering the high frequency of the COP, any possibilities to reduce the risks associated with the operational delivery will have significant advantages both for individual fevering and in terms of economic costs.
Compared to natural genus Maternal mortality rates for CS (40 per 10,000 cases) 4 times higher than for all types of vaginal delivery, and 8 times higher than for normal vaginal genera (5 out of 10,000 cases).
Planned caesarean section
The cesarean section operation can be carried out when the doctor together with the female has decides in advance about operational childbirth, as the safest method of the delivery, or is emergency when indications arise to an urgent operational delivery. While registering an obstetrician-gynecologist collects a history of pregnant. Based on this information, he decides on the form of a rapid proposal recommended by this woman. Indications for a planned caesarean section can be both from the mother and from the fetus.
These include the following states:
From the mother:
The prevention of the placenta, which is confirmed by an ultrasound study after the 36th week of pregnancy (the edge of the placenta is less than 2 cm from the inner session);
Scar in the uterus in the presence of contraindications to subsequent vaginal childbirth:
- The presence of any contraindications to vaginal childbirth;
- Previous corporate ks;
- Previous T and J-shaped incision on the uterus;
- Uterine breaks in history;
- Any previous reconstructive operations in the uterus, resection of the angle of the uterus, hysterotomy, momectomy with the penetration of the uterine cavity in history, laparoscopic momectomy in the absence of inventing the uterus with modern suture materials;
- More than one COP in history. As an exception, vaginal labor is allowed in women who have undergone 2 COPs, if there are at least some vaginal genera in history;
- Failure of a woman from attempting vaginal childbirth;
HIV-infected women:
- women taking three antiretroviral drugs and having a viral load over 50 copies of 1 ml;
- women taking monotherapy assvudin;
- Women infected with HIV and viral hepatitis with at the same time.
in such cases, the COP is shown on the period of 38 obstetric weeks, to the rupture of the fetal shells;
The appearance of first genital herpes for 6 or less weeks before childbirth;
The presence of extragnenital pathologies (the diagnosis must be set or confirmed by a specialized physician):
- from the side of the cardiovascular system - arterial hypertension of the III degree, the coarcation of the aorta (without operational correction of vice), aortic aneurysm or other large artery, the systolic dysfunction of the left ventricle with the emission fraction
- ophthalmic - hemorrhagic form of retinopathy, perforated corneal ulcers, wound an eyeball with penetration, "fresh" burn. Other pathology of the bodies of vision are not indicated to the COP;
- pulmonological, gastroenterological, neurological pathologies, under which the attending physician recommends childbirth through the COP;
- Tumors of the small pelvis organs or the consequences of the pelvis injury, preventing the birth of a child;
- Cervical cancer;
- States after the rupture of crotch III degree or plastic operations on the crotch;
- States after the surgical treatment of urinary and intestinal-sexy fistulas;
From the fetus:
- Pelvic prevention of the fetus for a period after the 36th week;
- Pelvic presence or improper position of the fetus for multiple pregnancy;
- Transverse preservation of the fetus;
- Monoamniotic twins;
- Syndrome of the growth delay of one of the fruits in multiple pregnancy;
- Gastroshisis, diaphragmal hernia, spina bifida, a teratom of the fetus, the fighting of twins - subject to the possibility of providing operational assistance to the newborn child;
COP at the request of a woman in the absence of listed readings is not conducted. On this occasion in medicine there are discussions. On the one hand, women want to independently decide which way to give birth to a child, and on the other, Cesarean section is an operation and conjugate many risks for the mother and fetus. In case of failure of a woman from the shown operation, it must sign an informed refusal to sign.
Terms of execution of the planned cesarean section
Perform after complete obstetric 39 weeks of pregnancy. This is due to the minimization of respiratory distress syndrome (RDS) in a newborn.
In the case of multiple pregnancy, the planned COP is performed after 38 weeks.
In order to prevent the vertical transmission of the disease in the HIV-infection of the mother - in 38 weeks of pregnancy, before the fattening of the oily water or before the start of the generic activity.
With a monoamniotic double, the COP operation must be performed on a period of 32 weeks after the prevention of the Fetal RDS (special injections are made that contribute to the disclosure of the lungs).
Our life is changing every day. And medicine, and science develop rapidly, saving and facilitating life with the help of new technologies. We are delivered from many who existed earlier, problems. But the main thing is not changing - we continue to love, hope, give birth and educate children. In our life, the child's child is always the most amazing and significant event.
Pregnancy - physiological process, not a disease, argue many doctors. However, during this period of life, women's health is checked for strength, it needs to go through increased loads, which makes it more sensitive and wounded. Childbirth is also not a pathological condition, but the necessary difficult process, which ends with the birth of the kid. But it is a huge stress for both and sometimes requires special medical intervention.
There is no general opinion among the doctors about the only right, safe and most painless way of childbirth, especially for healthy women with normal pregnancy.
an exemplary woman has the right, and now the opportunity to choose the best and most secure and child for himself the option of the delivery, selected together with its observing physician and approved by him in accordance with all the testimony that has arisen during pregnancy.
But there are situations where an obstetrician gynecologist definitely or weighing risks insists on holding a cesarean section - a surgical operation that allows the child to appear by extracting it from a mother's belly that cannot or can not be given by it in the usual way.
