How does a caesarean section occur during childbirth? Caesarean section, operation, consequences, indications, recovery. When is surgical delivery indicated?

When childbirth cannot be carried out through the natural birth canal, surgery has to be resorted to. In this regard, expectant mothers are concerned about many questions. What are the indications for a caesarean section and when is the operation performed for emergency reasons? What should a woman in labor do after surgical delivery and how is the recovery period? And most importantly, will a baby born through surgery be healthy?

Caesarean section is a surgical operation in which the fetus and placenta are removed through an incision in the abdominal wall and uterus. Currently, between 12 and 27% of all births are performed by caesarean section.

Indications for caesarean section

The doctor can make the decision to perform surgical delivery at different terms pregnancy, which depends on the condition of both the mother and the fetus. In this case, absolute and relative indications for caesarean section are distinguished.

TO absolute indications include conditions in which vaginal delivery is impossible or is associated with a very high risk to the health of the mother or fetus.

In these cases, the doctor is obliged to carry out the birth by cesarean section and no other way, regardless of all other conditions and possible contraindications.

In each specific case, when deciding whether to perform a cesarean section, not only the current condition of the pregnant woman and the child is taken into account, but also the course of the pregnancy as a whole, the state of the mother’s health before pregnancy, especially if chronic diseases. Also important factors for deciding on a caesarean section are the age of the pregnant woman, the course and outcomes of previous pregnancies. But the desire of the woman herself can be taken into account only in controversial situations and only when there are relative indications for a cesarean section.

Absolute indications for caesarean section:

Narrow pelvis that is, an anatomical structure in which the child cannot pass through the pelvic ring. The size of the pelvis is determined during the first examination of a pregnant woman; the presence of a narrowing is judged by its size. In most cases, it is possible to determine the discrepancy between the size of the mother’s pelvis and the presenting part of the child even before the onset of labor, but in some cases the diagnosis is made directly during childbirth. There are clear criteria for the normal size of the pelvis and narrow pelvis according to the degree of narrowing, however, before entering labor, only a diagnosis of anatomical narrowing of the pelvis is made, which allows only a certain degree of probability to suggest clinically narrow pelvis- discrepancy between the size of the pelvis and the presenting part (usually the head) of the child. If during pregnancy it is discovered that the pelvis is anatomically very narrow (III-IV degrees of narrowing), a planned cesarean section is performed; with II degrees, the decision is most often made directly during childbirth; with I degrees of narrowing, childbirth is most often carried out through the natural birth canal. Also, the cause of the development of a clinically narrow pelvis may be incorrect insertion of the fetal head, when the head is in an extended state and passes through bony pelvis with its largest dimensions. This happens with frontal, facial presentation, while normally the head passes through the bony pelvis bent - the baby’s chin is pressed to the chest.

Mechanical obstacles preventing vaginal delivery. A mechanical obstacle can be uterine fibroids located in the isthmus region (the area where the body of the uterus meets the cervix), ovarian tumors, tumors and deformities of the pelvic bones.

Threat of uterine rupture. This complication most often occurs during repeated births, if the first was performed by cesarean section, or after other operations on the uterus, after which a scar remained. With normal healing of the uterine wall with muscle tissue, the uterus does not threaten to rupture. But it happens that the scar on the uterus turns out to be insolvent, that is, it threatens to rupture. The failure of the scar is determined by ultrasound data and the “behavior” of the scar during pregnancy and childbirth. A caesarean section is also performed after two or more previous caesarean sections, because this situation also increases the risk of uterine rupture along the scar during childbirth. Numerous births in the past, leading to thinning of the uterine wall, can also create a threat of uterine rupture.

Placenta previa. This is the name given to its incorrect location, in which the placenta is attached to the lower third of the uterus, above the cervix, thereby blocking the exit of the fetus. It's threatening heavy bleeding, dangerous for both the life of the mother and the child, since during the opening of the cervix the placenta separates from the wall of the uterus. Since placenta previa can be diagnosed by ultrasound before the onset of labor, elective cesarean section is performed, most often at 33 weeks of gestation or earlier if bleeding occurs, indicating placental abruption.

Premature detachment placenta. This is the name for a condition when the placenta separates from the wall of the uterus not after, but before or during childbirth. Placental abruption is life-threatening for both the mother (due to the development of massive bleeding) and the fetus (due to the development of acute hypoxia). In this case, a caesarean section is always performed for emergency reasons.

Presentation and prolapse of umbilical cord loops. There are cases when the umbilical cord loops are in front of the head or pelvic end of the fetus, that is, they will be born first, or the umbilical cord loops fall out even before the birth of the head. This can occur with polyhydramnios. This leads to the fact that the umbilical cord loops are pressed against the walls of the pelvis by the fetal head and blood circulation between the placenta and the fetus is stopped.

