What are the medical indications for a caesarean? Techniques for caesarean section

The date: 24.04.2019

For many women, surgery with an incision becomes an inevitable test, giving birth through natural birth canal for which it is impossible or dangerous for her and her baby. Like any other surgical operation, caesarean section is performed only after medical indications.

Indications for surgery may be on the part of the mother, when childbirth poses a threat to her health, and on the part of the fetus, when the process of childbirth is a burden for him, which can lead to birth trauma and fetal hypoxia. They can occur both during pregnancy and childbirth.

First, let us dwell on certain points, the presence of which presupposes such an operation in pregnant women.

Indications for caesarean section during pregnancy:

Placenta previa. When the placenta children's place) is located in the lower part of the uterus and covers the internal os (the entrance to the uterus from the side of the vagina). This threatens with severe bleeding, dangerous both for the life of the mother and for the fetus. The operation is performed at 38 weeks of pregnancy or earlier if bleeding occurs.
Premature detachment of a normally located placenta. Normally, the placenta separates from the uterine wall after the baby is born. Sometimes this happens during pregnancy, then severe bleeding begins, which threatens the life of the mother and fetus and requires immediate surgery.
Failure of the scar on the uterus after an incision in a previous birth or other operations on the uterus.
A scar on the uterus is considered insolvent if, according to ultrasound, its thickness is less than 3 mm, the contours are uneven and there are inclusions of connective tissue. If the postoperative period after the first operation was difficult (fever, inflammation of the uterus, prolonged healing of the suture on the skin), this also indicates the insolvency of the scar on the uterus.
Two or more scars on the uterus after an incision operation. Two or more caesarean deliveries are thought to increase the risk of uterine rupture along the scar in childbirth due to the weakness of the scar tissue. Therefore, the incision is made before the onset of labor.
Anatomically narrow pelvis (the so-called anatomical limitation of the size of the pelvic ring of a woman, which makes it difficult for the fetal head to pass through this ring) II-IV degree of narrowing. Every woman has her pelvis measured during pregnancy. Obstetricians have clear criteria normal sizes pelvis and narrow pelvis according to the degree of narrowing. Tumors and deformities of the pelvic bones. They can serve as an obstacle to the birth of a child.
Malformations of the uterus and vagina. Tumors of the uterus, ovaries and other organs of the pelvic cavity, closing the birth canal.
Large fetus in combination with another pathology. A large fetus is considered when its mass is 4 kg or more.
Expressed symphysitis. Symphysitis or symphysiopathy - divergence of the pubic bones. In this case, there are pronounced difficulties and pain when walking.
Multiple myoma uterus large sizes, malnutrition of myomatous nodes.
severe forms preeclampsia and lack of effect from treatment. Preeclampsia is a complication of pregnancy, in which there is a disorder in the function of vital organs, especially vascular system and blood flow. Severe manifestations of preeclampsia - pre-eclampsia and eclampsia. At the same time, microcirculation in the central nervous system is disturbed, which can lead to severe complications both for mother and fetus.
Severe illnesses. Diseases of the cardiovascular system with symptoms of decompensation, diseases nervous system, diabetes, high myopia with changes in the fundus, etc.
Severe cicatricial narrowing of the cervix and vagina. May occur after previous operations or childbirth. This creates insurmountable obstacles to the opening of the cervix and stretching of the walls of the vagina, necessary for the passage of the fetus.
Condition after plastic surgery on the cervix and vagina, after suturing urogenital and enterogenital fistulas. A fistula is an unnatural communication between two adjacent hollow organs.
perineal tear III degree in previous births. If during childbirth, in addition to the skin and muscles of the perineum, the sphincter is torn (the muscle that locks anus) and / or rectal mucosa, then this is a third-degree perineal rupture, a poorly sutured rupture can lead to gas and fecal incontinence.
Severe varicose veins in the vagina. In spontaneous childbirth, bleeding from such veins can become life-threatening.
Transverse position of the fetus.
Conjoined twin.
Breech presentation of the fetus (especially a boy) in combination with a fetal weight of more than 3600 g and less than 1500 g, as well as with narrowing of the pelvis. Breech presentation increases the risk of birth injury at birth of the fetal head.
In vitro fertilization, artificial insemination in the presence of other complications from the mother and fetus.
Chronic fetal hypoxia, fetal hypotrophy, resistant to drug therapy. In this case, the fetus receives an insufficient amount of oxygen and for him the process of childbirth is a load that can lead to birth trauma.
The age of primiparous older than 30 years in combination with another pathology.
Prolonged infertility in combination with other pathology.
Hemolytic disease of the fetus with the unpreparedness of the birth canal. With Rh (less often - group) incompatibility of the blood of the mother and fetus develops hemolytic disease fetus - destruction of red blood cells(erythrocytes). The fetus begins to suffer from a lack of oxygen and harmful influence breakdown products of erythrocytes.
Diabetes mellitus with the need for early delivery and unprepared birth canal.
Post-term pregnancy with unprepared birth canal and in combination with other pathologies. The process of childbirth is also a stress that can lead to birth trauma to the fetus.
Cancer of any localization.
Exacerbation of genital herpes. With genital herpes, the indication is the presence of vesicular herpetic eruptions on the external genitalia. If by the time of childbirth it is not possible to cure a woman of this disease, there is a risk of infection of the fetus (if membranes or the passage of the fetus through the birth canal).

In any case, doctors first try to solve the problem with conservative (i.e., non-surgical) methods. And they resort to surgical intervention only when their attempts did not lead to the proper result.

In addition to the above cases, there are also acute situations that require surgical delivery.