Causes of increasing the frequency of cesarean section
Increasing the number of women who decided to give birth only after 30 years in combination with possible gynecological pathologies (adnexitis, endomyometritis, neuroendocrine disorders, infertility, operations in the uterus and appendages, the mioma of the uterus, endometriosis, etc.).
The frequent course of pregnancy against the background of various other non-gynecological diseases, when pregnancy proceeds with complications. Often there is a complicated childbirth.
Improving the diagnosis of pathology during pregnancy at the expense of new research methods to establish a more accurate diagnosis.
Expansion of testimony for cesarean section with severe gestosis, premature pregnancy, the pelvic preservation of the fetus.
Expansion of testimony for cesarean section performed in the interests of the fetus.
The ability to avoid the imposition of obstetric tongs.
Most of the pregnant women who previously undergoing Cesarean, which is not recommended to give birth independently.
Despite all these reasons and testimony, specialists in one vote recommend that if there is an opportunity to give birth on their own, then no matter what a cesarean section of speech should not go, because the risks for both the mother and for the child with a cesarean section are not lower, but Often higher than with natural childbirth.
Indications for Cesarean section
Kesarean section has to resort when pregnancy proceeds with complications and natural labor becomes dangerous. Well, if the obstacles are detected long before delivery, then the doctor can plan the operation in advance and prepare a fever. In this case, Cesarean section is called planned. But sometimes it happens that the woman begins to give birth normally, but something happens not so and the situation becomes dangerous. In this case, the emergency operation is carried out.
Caesarean section is carried out exclusively by appointing a doctor. Well, if the future mother weighs all "for" and "against" and turn to several specialists. As a rule, pregnant women are offered artificial delivery for several reasons. The indications for the planned caesarean cross section may be the following.
Indications for a planned operation
For these reasons, during pregnancy, the doctor can schedule Caesarean sections:
Indications for emergency cesarean section
These are any complications during childbirth that violate their normal moves and threaten the lives and state of health mom and baby.
Anesthesia methods for cesarean sections
There is a general (endotracheal) and regional (epidural or spinal anesthesia) anesthesia methods for cesarean sections.
Endotracheal anesthesia immerses the harmonic to a medical sleep, and the anesthesia is carried out in the respiratory trachea (trachea) through the tube. Therefore, it is called endotracheal. Entitful anesthesia is faster, but after awakening it often causes unpleasant consequences: nausea, pain in shoulders, burning, drowsiness.
With the "epiduril" makes an injection in the spinal channel. Only the bottom of the body is anesthetized. During the operation, the fever is in consciousness, but does not feel pain. To see the whole process does not have to - health workers will hang at the chest level of a pregnant special screen. After the anesthesia worked, the doctor gently cuts the abdominal wall, then the uterus. The crumb is taken out after 2-5 minutes. As soon as the baby was born, mom can see him and attach to the chest. Epidural operation lasts about 40-45 minutes and, first of all, suitable for mothers who are experiencing that under anesthesia they will not be performed by their "participation" in childbirth and will not be able to see their first kids ...
Consequences of Cesarean section
Cesarean section increases the risk of serious problems with anesthesia, infection and bleeding. It will take a longer hospitalization. Pains appear after a week after childbirth and difficulties in care for the newborn and other children, will need more painkillers, antibiotics and blood transfusions are more likely than after childbirth through natural ways. It is not so soon possible to return to home responsibilities or to work. Moreover, financial expenses are much larger than with natural childbirth.
Children born by a caesarean cross section have more problems with breathing and maintaining temperature, especially if there were no fights at all. Even compared to long-term or difficult births through natural paths, this additional risk exists.
By making a decision regarding the cesarean section, you with your doctor must weigh the risk and advantages. The risk of cesarean sections pays off only in situations where childbirth through natural ways can create even greater risk for a mother or child.
Cesarean section, called yet "Roman kinds", is an operation, during which the woman is cutting the abdominal cavity and the wall of the uterus, after which the child and the last are removed. The reasons for such a transaction can be a variety of factors, but at what date the planned caesarean is done, solves the attending physician.
The planned caesarean section is usually not done earlier than 38 weeks of pregnancy, as it is believed that, starting with this period, the child becomes viable. In rare cases, the planned caesarean can be appointed earlier than 38 weeks of pregnancy, which is associated with the factors, due to which the guinea cannot wait for the fights and live. In any case, the woman passes a special preparation for the operation, which will reduce the operational risks and simplifies the postoperative period.
Causes of destination Kesarean
A planned caesarean section is appointed in cases where natural childbirth is dangerous due to a high degree of threat of life and health for a guinea or infant.
Causes of the impossibility of natural delivery:
Sometimes the planned caesarean section is prescribed due to the combination of two or more factors.
When should I go to the hospital when appointing planned caesarean?
While the observation lasts, the doctor, relying on the factors impeding the conduct of natural childbirth, pronounces with the patient the need to fulfill the planned caesarean section, no one does from this. Moreover, the doctor will thoroughly explain the reasons for which Kesarean is appointed, how much the operation will continue, will discuss the preparation and timing of it.