TO relative indications include situations in which delivery through the natural birth canal is possible, but the risk of complications during childbirth is quite high. These indications include:

Chronic diseases of the mother. These include cardiovascular diseases, kidney diseases, eye diseases, nervous system diseases, diabetes mellitus, and cancer. In addition, indications for cesarean section are exacerbations in the mother of chronic diseases of the genital tract (for example, genital herpes), when during natural childbirth the disease can be transmitted to the child.

Pregnancy occurring after infertility treatment in the presence of other complications from the mother and fetus.

Some pregnancy complications which may pose a threat to the life of the child or the mother herself during childbirth naturally. First of all, this is gestosis, in which the function of vital organs, especially the vascular system and blood flow, is disrupted.

Persistent weakness of labor, when labor, which began normally, subsides for some reason or goes on for a long time without noticeable progress, and drug intervention does not bring success.

Breech presentation of the fetus. Most often, a caesarean section is performed if breech presentation is combined with some other pathology. The same can be said about a large fruit.

Progress of caesarean section operation

At elective surgery After a cesarean section, a pregnant woman is admitted to the maternity hospital several days before the expected date of the operation. In the hospital, additional examination and drug correction of identified deviations in the state of health are carried out. The condition of the fetus is also assessed; Cardiotocography (registration of fetal heartbeats) and ultrasound examination are performed. The expected date of surgery is determined based on the condition of the mother and fetus, and, of course, the gestational age is taken into account. As a rule, elective surgery is performed at 38-40 weeks of pregnancy.

1-2 days before the operation, the pregnant woman must be consulted by a therapist and an anesthesiologist, who discusses the pain management plan with the patient and identifies possible contraindications to various types of anesthesia. On the eve of the birth, the attending physician explains the approximate plan of the operation and possible complications, after which the pregnant woman signs consent to perform the operation.

The night before surgery, the woman is given cleansing enema and, as a rule, sleeping pills are prescribed. On the morning of surgery, the bowels are cleaned again and a urinary catheter is then inserted. On the day before the operation, a pregnant woman should not have dinner, and on the day of the operation she should neither drink nor eat.

Currently, when performing a cesarean section, regional (epidural or spinal) anesthesia is most often performed. The patient is conscious and can hear and see her baby immediately after birth and attach him to the breast.

In some situations, general anesthesia is used.

The duration of the operation, depending on the technique and complexity, averages 20-40 minutes. At the end of the operation, an ice pack is placed on the lower abdomen for 1.5-2 hours, which helps to contract the uterus and reduce blood loss.

Normal blood loss during spontaneous childbirth is approximately 200-250 ml; this volume of blood is easily restored by a woman’s body prepared for this. During a caesarean section, the blood loss is somewhat greater than physiological: its average volume is from 500 to 1000 ml, therefore during the operation and in the postoperative period, intravenous administration of blood replacement solutions is performed: blood plasma, red blood cells, and sometimes whole blood - this depends on the amount lost during the time of the blood operation and the initial condition of the woman in labor.

Emergency caesarean

An emergency caesarean section is performed in situations where childbirth cannot be quickly carried out through the natural birth canal without compromising the health of the mother and child.

Emergency surgery requires minimal preparation. For pain relief during emergency surgery, general anesthesia is used more often than during planned operations, since with epidural anesthesia the analgesic effect occurs only after 15-30 minutes. Recently, during emergency caesarean section, spinal anesthesia has been widely used, in which, just like with epidural, an injection is given in the back in the lumbar region, but the anesthetic is injected directly into the spinal canal, while with epidural anesthesia - into space above the dura mater. Spinal anesthesia takes effect within the first 5 minutes, allowing the operation to begin quickly.

If during a planned operation a transverse incision is often made in the lower abdomen, then during an emergency operation a longitudinal incision from the navel to the pubis is possible. This incision provides greater access to the abdominal and pelvic organs, which is important in a difficult situation.

Postoperative period

After surgical delivery, the woman in labor spends the first 24 hours in a special postpartum ward (or intensive care ward). She is constantly monitored by an intensive care unit nurse and an anesthesiologist, as well as an obstetrician-gynecologist. During this time, the necessary treatment is carried out.

In the postoperative period, painkillers are prescribed; the frequency of their administration depends on the intensity of pain. All drugs are administered only intravenously or intramuscularly. Typically, anesthesia is required in the first 2-3 days, then it is gradually abandoned.

It is mandatory to prescribe drugs for better uterine contractions (Oxytocin) for 3-5 days to contract the uterus. 6-8 hours after the operation (of course, taking into account the patient’s condition), the young mother is allowed to get out of bed under the supervision of a doctor and nurse. Transfer to the postpartum department is possible 12-24 hours after surgery. The child is currently in the children's department. IN postpartum department the woman herself will be able to start caring for the child and breastfeeding him. But in the first few days she will need help from medical staff and relatives (if visits are allowed in the maternity hospital).

For 6-7 days after a cesarean section (before the stitches are removed), the procedural nurse daily treats the postoperative suture with antiseptic solutions and changes the bandage.