Indications for caesarean section in childbirth:

Clinically narrow pelvis. This is a discrepancy between the fetal head and the mother's pelvis.
Premature effusion amniotic fluid and the absence of the effect of labor induction. When the waters are poured out before the start of contractions, they are tried to be induced with the help of medications (prostaglandins, oxytocin), but this does not always lead to success.
Anomalies of labor activity that are not amenable to drug therapy. With the development of weakness or discoordination and labor activity, drug therapy, which also does not always lead to success.
Acute fetal hypoxia. When the heartbeat suddenly becomes rare and does not recover.
Detachment of a normally or low-lying placenta. Normally, the placenta separates from the uterine wall after the baby is born. Sometimes this happens during contractions, then severe bleeding begins, which threatens the life of the mother and fetus and requires immediate surgery.
Threatening or incipient uterine rupture. It must be recognized by a doctor in a timely manner, since a late operation can lead to fetal death and removal of the uterus.
Presentation or prolapse of the umbilical cord. If an incision is not made during the prolapse of the umbilical cord and head presentation of the fetus within the next few minutes, the child may die.
Incorrect insertion of the fetal head. When the head is in an unbent state (frontal, facial presentation), as well as a high straight standing of the head.

Sometimes a caesarean section is performed for combined indications, which are a combination of several complications of pregnancy and childbirth, each of which individually does not serve as an indication for surgery, but together they pose a real threat to the life of the fetus. And always a caesarean section is an extreme measure, when all attempts to help a woman give birth on her own are futile.

In this article:

Caesarean section refers to a number of surgical medical interventions in the human body. This operation is designed to resolve childbirth and extract the fetus through an incision in the abdominal wall of the woman and the subsequent dissection of the uterine wall. Indications for cesarean section are a number of pathologies and diseases of a pregnant woman. They lead to the impossibility of childbirth. naturally due to various complications that are dangerous to the life and health of the mother and unborn child.

The need for this type of intervention can be established during pregnancy (then it can be planned or emergency), as well as already during childbirth. In this article, we will consider the indications for planned and emergency CS surgery, as well as its indications during childbirth. But perhaps many readers will first be interested in learning a little about the history, which is rooted in the distant past.

The history of childbirth caesarean section is associated with the name of the great ancient Roman figure - the commander Gaius Julius Caesar. According to legend, he was brought to light from the mother's womb through an incision in her abdomen. For the first time, a real KS operation was documented, performed by the famous doctor J. Trautman from Wittenberg, in 1610. As for Russia, in our country the first such childbirth was performed by V. M. Richter in 1842 in the city of Moscow.

Planned operation

A planned caesarean section is called, the indications for which were established by the attending physician during the course of pregnancy. A woman enters the pathology department in advance of the day of the operation and undergoes necessary examination and preparation. During this period, experts should evaluate physiological state women, identify all possible violations and risks, as well as assess the condition of the fetus. The anesthesiologist will talk to the woman in labor and talk about the types of anesthesia that are acceptable, their benefits, and possible consequences will help you choose the most suitable option. He needs to be informed about the presence or absence of allergies or hypersensitivity to some components of the drugs.

For a planned caesarean section, the indications may be as follows:

. This violation lies in the fact that the placenta (the location of the child) moves to the lower part of the uterus and blocks the entrance to it. With such a diagnosis, there is a risk of severe bleeding, which is dangerous for both the mother and the unborn child. Therefore, the intervention is carried out at the 39th week of pregnancy, but it is possible even earlier if the appearance of discharge with blood is noticed.
The scar on the uterus, according to the results of ultrasound, was recognized as insolvent, that is, its thickness is less than 3 mm, its contours are uneven. This pathology may be the result of a previous CS or other surgical interventions on the uterus. This diagnosis is evidenced by various complications after surgery - fever body in recovery period, long-term healing outer seam, inflammatory processes in the pelvic organs.
Several CS in history. If a woman has previously had two or more such interventions, she is usually not allowed to give birth, as this threatens to rupture the uterus along the scar. The operation is scheduled, you should not wait for the start of a natural resolution.
Myoma of the uterus. When it is multiple and is characterized by the location of the node in the cervix or the presence of large nodules, the nutrition of which is impaired, cesarean delivery is indicated.
Pathologies of the pelvic organs, including tumors of the uterus or its appendages, II and higher degree of narrowing of the pelvis, and others.
Pathologies hip joints Key words: ankylosis, congenital dislocation, surgeries.
The size of the fetus at the first birth is more than 4 and a half kilograms.
The cervix and vagina have pronounced cicatricial narrowing.
Expressed symphysitis. This disease is characterized by a divergence to the sides of the pubic bones. Clinical manifestations- Difficulty walking, accompanied by pain.
Conjoined twins.
The number of fruits is more than two.
Malposition of the fetus in late dates in primiparous (gluteal-leg).
The fruit is located transversely.
Cancers of the uterus and its appendages.
Genital herpes in the acute stage, which occurred 1-14 days before the end of the pregnancy. CS is indicated when there is a blister-like eruption on the surface of the vulva.
Severe diseases of the kidneys, nervous, cardiovascular systems, lung diseases, as well as a sharp deterioration in the general health of a pregnant woman.
Chronic hypoxia of the fetus, its malnutrition (growth retardation), which is not amenable to drug therapy. In this case, the fetus does not receive the amount of oxygen it needs, and natural childbirth can result in severe injury.
The age of a woman at the first birth is over thirty years old, combined with any other pathology.
Malformations of the fetus.
In vitro fertilization (especially if it happened more than once) in combination with other complications.
Also, a serious visual impairment is an indication for a caesarean section. It is valid for myopia (diagnosis of myopia), which occurs in a woman in labor in a complex form, where there is a threat of retinal detachment.