If the pregnancy proceeds normally, the patient comes to the maternity hospital for a period of 36-37 weeks, then observed from specialists, and if the testimony for operation is still present, an operation is carried out on the period of 38-39 obstetric age weeks.
In the case when there is a threat of interrupting pregnancy, the patient is sent to the hospital for a period of 33-34 weeks or earlier if there is a need. The factory aimed at preserving pregnancy is appointed in the maternity hospital, and then the operation is also carried out for a period of 38-39 weeks.
In exceptional cases, the planned operation can be appointed for a period of 36 weeks. This happens when the patient, due to various circumstances, it is impossible to wait for kits.
Operation
Anesthesia used during Cesarean:
- Epidural anesthesia - anesthesiologist is introduced an anesthetic substance into the epidural area of \u200b\u200bthe spine, as a result of which the temporary blockade of nerve endings occurs, and the patient does not feel pain from the operation, but is conscious and can see and hear his newborn baby.
- The spinal anesthesia is similar in action with epidural, the main difference is that an anesthetic is introduced into the spinal spinal area and causes the blockade of the spinal cord.
- General anesthesia - in current medicine, it is used as a certain exceptional measure when the patient has intolerance to local anesthesia. Such anesthesia affects the born baby, it is sluggish, sleepy, in addition, under the influence of general anesthesia, a woman is devoid of opportunity to immediately see his baby, hear his first cry.
During the operation, the fabrics of peritoneum and uterus are cutting horizontally, remove the baby and cut the umbilical cord. Then the baby is washed, removed from the nose and mouth mucus and the residues of the octoped water. In the meantime, remove the last, overlap several seams and completed the operation. The duration of the operation on average is about half an hour. Since there are no need for planned operations with viable babies, it is usually no need to put them in the kuvez.
Then the woman stays in the postoperative ward under observation during the day. It is prescribed to the painkillers and the medicine-cutting uterus, as well as the introduction of bloodstream solutions, which ignite the blood loss that occurred during the operation.
With the normal course of the postoperative period, the patient is transferred to the postpartum separation, where it is already in conjunction with the baby. A few days later, they make painkillers and cutting injections, observed for the state of the seam, processing it daily by antiseptics.
Postoperative period
How much fever will be in the maternity hospital after the operation, solves the attending physician who is observing its condition. As a rule, for the 5-7th day, a woman is discharged home. It is prescribed a special diet to restore normal intestinal functions, two-month sexual rest and refusal to physical exertion for up to six months.
Complications related to the operation:
After the operation, the doctor prescribes several ultrasound studies, the first of which is two months after the operation.
Ultrasound will show how the healing of the seam and the restoration of the operated regions. It is believed that in 2-3 years, the female organism passes after the operation, and the subsequent pregnancy is better planning a minimum of 3 years after Cesarean.
Observing the prescriptions of the doctor, as well as regularly visiting the gynecologist for the seam inspection, the woman minimizes all possible risks and complications associated with the cesarean operation.
Caesarean section can be emergency and planned, that is, conducted in the timely installed time or before that time, and even a woman at all, which has not been planned. What to expect from the operational delivery? How to prepare a woman? What is the difficulty of restoring the body after surgery? And what scheduled caesarean section has causes for conducting?
Usually about a possible operation, if there are any reason to it, a woman will know in advance, a few weeks before the alleged start of the beginning of the generic activity, from a female consultation doctor leading her pregnancy. However, there will be an operation or not, the question is not solved. And the doctor does not discharge the direction to the hospital so that his patient was planned. From a doctor leading pregnancy, only the direction in the maternity hospital is required, namely, in the department of pregnancy pathology. The question of the operation, its need, the timing, anesthesia is accepted directly by the doctors of the maternity hospital.
Usually, the planned caesarean make on the period as close as possible to the estimated date of birth. But without special testimony not on weekends or holidays. This is especially true in the conditions of small maternity houses of small towns, where there are no constantly on duty in the maternity hospital of the anesthesiologists.
Upon admission to the pathology of pregnancy, a woman is carefully examined. Let even in front of hospitalization already handed over urine and blood tests, it defies everything. In addition to general analyzes, it takes blood from Vienna on HIV, RW (syphilis), hepatitis, biochemical analysis, sugar, blood group and a rhesus factor. On a large period, especially with low arterial pressure, in the morning, an empty stomach, when donated blood from Vienna, a woman can become bad. If you have already been not good during blood, ask the medical sister to make her fence in you in the lying position, on the couch. And immediately after eat a piece of chocolate. He will quickly return to you vigor.
Preparations for the planned caesarean also includes bypassing different doctors. Necessarily an oculist, therapist, otolaryngologist. The day before the operation, the ECG is performed. There is a conversation with anesthesiologist. If hospitalization is carried out a few days before the operation, a woman can make droppers with saline. It is necessary to saturate the body with liquid, because with operational intervention, a large blood loss is expected. This liquid will go to its replenishment. In addition, the women make intravenous injections of Piracmetam - a drug that improves brain blood supply.