Emergency caesarean section during pregnancy

Indications for urgent surgical intervention may be unforeseen situations or severe complications during pregnancy, when the life and health of the mother and fetus are at risk. Among them:

Placental abruption. If the placenta is located normally, then its separation from the uterine wall should occur at the end of childbirth. But there are cases when the placenta exfoliates during pregnancy and is accompanied by severe bleeding that threatens the life of the fetus and mother.
Symptoms of uterine rupture along the scar. When there is a threat of rupture, it is important to perform an urgent operation on time, since fetal loss and removal of the uterus are possible.
Acute fetal hypoxia, when the child's heart rate decreases sharply and cannot be restored.
The transition of preeclampsia into a severe form, the occurrence of preeclampsia and eclampsia.
Placenta previa, sudden bleeding.

caesarean section during childbirth

If during childbirth pathologies and disorders are found that are indications of a caesarean section during pregnancy, as well as complications suddenly arise, it is necessary to perform an operation. Complications that may occur during childbirth:

Rupture of the uterus along the scar.
Violation of correspondence between the pelvis of the woman in labor, which turned out to be clinically narrow, and the head of the child.
In the contractions of the uterus, there were violations, which cannot be corrected or impossible.
Presentation of the fetus legs forward.
Prolapse of the loops of the umbilical cord.
The outflow of amniotic fluid ahead of time, labor induction does not give any effect.

Possible consequences of a caesarean section

Before, during, and after a caesarean section, many women feel much better than if they had to have a natural delivery. This is explained by the fact that they do not have to worry about labor pains in advance. The second reason is that during the artificial resolution, the woman does not experience pain and torment. And due to the fact that there are no stretch marks and ruptures of the perineum, after discharge from the hospital female body recovers much faster. Of course, if there are no undesirable complications.

However, do not flatter yourself, because none of the people is immune from complications and unforeseen situations. Despite the fact that this operation, combined with modern methods and medical equipment, is reliable, proven and quite safe, complications are possible.

Surgical complications. During the operation, accidental entry into the vascular branch during the incision of the uterus is possible, as a result of which bleeding may occur. It is also possible that grazing Bladder or intestines, and in rare cases, the fetus itself is injured.
Complications on the background of anesthesiology. After surgery, there is a risk uterine bleeding. It can occur for the reason that the contraction of the uterus is disturbed due to surgical trauma. It can also be caused by the action of medications. A change in the physicochemical composition of the blood, which necessarily occurs under the influence of anesthesia, can lead to thrombosis and blockage of blood vessels.
Purulent complications and infection. After the birth of a caesarean section, the sutures may fester, and their divergence is still possible.

You should also beware of endometritis (due to inflammation of the uterus), adnexitis (when the appendages are inflamed), parametritis (the periuterine tissue becomes inflamed). To prevent these diseases, antibiotic treatment is necessary during and after surgery.

As for the child, after medical intervention, he may have problems with the respiratory organs and their pathologies. In order to partly prevent this threat, the date of the planned operation is scheduled as close as possible to the date that is the end of the pregnancy. Also, CS can be a consequence of the difficulties of breastfeeding.

The formation of lactation occurs late, since there has been a significant loss of blood, the mother needs to move away after surgical stress, the child's adaptation to a new way of existence is impaired. In addition, a woman needs to find a comfortable position for feeding, since the standard position - sitting with the baby in her arms - causes pain and discomfort, as the child presses on the seam.

After CS there may be disturbances in the work of the baby's heart, there is reduced level glucose and thyroid hormones. Excessive lethargy and drowsiness of the child are noticeable, muscle tone is lowered, the wound on the navel heals more slowly, and the immune system copes with its activities worse than in children born naturally. But the use of the achievements of modern medicine leads to the restoration and normalization of the physiological parameters of the baby by the day of discharge.

The question that arises quite rightly among women, which is better - childbirth or caesarean - cannot be given an unambiguous answer. Of course, it is always better what is laid down by nature itself, what is called natural and does not require additional intervention. Therefore, the caesarean section is not performed at the request of the woman, but only if there are necessary indications.

The doctor's story about when to do a caesarean

To date, the birth of a child with the help of surgical intervention is an actual way solving cases where the life of mother and child is at stake. Like any other surgical intervention, it has postoperative complications, however, quite infrequently. Children born by the method of dissection of the anterior wall of the abdomen quite abruptly enter the new environment and childbirth with the use of anesthesia also affects general condition child. Adaptive skills deteriorate, and over time, neurological and respiratory pathologies. So natural method much safer and better. But there are a number of situations where it is more important to save the life of the child and his mother.

The need for such an operation is needed by mothers who, according to physiological reasons cannot give birth naturally.

Historians suggest that this operation was carried out even in ancient times. The people made up legends about how the father of Julius Caesar saved the baby's life by cutting the belly of the woman in labor, as she died during childbirth. During the reign of Caesar, a law was introduced, upon the death of a woman in labor, it is imperative to try to save the child by dissecting the abdomen. This procedure became known as caesarean operation, and only then a caesarean section, which comes from the word flog. This terminology was introduced in 1598.

Basically, all indications for caesarean section are based on the inability to give birth in the usual way. In England future mom she herself can decide how she will give birth, but so far, we do not have such a practice, and for indications for such an action, examinations should be carried out, on the basis of which they will exclude the ability to give birth on their own in the standard way. However, there are no documents for the ban either. So, in some cases, future mothers themselves can decide the method of delivery.

Please read: indications for caesarean section list 2017

Reasons for surgical intervention can be divided into two subgroups:

When the condition of the patient or baby makes doctors need to perform a surgical intervention in order to ensure safety for the mother and her child. This is an absolute reading;
There are also relative indications. In the event that the expectant mother can still give birth on her own, a meeting of medical workers decides all the pros and cons and discusses the risks and consequences that may arise if the operation is not performed and come to a consensus. The outcome will depend on the decision of experts.

In addition, there are still unplanned situations that occur during childbirth or pregnancy. They are divided into two causes: fruit and maternal.