In the evening, before surgery, a woman is consumed. Cleansing the intestines are carried out again in the morning. Put the catheter in the bladder. Well, further, the work of doctors and honey. sisters. The way the Operation of Planned Cesarean is being passed - how successful, depends on them, and from the individual features of the health of the female in labor and the flow of its pregnancy. Woman make spinal (epidural) anesthesia or endotracheal (general) anesthesia. The incision of the peritoneum is usually performed in the lower stomach segment, transverse, less often vertical. The second heals worse and gives more complications. Therefore, it is performed only when it is carried out, especially with premature pregnancy, or planned, but with the life-threatening life of the guinea or child. It is bad that type of incision of its inesthetics and long healing. This not only reduces the quality of the life of a woman in the first months after the operation, but also negatively affects the occurrence of the next pregnancy. So, complications after the planned caesarean section in the form of an insolvent scar in the uterus, in the case of a horizontal cut, is a rarity. True, not only the type of cut, but also the operation and the postoperative period plays.
Thus, the following are issued pros and Cons Planned Cesarean.
- no generic pain;
- there is no fear for the fact that the child will have a generic injury;
- no crotch breaks, cervix.
- long, healing of seams and problems in the form of hernia and other surgical complications;
- problems with the establishment of breastfeeding (due to the late application of the child to the chest and its rare sucking);
- often developing endometritis (inflammation of the uterus), requiring treatment with antibiotics - common consequences of the cesarean section;
- possible discrepancy between the Oblats during the next pregnancy;
- postoperative pain;
- the need to use contraception, pregnancy planning no earlier than two years after surgery.
Indications for the planned caesarean section and the timing of its implementation
The reasons why doctors can solve to work out a woman, quite a lot. This is only some of them, the most common.
1. Clinically narrow pelvis. This is the case when there is a very strong sense of its narrowing. The doctor clearly understands that the child can not be born independently. But more often a certain narrowing of the pelvis is diagnosed, in which it is still possible to give birth to a small child.
2. High degree of myopia (myopia). The question of the operation is solved after the consultation of the ophthalmologist. It often happens that a woman is still allowed in natural childbirth, but using epidural anesthesia and try to reduce the sweep period as much as possible.
3. The threat of the discrepancy of the scar in the uterus. What time is the planned caesarean section, and how it passes, depends on the viability of the scar on the uterus, that is, its thickness all over. If there is a suspicion of its inconsistency, the operation can be transferred to earlier deadlines, 37-38 weeks.
4. Pelvic presence of the fetus or other, not head. The planned fetus is done if the woman is entering the boy. Fortunately, modern ultrasound devices make it possible to be almost unmistakable determination of the sex of the child. Or if the kid weighs more than 3.5 kg and the woman is primary. Girls can give independently to give birth to women repeatedly, if the weight of the child is less than 4 kg, and in the maternity hospital there is an opportunity to conduct an emergency operation. The transverse position of the fetus is an absolute indication for the operation.
5. Symphyzit. A planned caesarean section in 39 weeks or even earlier in this pathology. Depends on the degree of divergence of bones of the pelvis of a pregnant woman and her well-being. With a pronounced symptite, independent childbirth is contraindicated. The exact diagnosis is made on the basis of ultrasound data.
6. Untezzlement of generic activities, despite the "stimulating" therapy. Sometimes it happens that the fetal has already appeared signs of "overrearness", there is reason to believe in him hypoxia, the accumulate waters are not enough, but the childhood does not begin. Then, especially if a woman over 28 years old and gives birth to the first time, doctors can recommend a future mother to be resolved from the burden of operational way. What week do the planned caesarean cross section in this case? Usually adverse signs of transferred pregnancy appear in 41-42 weeks. That is, the deadlines for the operation are individual.
7. Some cardiovascular diseases, heart defects. If a woman is generally a good pregnancy, in the hospital she can be offered to hospitalize directly at the beginning of a generic activity, or when as a result of the inspection of the cervix, it becomes clear that independent childbirth is about to begin. What time is the scheduled - you ask? At the most closely close to the beginning of natural labor. After all, otherwise, it remains a high probability of difficulty with adaptation to the external environment in the fetus. Sometimes even the dead children who appeared on the light of cesarean sections, but prematurely, there are problems with independent breathing. That is, often scheduled second caesarean makes about 40 weeks for a period of about 40 weeks, when fermented waters depart, or a woman begins to feel grapple-shaped pain.
Less often, the reasons for the operation becomes varicose expansion in the vagina region, expressed by hemorrhoids (there is a chance of thrombosis of nodes).
Surgical delivery (cesarean section) are carried out according to the testimony when there is a threat to health and / or mother's life or baby. However, today many of the women in labor due to fear are thinking about auxiliary version of the delivery even in the absence of health problems. Is it possible to Cesarean at will? Is it worth insist on surgical childbirth if there is no indication? Future mom needs to learn as much as possible about this operation.
Newborn baby, which appeared on light by surgical intervention
The COP is a surgical method of a delivery, which assumes the extraction of the baby from the uterus through a cut in the abdominal wall. The operation requires a certain preparation. The last meal is admitted 18 hours before the operation. Before the COP make the enema, conduct hygienic procedures. A catheter is introduced into the bladder patient, and the stomach is necessarily treated with a special disinfectant.
The operation is carried out under epidural anesthesia or under general anesthesia. If the COP is done according to plan, then doctors are leaning towards epiduril. Such a kind of anesthesia suggests that the patient will see everything that happens around, but will lose tactile and pain below the lower back. Anesthesia is done by puncture of the lower part of the back, where the nerve roots are located. Common anesthesia in surgical sorts are used as if time to wait for the actions of regional anesthesia.
The operation itself consists of the following steps:
- The cut of the abdominal wall. It can be longitudinal and transverse. The first is intended for emergency cases, because it gives the opportunity to get a kid as quickly as possible.
- Sliding muscles.
- Incision of the uterus.
- Opening of the fruit bubble.
- Removing the baby, and after the placenta.
- Sushing of the uterus and abdominal cavity. For the uterus, self-sessive threads are used.
- Outing a sterile dressing. Ice lay on top of it. This is necessary to increase the intensity of uterine contractions and reduce blood loss.
In the absence of any complications, the operation lasts for a short time - a maximum of forty minutes. The baby gets from the mother's lamp in the first ten minutes.
It is the opinion that Cesarean is a simple operation. If you do not delve into the nuances, it seems that everything is extremely easy. Based on this, many women in labor dream of a surgical method of roossession, especially considering which efforts require natural childbirth. But it should always be remembered that the medal can not be one side.
When the CS is obligatory
The attending gynecologist will decide whether the female in the operation needs
In most cases, the COP is planning. The doctor determines whether there are threats to mother and crumbs if the childbirth will be naturally held. Then the obstever discusses the options for the delivery of the delivery. The planned COP is carried out in a pre-designated day. A few days before the operation, the future mother should go to the hospital for the control examination. While the pregnant planning is in the hospital, the doctor monitors its condition. This allows you to predict the likelihood of a prosperous outcome of the operation. Also, the examination before the COP is aimed at determining the consecration of pregnancy: with the help of various diagnostic methods, it is revealed that the baby is ready for birth and you can not wait for the bumps.
The operation has a number of indications. Some factors leave a place for discussion about the method of roostening, others are absolute indications, that is, those in which the EP is impossible. Absolute indications include the states threatening the lives of the mother and the baby in the natural delivery. CS necessarily do at:
- absolutely narrow pelvis;
- the presence of obstacles in the birth paths (moma of the uterus);
- failure of the uterine scar from past CS;
- thinning the wall of the uterus, which threatens it with a gap;
- prelation of the placenta;
- foot prediction of the fetus.
There are relative readings for the COP. These factors are also possible and natural, and surgical labor. The option of the delivery is selected taking into account the circumstances, the health and age of the mother, the state of the fetus. The most common relative indication to the COP is a pelvic preview. With incorrect position, the type of prelation is taken into account, the gender floor. For example, with a butt-foot-foot position, the EP is permissible, but if the boy is waiting, the doctor insists on Cesarean to avoid damage to the scrotum. With relative readings to Cesarean, the correct solution relating to the method of the appearance of a baby to the light can only tell the obstetrician gynecologist. The task of the parents is to listen to his arguments, because they will not be able to evaluate their own risks.
Cesarean can be carried out in an emergency. This happens if the childbirth began naturally, but something went wrong. Emergency COP is carried out if bleeding began in the process of natural output, a premature placental detachment occurred, the fetus has acute hypoxia. The operation is made in an emergency, if the generic activity is difficult due to a weak cutting of the uterus, which cannot be adjusted by drugs.
Elective CS: Is it possible
Happy mom with long-awaited daughter
Is it possible to make a COP at the request of the girlfriend - the question is controversial. Some believe that the decision on the way of the family should remain for the woman, others are confident that only the doctor can choose the optimal method. At the same time, the popularity of elective caesarean is growing. Especially this trend is noticeable in the West, where future mothers actively choose the way of birth of their own baby.
Genuineers prefer surgical childbirth, guided by fear of fasting. In paid clinics, doctors listens to the wishes of future mothers and leave the right to choose. Naturally, if there are no factors in which the COP is undesirable. The operation does not have absolute contraindications, but there are conditions that increase the risks of the occurrence of infectious and septic complications after surgical labor. These include:
- infectious diseases of the mother;
- diseases disturbing blood microcirculation;
- immunodeficiency states.
In the CIS countries, the attitude to the elective COP differs from West. Without testimony, make Cesarean problematic, because the doctor is legal responsibility for every surgical intervention. Some girlfriends, considering the surgical childbirth with a painless way to make a baby on the light, even invent diseases that could serve as relative testimony for the COP. But is it worth the game of the candle? Do I need to defend the right to choose the method of birth of a child? To understand this, the future mother should understand the intricacies of the operation, compare "for" and "against", to study the risks that exist with any surgical intervention.
Benefits of the COP at will
Why many future mothers want to make Cesarean? "Order" the operation of many pushes fear of natural childbirth. The birth of a kid is accompanied by strong painful sensations, the process requires a lot of effort from a woman. Some future mothers fear that they would not cope with their mission and begin to persuade the doctor to cry for them, even if there were no testimony for surgical labor. Another common fear is associated with the fact that the passage of the baby through the generic paths is difficult to control, and the threat to his health or even life may arise.
Fear of EP - normal phenomenon. But not all future mothers can handle it with him. For patients who see in the natural delivery of the mass of threats, the advantages of the "customized" COP are obvious:
An additional bonus is the opportunity to choose the birth date of the baby. However, only this should not push the feminine to insist on the COP, because, in fact, the date does not mean anything, the main thing is the health of the kid.