The reasons for the expectant mother to allow a caesarean section may be:

Anatomical narrowing of the pelvic bone. Depends on the degree of narrowing. A degree greater than 3-4 may lead to negative consequences for both mother and child. Most women with a narrow pelvis during childbirth experience:

Weakening of contractions;
Premature convergence of waters;
The possibility of infection of the fetus with infections, the appearance of endometritis and chorioamnionitis;
The development of hypoxia in the womb.
With attempts, the following consequences should not be ruled out:
uterine rupture;
Birth trauma of the fetus;
Injuries of nerve endings and pelvic joints;
Tissue death and fistula formation in the genitourinary and intestinal tract;
With the admission of the third stage of childbirth, perhaps postpartum hemorrhage.
Overlapping of the internal os by the placenta.

The placenta is an integral link between the child and his mother throughout pregnancy. Through the placenta, the baby receives everything useful material and for normal development and growth. Without pathologies, it is located either in the uterus, or in the posterior, anterior wall. If the location of the placenta is disturbed, and it completely covers the internal os, similarly closing the exit of the fetus natural way, surgical intervention is necessary here. In addition, this condition is fraught with uncontrolled bleeding from the mother during the entire pregnancy.

Incomplete occlusion of the internal os by the placenta, accompanied by bleeding.

This is the condition when the placenta covers only part of the lateral or marginal pharynx.

With lateral overlap, the pharynx is half closed;
The edge overlap slightly touches the internal pharynx.

This situation promises a large blood loss, the intensity of which cannot be guessed. Most often, it occurs at the time of contractions, when the internal os opens and the placenta begins to separate. Due to bleeding, this condition promises a danger to the health and life of both. The best way out of this situation is a caesarean section.

Earlier discharge of the placenta with a usual location.

With early detachment of the placenta, bleeding also opens. It appears in closed, open and mixed forms. Closed bleeding accumulates between the wall of the uterus and the placenta without visible, at first glance, symptoms, open bleeding is characterized by obvious bloody through the vagina, mixed, combines both types of bleeding at the same time. This can not only harm the health of the fetus and mother, but also threatens their lives. To prevent a disastrous outcome, an emergency operation is performed to extract the fetus.

Rupture of the uterus

Many factors can lead to this condition. Inexperienced obstetrician, incorrect distribution of the force of attempts, a neglected state of the disease. When the uterus ruptures, neither the mother nor the child remains alive.

Wrong scar

With improper suturing after any surgical intervention in the uterus, a caesarean section is done. The inferiority of the scar is determined by ultrasound and by the general postoperative condition of the patient.

Carrying out two or more operations

The presence of two or more scars on the uterus is a contraindication to the normal way of having a baby. The consequence of such actions may be ruptures of postoperative sutures.

Unsuccessful treatment of seizures

late, characterized seizures with a subsequent coma with negative results of therapy, it promises an emergency surgical intervention to extract the fetus within two hours, since in case of inaction, a fatal outcome for mother and child is guaranteed.

Severe illness during pregnancy

A caesarean section is done if:

Violation of the heart;
Exacerbation of diseases of the nervous system;
Severe condition of thyroid diseases;
Hypertension and other related diseases;
Diabetes.

There are contraindications for normal childbirth, in case of eye surgery or complicated myopia. With prolonged and strong attempts, a woman can go blind due to retinal detachment.

Improper development of the uterus and birth canal

In this case, the fetus cannot come out on its own due to weakness of uterine contractions and obstruction and will require surgical intervention.

This state can be caused by:

The presence of tumors in the pelvic organs. Uterus and appendages;
The tumor can close the birth canal and the child will not be able to be born naturally;
malignant tumor;
late pregnancy.

At late pregnancies birth chance in the usual way decreases significantly. With age, the elasticity of the vaginal muscles is lost, which can lead to significant vaginal tears.

Demand for the fetus in surgical intervention
The fetus is malpositioned

The normal location of the fetus is considered head down to the pelvis of the pregnant woman. If the weight of the child is less than one and a half kg or more than three six hundred, a caesarean section is performed if the fetus is in the wrong position. Despite the weight, only boys need surgical intervention, because a deviant position during the exit from the still unexpanded birth canal can lead to squeezing of the testicles, which, in turn, can result in congenital infertility of the boy, as well as squeezing the baby's head.

hypoxia

In this situation, the child does not receive the amount of oxygen that he needs in the womb. In this case, a caesarean section is done immediately because it only worsens the baby's condition, and he can suffocate.

Cord prolapse

Surgery must be urgent. The loops of the umbilical cord cover the baby so that he simply suffocates. Unfortunately, very infrequently, doctors manage to save the child.

Life of the fetus after the death of the mother

With the death of a woman in labor, the fetus can remain alive for some time. In this case, a cesarean is done to save the fetus.

narrow pelvis

Surgical intervention is carried out while being, during normal delivery, inconsistencies in the size of the head and pelvic inlet. Such a situation could happen with a particularly large fetus, insufficient strength of contractions, an incorrect position of the head, and much more.

discrepancy pelvic bones

All women experience a divergence of the pelvic bones during pregnancy. There is pain in the pubic area, swelling and clicking when walking or probing. The gait is changing. It is difficult for a woman to get up and walk herself. After diagnosis, bed rest and rest are recommended, plus a special corset. More often, in order to comply with all norms, the patient is hospitalized or otherwise placed in the hospital for preservation.

If the pelvis does not diverge enough, the weight of the child is about three eight hundred grams, and the woman is physiologically required to have a caesarean section. To prevent breaks.

Weak tribal forces

If, when opening the fetal bladder, it is still not possible to activate independent childbirth, do caesarean. This is necessary so that the fetus does not suffocate and to prevent postpartum hemorrhage and injuries.

Pregnancy beyond term

In this case, surgical intervention is necessary when the stimulation of labor shows a negative result, insufficient intensity of contractions that the pregnant woman has gynecological pathologies and severe illness.

Artificial insemination and long-term infertility

Diagnosis of indications regarding the resolution of natural birth is made. In the presence of abortions, the birth of dead fetuses, rejection of the embryo, the normal method is excluded.