Reverse side of the "customized" CS
Many future mothers see the caesarean section with a wisdom of a woman anything bad. The operation is represented by him as a simple procedure, where the female inherine falls asleep, and wakes up with the baby in his arms. But those women that pass through surgical labor is unlikely to agree with this. Easy path has a reverse side.
It is believed that the COP, in contrast to the EP, passes painlessly, but it is not true. In any case, this is an operation. Even if anesthesia or anesthesia "turn off" pain during surgical delivery, it returns after. The separation from the operation is accompanied by painful sensations in the seam. Sometimes the postoperative period becomes completely unbearable due to pain. Some women suffer from pain for the first couple of months after surgery. Difficulties arise in the "maintenance" of themselves and the child: the patient is hard to get up, take the crumb into the hands, feed it.
Possible complications from the mother
Why are Cesarean in many countries make solely by testimony? This is due to the possibility of complications after surgery. Complications relating to the female organism are divided into three types. The first type includes complications that may appear after the operation on the internal organs:
- Big blood loss. At COP, the body always loses more blood than with EP, because when the tissues are cut - blood vessels are damaged. Never predict how the body will react to it. In addition, bleeding is open in pathology of pregnancy, violation of the operation of the operation.
- Spikes. Such a phenomenon is observed in any surgical intervention, this is a kind of protective mechanism. Usually, the spikes do not show themselves, but if there are many of them, a failure in the work of internal organs may occur.
- Endometritis. The uterine cavity in the process of operation "Contact" with air. If disaster microorganisms fall into the uterus during surgical delivery, then one of the forms of endometritis occurs.
After the COP, complications on the seams often appear. If they manifest immediately after surgery, they will notice the doctor who made the COP when inspection. However, not always suture complications make themselves know right away: sometimes they are manifested only after a couple of years. Early suture complications include:
Late complications after Cesarean include ligature fistulas, hernias, keloid scars. The complexity of determining such states is that women after some time cease to inspect their seams and can tritely skip the formation of a pathological phenomenon.
- failures in the work of the heart and blood vessels;
- aspiration;
- injuries throat from the introduction of the tube through the trachea;
- sharp decrease in blood pressure;
- neuralgic complications (severe head / spinal pain);
- the spinal block (with the use of epidural anesthesia, strong spinal pain arise, and even the respiratory stop may occur with incorrect puncture);
- poisoning toxins from anesthesia.
In many ways, the emergence of complications depends on the qualifications of the medical team that will do the operation. However, no one is insured against errors and unforeseen situations, so the woman inheritant, insisting on Cesarevo without indications, should know possible threats for its own body.
What may be complications in a child
Caesharita are no different from the babies born naturally
Caesarean section at will (in the absence of testimony) doctors are not taken to carry out due to the likelihood of complications in the baby. The COP is a spent operation to which it is often resorted, but no one has canceled its complexity. Surgical intervention can affect not only the female organism, but also influence the health of the baby. Casarean complications relating to the child may be varying degrees.
With a natural way of birth, the baby passes the generic path, which is stressful for him, but such stress is necessary for the crumb to adapt to the conditions of a new life - out oftobic. With no adaptation, there is no adaptation, especially if the extraction takes place according to the plan before the battle. Violation of the natural process leads to the fact that the kid appears unprepared. It is a huge stress for the rapid organism. COP can provoke the following complications:
- oppressed activity from drugs (increased drowsiness);
- disturbance and heartbeat;
- low muscular tone;
- slow healing navel.
According to statistics, "Caesaryat" often refuse breasts, plus moms may have problems with the amount of milk. You have to refer to artificial feeding, which imposes your imprint on the immunity of crumbs and addictive to the new environment. Children born by cesarean sections are more likely to suffer from manifestation of allergic reactions, intestinal diseases. "Caesaryat" can be lagging behind the development of peers, which is due to their passivity in generic activities. This is manifested almost immediately: they are harder to breathe, suck, scream.
Weigh everything
The COP really actually deserved the title of "Light Rhodework". But at the same time, many forget that surgical labor may have consequences for the health of both "process participants." Of course, the majority of complications at the kid can be easily "removed", if you pay maximum attention to this issue. For example, massage is able to adjust the muscular tone, and if the mother comes to breastfeeding, the immunity of the crumbs will be strong. But why complicate my life if there is no reason for this, and the future mom just lead fears?
Cesarean is not worth doing. Naturally, a woman should have the right to choose, but no wonder this operation is carried out according to the testimony. Only a doctor can determine when it is advisable to contact Kesarean, and when it is possible a natural delivery.
Nature thought out everything itself: the process of childbirth is most prepared by the baby to the extra-utilized life, and at least a large load on the body, but the recovery occurs much faster than after surgery.
When there is a threat to the fetus or mother and the doctor insists on caesarev, the operation is categorically prohibited. The doctor always determines the risks given the fact that it is safer for the life of the fever and the baby. There are situations where Cesarean is the only way to roosity. If the method is subject to discussion, always recommend to grab the possibility of natural labor. The momentary desire to "attach" to avoid pain, you need to suppress. For this, it is enough to talk to the doctor about the possible risks and the likelihood of complications after the operation.
To predict how the COP will be held in each case, one hundred percent is impossible. There is always the likelihood that something will go wrong. Therefore, doctors agitate for the natural childbirth always, when it is possible.
If the future mother itself cannot overcome its own fears associated with the upcoming moment of the appearance of the baby, it can always appeal to a psychologist. Pregnancy is not time for fears. It is necessary to release all bad thoughts, not to go about the momentary desires, and to clearly comply with the recommendations of the gynecologist - starting from the correction of the regime, ending with the method of roostening.
When the childhood fails through the natural generic paths, you have to resort to the operation. In this regard, the future mothers are worried about many questions. What are the testimony for cesarean sections and when the operation is carried out on emergency testimony? What should the guinea take after the operational delivery and how is the recovery period? And most importantly - will there be a healthy kid born by surgery?
Caesarean section is a surgical operation at which the fruit and the last is removed through the incision of the abdominal wall and the uterus. Currently, from 12 to 27% of all types are carried out with the help of cesarean section.
Indications for Cesarean section
The decision to conduct an operational delivery of the doctor may be adopted at different times of pregnancy, which depends on the state of both mother and the fetus. At the same time, absolute and relative indications of cesarean sections are distinguished.
TO absolute Indications include states in which childbirth through natural generic pathways are impossible or related to a very large risk to mother or fetus health.
Narrow pelvis That is, such an anatomical structure, in which the child cannot go through a pelvic ring. The sizes of the pelvis are determined by the first examination of the pregnant woman, the size of the essential is judged. In most cases, it is possible to determine the inconsistency of the sizes of the pelvic of the mother's pelvis and the presets of the child before the start of childbirth, but in some cases the diagnosis is already placed directly in childbirth. There are clear criteria for the normal sizes of the pelvis and a narrow pelvis according to the degree of narrowing, however, before joining the childbirth, only the diagnosis of the anatomical stiffness of the pelvis is put, which allows us to assume clinically narrow pelvis with some more likely to assume a clinically narrow pelvis - the inconsistency of the sizes of the pelvis and the presets of the child. If during pregnancy, it is found that the pelvis is an anatomically very narrow (III-IV degree of narrowing), a planned operation of the cesarean section is carried out, with the II degree, the decision is made most often immediately during childbirth, in the I degree of narrowing, childbirth is most often carried out through natural generics. Also, the cause of the development of the clinically narrow pelvis can be incorrect insertion of the fetus head, when the head is in a dispere state and passes through the bone poles with its largest sizes. It happens in front of the frontal, facial preview, while in the norm the head passes through the bone tase of the bent - the chin of the baby pressed to the breast.
Mechanical obstacles that prevent childbirth through natural generic paths. The mechanical obstacle may be the mioma of the uterus, located in the region of the cumshot (the site where the uterine body goes into the cervix), the tumors of the ovaries, tumors and deformation of the bones of the pelvis.
The threat of rupture of the uterus. This complication occurs most often when, if the first was performed using cesarean sections, or after other operations in the uterus, after which the scar was left. With the normal healing of the wall of the uterus, the muscle tissue rupture the uterus does not threaten. But it happens that the scar in the uterus turns out to be insolvent, that is, it has a threat to break. The failure of the scar is determined by the data of the ultrasound and the "behavior" of the scar during pregnancy and childbirth. Caesarean cross-section is done and after two or more preceding cesarean operations, because this situation also increases the risk of the uterus in the fence in childbirth. Numerous genera in the past, leading to thinning the walls of the uterus, can also create a threat to breaking the uterus.
. It is so called its improper location, in which the placenta is mounted in the lower third of the uterus, above the cervix, thereby overlapping the outlet. It threatens with strong bleeding, dangerous both for the life of the mother and for the child, since in the process of opening the cervix, the placenta is peeling from the wall of the uterus. Since the preposition of the placenta can be diagnosed on the ultrasound before the start of the generic activity, the caesarean section is planned, most often on the period of 33 weeks of pregnancy or earlier, if there are blood discharges, talking about the placenta detachment.
Premature. So the state is called when the placenta is separated from the wall of the uterus not after, but before childbirth or during them. The placenta detachment is dangerous for life as a mother (due to the development of massive bleeding) and the fetus (due to the development of acute hypoxia). At the same time, the Caesarean cross section is always performed on emergency testimony.
Prelation and loss of cord loops. There are such cases when the cord loops are preferred before the head or the pelvic end of the fetus, that is, they will be born first, or the loops of the umbilical cord falls even before the birth of the head. This may occur with multi-way. This leads to the fact that the pupil loops pressed against the walls of the pelvic of the fetus head and the blood circulation is stopped between the placenta and the fruit.
TO relative Indications include situations in which childbirth is possible through natural generic paths, but the risk of complications during the birth is large enough. Among such testimony:
Chronic mothers diseases. These include cardiovascular diseases, kidney disease, eyes, diseases of the nervous system, diabetes, oncological diseases. In addition, the testimony for Cesarean section are exacerbations of the mother of chronic genital diseases (for example, genital herpes), when a child can pass the disease.
Pregnancy, coming after the treatment of infertility If there are other complications from the mother and the fetus.
Some pregnancy complications Which can create a threat to the life of a child or mother itself during childbirth naturally. First of all, it is a prostose, in which the disorder of the function of vital organs, especially the vascular system and blood flow occurs.