Fetal growth retardation and lack of oxygen

If the fetus did not receive enough oxygen throughout the pregnancy and this problem was not solved with medication. Doing a caesarean ahead of schedule in the best interests of the child.

Immature cervix

In this case, a caesarean section is mandatory. The uterus is not prepared for such loads during a natural birth.

big baby

A large child is considered if its mass exceeds four kilograms. Children are called heroes, whose weight exceeded five kilograms. Operational intervention here does not need an explanation. Mom is simply not able to give birth without consequences on her own. There may be numerous tears, and injuries to the fetus itself.

Large pregnancy

If the pregnancy consists of three or more babies, such a measure is mandatory.

Varicose veins

The pubic varicose veins during pregnancy and childbirth are dangerous because with strong attempts, these veins can burst and bleeding will open, which is life-threatening for mother and baby. Therefore, with such a disease, surgical intervention is necessary.

Any actions are performed in the interests of preserving the fetus and mother. If this is not possible, save someone alone. The limits are not absolute.

Prematurity, death of the baby;
Severe infection of the child;
Diagnostics carried out through the vagina more than 5 times;
Chorioamnionitis during childbirth, accompanied by a feverish state;
Childbirth lasting more than a day;
Negative results when trying to give birth naturally.

Living fruit. In the case of a dead fetus, the operation is performed to save the life of the woman in labor;
Consent in writing for a caesarean section;
A catheter to remove urine from the bladder. The need for surgical intervention;
Diagnosis of lesions before childbirth;
The operation must be performed by an experienced obstetric surgeon in a specially equipped operating room;
Accurate diagnosis of indications and agreement of the expectant mother in writing.

It is best to do a caesarean section when generic activity. In this state, uterine contractions will help the process and further adaptation of the child to external stimuli. With a planned operation, they are hospitalized at the 38th week of pregnancy, definitely not earlier. If the operation is not urgent.

Often, doctors make the deepest mistake by notifying a pregnant woman of the need for an operation long before the process itself. Such a turn of events will only create a nervous state for a woman in anticipation of a baby. It is best to say this directly closer to the deadline. For women who need a caesarean section, thorough examinations are carried out for foci of infections and bacteria, for their timely detection. This is done so that during the operation they do not get into the small, still very weak body of the newborn, and also do not lead to more complicated types of focal infection of the woman in labor.

Before the start of a planned operation, a complete diagnosis of the patient is carried out, including ultrasound to exclude pathologies or abnormalities in the development of the fetus. Of course, no one canceled urine either. Other destinations for additional examinations will be assigned for each individual case.

You need to make sure that the woman is in a positive mood, otherwise even such a trifle can lead to complications during the operation. It should be examined by an anesthesiologist, a therapist and the head of the department, after which they should explain the validity of this operation and emphasize the safety of its implementation.

The day before the planned operation, the expectant mother should eat lightly. An enema is given at night, as well as two to four hours before surgery.

On the way to the operating room, the doctor checks the baby's heartbeat and marks the location of the head.

Before an urgent operation, if the pregnant woman ate the day before, the stomach is cleansed through a probe and a cleansing enema is given.

An anesthesiologist selects methods of anesthesia individually. But most often anesthesia is performed spinally.

After the operation, an ice compress will be placed on the lower abdomen. Within 1-6 hours after a caesarean section, medical workers closely monitor the condition of the woman in labor. They check the pulse, skin tone, condition of the mucous membranes, pressure and pulse, discharge, body temperature. Spend breathing exercises for postpartum relief.

A caesarean section is done with local anesthesia mostly in the back. During the operation, the surgeon makes an incision in abdominal wall and the uterus, after which the child is carefully taken out. All incisions are closed with a continuous suture and staples are applied to the sutures. It is removed on the sixth day after the operation, almost before discharge. They are allowed to go home on the sixth or seventh day after surgery with the condition that there are no complications.

The psychological state of a woman. Often, mothers begin to regret that they did not give birth to a baby in the usual way;
Complicated exit from anesthesia with manifestations of dizziness, vomiting, nausea, headaches;
Inability to look after the child herself immediately after childbirth;
Inability to start breastfeeding from the very beginning;
Postoperative antibiotic therapy;
Neurological complications in a child.

There is a version that children who were born by caesarean section are not adaptive or poorly adaptive to external environment. Since they were born in a simplistic way, and due to this, they lack the instinct to fight. Although according to this famous person, like Gaius Julius Caesar, it was not at all noticeable, from the point of view of doctors, the conclusion remained the same. A caesarean section is justified only if there are no suitable conditions for conventional, natural childbirth or in emergency cases where the life of the mother and child, or at least one of them, is at risk.

Sometimes during pregnancy and childbirth, caesarean section is a lifeline for mothers and their children. There are many situations where, without surgical intervention, you can lose both participants in childbirth or lead to colossal errors that can become critical for the life and health of the child. Before agreeing to such a responsible step, it is worth thinking about the consequences that may occur after the operation. Count all the pros and cons, positive and negative sides such an important step.

Listen to the opinion of a specialist, he will be able to thoroughly explain the whole outcome of events to you. Do not be stubborn, it's about urgency, especially if your life and your baby are at stake. Go through all the consultations and scheduled ultrasound scans in time, so that you can monitor the condition of your baby and, in case of any deviations or developmental disorders, you can provide timely assistance. Don't be afraid to visit your gynecologist if you feel something is amiss. Women's intuition is a very interesting and mysterious thing, listen to it.

Even if everything is fine, for your own peace of mind, just check with your doctor. Hear that everything is fine with you and your baby and calm down. In this position, the nerves will only interfere and disrupt the normal process of fetal development. Rest more, do not load yourself heavy physical activity, especially if you have serious contraindications to this. Even if you have some kind of problem that requires a caesarean section, don't worry. Specialists will do everything possible to keep your child and you without harm to health and serious consequences. Do not cut off the shoulder, think carefully before agreeing or refusing the operation. Think not only about yourself, but also about the health of your baby. Set yourself up for the positive. Do not think badly, because everything you say and think is attracted to you. Take care of your health and your baby's development.