Stubborn weakness of labor activities When the bodies began normally for any reason, they subside or for a long time they go without noticeable progress, and the medical intervention does not bring success.
Pelvic indiscrimination of the fetus. Most often, caesarean section is performed if combined with any other pathology. The same can be said about the major fruit.
Kesarean cross section
With a planned operation of the cesarean section, a pregnant woman enters the maternity hospital a few days before the expected date of operation. In the hospital there is an additional examination and drug correction of revealed abnormalities in health. The state of the fetus is also rated; Cardiotocography is carried out (registration of fetal heartbeats), ultrasound examination. The estimated date of operation is determined on the basis of the state of the mother and the fetus, and, of course, the period of pregnancy is taken into account. As a rule, the planned operation is carried out on the 38-40th weeks of pregnancy.
1-2 days before the operation, pregnant necessarily advises the therapist and anesthesiologist, which discusses the pain relief plan with the patient and reveals possible contraindications to various types of anesthesia. The attending physician on the eve of childbirth explains the approximate plan of the operation and possible complications, after which the pregnant sign consent to the operation.
For the night before surgery, a woman is cleaned by purification and, as a rule, assign sleeping pills. In the morning, the intestine is cleaned before the operation and then put the urinary catheter. On the day before, the operation of a pregnant woman cannot be dinner, on the day of operation it is impossible to drink or eat food.
Currently, when conducting a cesarean operation, regional (epidural or spinal) anesthesia is most often carried out. The patient at the same time is in consciousness and can hear and see his child immediately after birth, attach it to his chest.
In some situations, general anesthesia is used.
The duration of the operation, depending on the technique and complexity, on average is 20-40 minutes. At the end of the operation on the lower abdomen, a bubble with ice is a 1.5-2 hours bubble, which helps reduce the uterus and reduce blood loss.
Normal blood loss in spontaneous genus is approximately 200-250 ml, such a blood volume is easily restored to a woman prepared for this organism. With a cesarean section, the blood loss is somewhat more physiological: its average amounts from 500 to 1000 ml, so during surgery and in the postoperative period, intravenous administration of bloodstream solutions is carried out: blood plasma, erythrocyte mass, and sometimes whole blood - it depends on the number of lost The time of blood surgery and on the original state of the feminine.
Emergency Cesarean
Emergency operation of the cesarean section is performed in situations where childbirth can not be quickly held through natural generics without prejudice to the health of mom and child.
Emergency operation implies the necessary minimum training. For anesthesia during an emergency operation more often than when planned operations, general anesthesia use, since with epidural anesthesia, an anesthetic effect occurs only after 15-30 minutes. Recently, a spinal anesthesia has been widely used with an emergency caesarean section, at the same way as the epidural, the back in the lumbar region is made, but anesthetic is introduced directly into the spinal cord channel, while in the epidural anesthesia - in Space over a solid cerebral shell. Spinal anesthesia begins to act during the first 5 minutes, which provides the ability to quickly start the operation.
If the planned operation is more likely made cross-section at the bottom of the abdomen, then during an emergency operation is possible a longitudinal cut from the navel to the pubic. Such a cut provides greater access to the abdominal and small pelvis organs, which is important in a difficult situation.
Postoperative period
After the operational delivery of the parental during the first day is in a special postpartum chamber (or the ward of intensive therapy). It is carried out by constant observation of the nurse of the department of intensive therapy and an anesthesiologist, as well as an obstetrician gynecologist. Throughout this time, the necessary treatment is made.
In the postoperative period, neglection drugs are prescribed, the frequency of their administration depends on the intensity of pain. All drugs are administered only intravenously or intramuscularly. Usually, the anesthesia is required in the first 2-3 days, in the future it is gradually refused.
In obligatory order to reduce the uterus, drugs are prescribed for better cutting of the uterus (oxytocin) for 3-5 days. 6-8 hours after surgery (of course, taking into account the patient's condition), a young mother is allowed to get out of bed under the supervision of a doctor and nurses. The translation into the postpartum separation is possible 12-24 hours after surgery. The child at this time is in the children's office. In the postpartum department, the woman herself will be able to start to care for the child, feed it with breasts. But in the first few days she will need help from medical personnel and relatives (if visits are allowed in the maternity hospital).
Within 6-7 days after the cesarean section (before the seams), the procedural nurse processes the postoperative seam by antiseptic solutions and changes the bandage.
In the first day after the cesarean section, only drinking water with lemon juice is allowed. On the second day, the diet is expanding: you can eat cereal, low-fat broth, boiled meat, sweet tea. You can completely return to a normal diet after the first independent chair (for the 3-5th day), products that are not recommended during breastfeeding are excluded from the diet. Usually, a cleansing enema is assigned to normalize the intestinal function to normalize the intestinal function.
When you can be written home, solves the attending physician. Usually on the 5th day after the operation, an ultrasound examination of the uterus is made, and on the 6th day, brackets or seams are removed. With a successful course of the postoperative period, the extract is possible on the 6-7th day after the cesarean section.
Alexander Vorobyev, doctor obstetrician-gynecologist, Cand. honey. science
MMA them. Sechenova, Moscow
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