We can only wish you peace, patience, great and good health to you and your baby and easy childbirth for you!

Cesarean section - surgery in which the fetus is removed through an incision in the anterior abdominal wall and uterus.

It is believed that the name of the operation is associated with the name of Gaius Julius Caesar, who was extracted through an incision in the abdomen. The first reliable report of a caesarean section on a living woman was in 1610. The operation was carried out by J. Trautman from Wittenborg. In Russia, the first caesarean section was performed by I. Erasmus in Pernov (1756) and by V. M. Richter (1842) in Moscow.

Caesarean section is performed when delivery through the natural birth canal is impossible or dangerous to the life of the mother and fetus. In Moscow, caesarean section is about 15% of all births.
Like any surgical operation, a caesarean section is performed strictly according to indications. They can be on the part of the mother, when childbirth poses a threat to her health, and on the part of the fetus, when the process of childbirth is a burden for him, which can lead to birth trauma and fetal hypoxia. Indications for caesarean section may occur during pregnancy and childbirth.

Indications for caesarean section during pregnancy:

Placenta previa. The placenta (baby place) is located in the lower part of the uterus and covers the internal os (the entrance to the uterus from the side of the vagina). This threatens with severe bleeding, dangerous both for the life of the mother and for the fetus. The operation is performed at 38 weeks of pregnancy or earlier if bleeding occurs.
Premature detachment of a normally located placenta. Normally, the placenta separates from the uterine wall after the baby is born. Sometimes this happens during pregnancy, then severe bleeding begins, which threatens the life of the mother and fetus and requires immediate surgery.
Failure of the scar on the uterus after a caesarean section or other operations on the uterus. A scar on the uterus is considered insolvent if, according to ultrasound, its thickness is less than 3 mm, the contours are uneven and there are inclusions of connective tissue. Complicated course postoperative period after the first operation (fever, inflammation of the uterus, prolonged healing of the suture on the skin) also indicates the insolvency of the scar on the uterus
Two or more scars on the uterus after caesarean sections. It is believed that two or more caesarean sections increase the risk of uterine rupture along the scar in childbirth. Therefore, a caesarean section is performed before the onset of labor.
Anatomically narrow pelvis II - IV degree of narrowing. Every woman has her pelvis measured during pregnancy. Obstetricians have clear criteria for the normal size of the pelvis and narrow pelvis according to the degree of narrowing.
Tumors and deformities of the pelvic bones. They can serve as an obstacle to the birth of a child.
Malformations of the uterus and vagina. Tumors of the uterus, ovaries and other organs of the pelvic cavity, closing the birth canal.
Large fetus in combination with another pathology. A fetus is considered large when its mass is 4 kg or more.
Expressed symphysitis. Symphysitis or symphysiopathy - divergence of the pubic bones. In this case, there are pronounced difficulties and pain when walking.
Multiple uterine fibroids of large sizes, malnutrition of myomatous nodes.
Severe forms of preeclampsia and lack of effect from treatment. Preeclampsia is a complication of pregnancy, in which there is a disorder in the function of vital organs, especially the vascular system and blood flow. Severe manifestations of preeclampsia - preeclampsia and eclampsia. At the same time, microcirculation in the central nervous system is disturbed, which can lead to serious complications for both the mother and the fetus.
Severe illnesses Diseases of the cardiovascular system with symptoms of decompensation, diseases of the nervous system, diabetes mellitus, high myopia with changes in the fundus, etc.)
Severe cicatricial narrowing of the cervix and vagina. May occur after previous operations or childbirth. This creates insurmountable obstacles to the opening of the cervix and stretching of the walls of the vagina, necessary for the passage of the fetus.
Condition after plastic surgery on the cervix and vagina, after suturing urogenital and enterogenital fistulas. A fistula is an unnatural communication between two adjacent hollow organs.
Rupture of the perineum III in previous births. If during childbirth, in addition to the skin and muscles of the perineum, the sphincter (the muscle that closes the anus) and / or the rectal mucosa is torn, then this is a third-degree perineal rupture, a poorly sutured rupture can lead to gas and fecal incontinence.
Severe varicose veins in the vagina. In spontaneous delivery, bleeding from such veins can become life-threatening.
Transverse position of the fetus.
Conjoined twin.
Breech presentation of the fetus in combination with a fetal weight of more than 3600 g and less than 1500 g, as well as with narrowing of the pelvis. Breech presentation increases the risk of birth injury at birth of the fetal head.
In vitro fertilization, artificial insemination in the presence of other complications from the mother and fetus.
Chronic fetal hypoxia, fetal hypotrophy, resistant to drug therapy. In this case, the fetus receives an insufficient amount of oxygen and for him the process of childbirth is a load that can lead to birth trauma.
The age of primiparous older than 30 years in combination with another pathology.
Prolonged infertility in combination with other pathology.
Hemolytic disease of the fetus with the unpreparedness of the birth canal. With Rh (less often - group) incompatibility of the blood of the mother and fetus, hemolytic disease of the fetus develops - the destruction of red blood cells (erythrocytes). The fetus begins to suffer from a lack of oxygen and the harmful effects of the breakdown products of red blood cells. If the condition of the fetus worsens, a caesarean section is performed.
Diabetes mellitus with the need for early delivery and unprepared birth canal.
Post-term pregnancy with unprepared birth canal and in combination with other pathologies. The process of childbirth is also a stress that can lead to birth trauma to the fetus.
Cancer of any localization.
Exacerbation of genital herpes. With genital herpes, the indication for caesarean section is the presence of blisters of herpetic eruptions on the external genitalia.

Indications for caesarean section in childbirth:

Clinically narrow pelvis. This is a discrepancy between the fetal head and the mother's pelvis.
Premature rupture of amniotic fluid and lack of effect from labor induction. When the waters are poured out before the start of contractions, they are tried to be induced with the help of medications (prostaglandins, oxytocin), but this does not always lead to success.
Anomalies of labor activity that are not amenable to drug therapy. With the development of weakness or discoordination and labor activity, drug therapy is carried out, which also does not always lead to success.
Acute fetal hypoxia. A sign of acute fetal hypoxia is, first of all, a sharp decrease in the fetal heart rate, which is not restored.
Detachment of a normally or low-lying placenta. Normally, the placenta separates from the uterine wall after the baby is born. Sometimes this happens during contractions, then severe bleeding begins, which threatens the life of the mother and fetus and requires immediate surgery.
Threatening or incipient uterine rupture. It must be recognized by a doctor in a timely manner, since a late operation can lead to fetal death and removal of the uterus.
Presentation or prolapse of the umbilical cord. If a caesarean section is not performed within the next few minutes during the prolapse of the umbilical cord and head presentation of the fetus, the child may die.
Incorrect insertion of the fetal head. When the head is in an unbent state (frontal, facial presentation), as well as a high straight standing of the head.

Sometimes a cesarean section is performed for combined indications, which are a combination of several complications of pregnancy and childbirth, each of which individually does not serve as an indication for cesarean section, but together they create a real threat to the life of the fetus.

From the depths of centuries

According to information that has come down to us from time immemorial, caesarean section is one of the most ancient operations. In myths Ancient Greece it is described that with the help of this operation, Asclepius and Dionysus were extracted from the womb of dead mothers. In Rome, at the end of the 7th century BC, a law was issued according to which the burial of a deceased pregnant woman was carried out only after the child was removed by ablation. Subsequently, this manipulation was performed in other countries, but only for dead women. In the 16th century, Ambroise Pare, the court physician of the French king, first began performing caesarean sections on living women. But the outcome was always fatal. The mistake of Pare and his followers was that the incision on the uterus was not sewn up, relying on its contractility. The operation was performed only to save the child, when the mother's life could no longer be saved.

It was only in the 19th century that it was proposed to remove the uterus during surgery, the mortality rate as a result decreased to 20-25%. Five years later, the uterus began to be sewn up with a special three-story suture. Thus began a new phase of the caesarean section. It began to be performed not only for the dying, but also in order to save the life of the woman herself. With the beginning of the era of antibiotics in the middle of the 20th century, the outcomes of the operation improved, and deaths during it became rare. This was the reason for the expansion of indications for caesarean section both on the part of the mother and the fetus.

Conditions for the operation

Distinguish between planned, scheduled and emergency caesarean section. A planned caesarean section is performed in advance at 38-39 weeks if there are indications for surgery from the uterus or the fetus in the absence of signs of labor. Emergency - during normal childbirth (for example, bleeding from the genital tract during placental abruption), in the presence of a situation where childbirth must be urgently completed. A planned caesarean section is an operation performed with the onset of labor or with the outflow of amniotic fluid. It is produced in the presence of relative indications (the woman enters into childbirth herself, but in the presence of any complications, childbirth ends with an operation according to a previously developed plan).

Indications for surgery

Indications for caesarean section are divided into indications on the part of the mother and on the part of the fetus. There are also absolute indications (the operation is inevitable) and relative indications (the issue is decided in favor of natural childbirth or surgery after complex analysis situations).

Absolute indications from the mother:

Anatomically narrow pelvis (3rd and 4th degrees of narrowing).
Complete placenta previa (the placenta is located above the internal os, the passage of the fetus through the birth canal becomes impossible).
Threatening and incipient uterine rupture (an emergency requiring slow delivery to save the mother's life).
Bleeding from the genital tract of the placenta layer, incomplete placenta previa, when the placenta partially blocks the exit from the uterus with an unprepared birth canal), which is also a life-threatening condition for both the mother and the child.
Defective scar on the uterus (the threat of divergence of the scar existing after a previous operation on the uterus).
Severe forms of preeclampsia with unprepared birth canal - a serious complication of pregnancy, which is characterized by vasospasm of many organs and systems. This complication is most often manifested by an increase in blood pressure, the appearance of edema, protein in the urine, in very severe cases, a woman develops an attack of convulsions - eclampsia.
Severe varicose veins in the vaginal area (the passage of the fetus through the genital tract can lead to bleeding against the background of even minimal tissue damage).

Obstacles along the birth canal cicatricial changes cervix, vagina, pelvic tumors).

Myopia (nearsightedness) of a high degree; against the background of labor, retinal detachment may occur.
Diseases of the cardiovascular system (heart defects), etc.

Relative indications from the mother:

Clinically narrow pelvis (during childbirth, there is a discrepancy between the fetal head and the size of the mother's pelvis).
Weakness of labor activity, which leads to prolonged traumatic childbirth.
Incorrect insertion and presentation of the fetal head (the head is not inserted in the smallest size, as normal, in this case a situation of a clinically narrow pelvis arises or childbirth is accompanied by other complications such as traumatism of the mother during childbirth, perineal ruptures, deterioration of the fetus is observed.
The transverse position of the fetus (the fetus in the uterus is not located longitudinally, but across).
Breech presentation in combination with other aggravating factors (not the head of the fetus, but the pelvic end, which creates difficulties during childbirth, especially when the weight of the fetus is over 3500 g), is presented to the birth canal.
The first birth at the age of over 30 years in combination with one of the above pathologies.
Fetal hypoxia (lack of oxygen and nutrients), chronic fetoplacental insufficiency, not amenable to medical correction (reduced oxygen supply to the fetus through the placenta, which disrupts the normal development of the child).
Prolonged infertility.
Post-term pregnancy1 in combination with another pathology (during a post-term pregnancy, the condition of the fetus worsens if labor induction does not give the desired effect.
Scar on the uterus after interventions (caesarean section in the past, removal of uterine fibroids).

Absolute indications on the part of the fetus:

Acute fetal hypoxia in the absence of conditions for immediate delivery.
The transverse position of the fetus after the outflow of amniotic fluid.
Extension (incorrect) insertion of the fetal head (if the normal head of the fetus is bent to the chin, which ensures its advancement with the smallest size of the head, then with extensor insertions the fetal head advances with the forehead or face).
Death of mother with live fetus.

Relative indications on the part of the fetus:

Chronic placental insufficiency (decreased blood circulation in the "mother - fetus" system).

Breech presentation of the fetus with its weight over 3500 g.
Multiple pregnancy with breech presentation of the fetus.

How is the operation performed

Cesarean section is divided into corporal, or classical, and caesarean section in the lower uterine segment. A corporal caesarean section is performed using a vertical incision along the midline, while on the uterus the incision is also vertical, passing through the entire body of the uterus. Such an operation is done when it is necessary to perform delivery before 28 weeks of pregnancy. Currently, in the vast majority of cases, an incision is made in the lower uterine segment I 2 I.

After a layer-by-layer opening of the abdominal wall, a transverse incision is made on the uterus, the presenting part of the fetus (head or pelvic end) is captured, and the fetus is removed. Then the incision on the uterus is sutured and the integrity of the abdominal wall is restored in layers.

As anesthesia for caesarean section, endotracheal general anesthesia or epidural, as well as spinal anesthesia is used. At endotracheal anesthesia The anesthetic is delivered through a tube inserted into the trachea. The patient is asleep and does not feel anything. With epidural and spinal anesthesia, the anesthesiologist makes an injection in the lumbar region of the woman, the anesthetic is injected into the space above the solid meninges or spread around spinal cord. Epidural and spinal anesthesia have a number of advantages over anesthesia: the woman is conscious and can see her child immediately after birth. There is no negative effect of the drug that enters the blood of the fetus through the mother's blood. Also, there are no many negative aspects of anesthesia, undesirable, for example, with concomitant cardiovascular pathology in a woman. In addition, recovery after general anesthesia less comfortable for a woman than after epidural and spinal anesthesia.

In the postoperative period, a woman spends up to a day in the ward intensive care. During the first few days, he receives pain medication. Already from the first days, in order to reduce pain in the scar area, a woman is recommended to wear postpartum bandage. Lactation in women who have undergone surgery is practically no different from women who have given birth spontaneously. Postoperative sutures removed on the 6-7th day. An extract is made on the 9th-10th day after the operation with a favorable course of the postoperative period.

The condition of the children born by caesarean section

In addition to the effects of drugs, in the case of using general anesthesia (a certain amount of the drug from the mother’s blood enters the fetus before the extraction and separation of the umbilical cord), on the body of the newborn big influence renders the method of delivery itself. The fetus does not pass the birth canal of the mother, there is no mechanical compression chest, squeezing out the fluid that fills the lungs in utero. The reasons for which the operation was performed are also important (for example, transferred fetal hypoxia). A planned caesarean section is the most favorable option for an operation, since labor activity triggers factors of "birth stress", as it were, prepares the fetus for the transition to a new habitat.

And yet, a reasonably performed caesarean section is for the baby a kind of insurance against troubles that can negatively affect the baby during pathological childbirth. Just in the first year of life, such a child may need a little more attention (massage, swimming, observation by a neurologist).

Contraindications for surgery

There are no absolute contraindications for caesarean section. All relative contraindications are associated with the development of inflammatory complications in the postoperative period. Any acute diseases or exacerbation chronic diseases in a woman, a long anhydrous interval (over 6 hours), the duration of labor is more than 12 hours, all immunodeficiency states are factors that increase the risk of developing inflammation. In these cases, during the operation, doctors closely monitor the condition of the young mother, as a rule, prescribe additional treatment, such as antibiotic therapy, treatment aimed at stabilizing the immune system.

Pregnancy after caesarean section

The high frequency of cesarean section operations has created a problem - the management of pregnancy and childbirth in women who have already undergone this operation in the past - the so-called women with a scar on the uterus.

Primarily, great importance has a postoperative course. It is important whether there was inflammation of the uterus (endometritis), how the stitches on the uterus and abdominal wall healed when the woman was discharged from the maternity hospital. The formation of a scar on the uterus begins just then. Traditionally, it is recommended to refrain from subsequent pregnancy for 2 years after surgery. Abortions during this period are also extremely unfavorable due to the effect on the tissue in the scar area. Therefore, a woman should especially carefully take care of contraception. The state of the uterus in the area of the scar can be assessed with ultrasound examination(thickness in the scar area, tissue uniformity). If the indications for surgery were an anatomically narrow pelvis and somatic diseases of the woman (for example, myopia or high myopia), subsequent births will also be performed by caesarean section. In the case of "transient" indications (incorrect insertion of the head, breech presentation, violation of the condition of the fetus, etc.), the situation requires analysis at the moment.

Spontaneous childbirth after a cesarean section was once possible with a full-fledged scar on the uterus, the absence of absolute and relative indications for a second operation, and the desire of the woman herself to enter into childbirth on her own. Of course, such a woman in labor requires special attention. If any complications occur, doctors should be prepared to proceed with a second caesarean section.

What is sterilization?

The operation of sterilization (creation of artificial obstruction of the fallopian tubes) is an irreversible procedure - for this the fallopian tubes stitched and tied with silk thread. Before a second cesarean section, as well as in a number of other situations (for example, the first cesarean section in a woman with severe somatic pathology and over 40 years of age), sterilization is suggested. The decision on whether or not to perform this intervention for any caesarean section is made by the woman herself. Even in the case of severe concomitant diseases, the obstetrician-gynecologist cannot resolve this issue, violating the woman's right to manage her health. However, the doctor must formulate these medical indications and convey them to the patient.