On the first day after a cesarean section, you are only allowed to drink water with lemon juice. On the second day, the diet expands: you can eat porridge, low-fat broth, boiled meat, sweet tea. You can completely return to a normal diet after the first independent bowel movement (on the 3-5th day); foods that are not recommended for breastfeeding are excluded from the diet. Usually, to normalize intestinal function, a cleansing enema is prescribed about a day after surgery.

When you can be discharged home, the attending physician decides. Typically, an ultrasound examination of the uterus is performed on the 5th day after surgery, and the staples or sutures are removed on the 6th day. If the postoperative period is successful, discharge is possible on the 6-7th day after cesarean section.

Alexander Vorobyov, obstetrician-gynecologist, Ph.D. honey. sciences,
MMA im. Sechenov, Moscow

It happens that pregnancy occurs with some disturbances, due to which it is contraindicated for a woman to give birth on her own. In such situations, the doctor may prescribe a planned birth via cesarean section. There is no clear answer as to when a planned cesarean section is performed, since each pregnancy is individual. Therefore, the time for surgical delivery is determined by the gynecologist on an individual basis.

A planned caesarean section is a pre-planned surgical procedure prescribed for pregnant women who have contraindications to natural childbirth. The operation is prescribed when there are absolute indications for its implementation. The question of the need for delivery in this way is decided in advance by the gynecologist.

The woman undergoes a thorough examination by a gynecologist, ophthalmologist, therapist, endocrinologist and other doctors. If the experts come to the conclusion that a cesarean section is necessary, the woman is given a date for the operation, approximately a week to a week and a half before which the patient is admitted to the maternity hospital. A pregnant woman needs to decide in advance on the type of pain relief. During the operation, the wall of the peritoneum and the uterus are cut, and then the child is removed through the incisions made.

Increasingly, during a planned caesarean section, a transverse incision is made, which is more cosmetic than a vertical suture crossing the peritoneum from the navel to the pubis. Similar delivery operations in obstetric practice occur quite often, saving the lives of thousands of babies.

Indications for planned caesarean section

Although delivery by cesarean section is often performed, such an operation cannot be considered the norm, because it is prescribed in the presence of certain indications, of which there are quite a few:

In all these clinical cases Traditionally, a planned caesarean section is prescribed. Although it happens that surgical delivery is carried out at the request of the woman in labor, when she is afraid of severe pain or possible complications. But doctors always try to dissuade the patient from cesarean section if there are no clear indications for it.

At what time is delivery performed by elective caesarean section?

Quite often, doctors wait until the last minute to perform a cesarean section, so women are worried about what week such an operation is performed. The reason for such uncertainty is the individuality of each case and the influence of many factors such as the condition of the pregnant woman, the course of pregnancy, characteristics of fetal development, etc. Although there are some generally accepted standards that doctors rely on.

The norm for planned surgical delivery is 39-40 weeks, i.e., a period as close as possible to natural childbirth. Such proximity is necessary to minimize respiratory distress syndrome in newborn babies. The ideal time is considered to be the time when the first contractions appear, the so-called. harbingers. But such terms are generally accepted for normal pregnancies.

If the pregnancy is multiple, then at what period is a planned cesarean section performed? For women with HIV infection or multiple pregnancies, planned surgical delivery is prescribed at 38 weeks. If monoamniotic twins are detected, then the operation is performed at 32 weeks. But these dates are approximate. The final timing depends on various additional factors such as abnormal placental presentation, etc.

For whom cesarean section is contraindicated?

There are no absolute contraindications for surgical delivery, because the factors leading to the appointment of such an operation are quite serious and often involve the issue of preserving the life of the child or mother. Possible contraindications include intrauterine fetal death, severe and long-term fetal hypoxia, various deformities or non-viability of the fetus, a high probability of postoperative complications in the mother, etc.

This also includes situations where it is impossible to exclude stillbirth or the death of a child during childbirth. In such clinical situations, the primary task becomes the preservation of women’s health and the maximum possible reduction in the likelihood of developing septic or infectious complications during surgical procedures, because dead child may cause a dangerous infection.

If the indications for cesarean section are absolute, although there is an infectious process, then an abdominal type of delivery is performed, that is, the child is removed along with the uterus.

Preparing for surgery

The operation is serious, so it is necessary to carefully prepare for it. To do this, the woman is admitted to the maternity hospital about a week before the appointed date so that she undergoes a detailed examination. In addition, during this period the intrauterine state of the fetus is assessed, and the pregnant woman is finally determined on the type of anesthesia. To avoid various types of allergic reactions, it is necessary to study the presence of intolerance or hypersensitivity to the medications used.

In general, anesthesia comes in several varieties:

1. General. This is general anesthesia, which involves placing the woman in labor into an artificial medical sleep. It is usually used in emergency cases because it does not require much time, although it has many undesirable consequences;
2. Endotracheal. This is also a type of general anesthesia, in which a tube connected to a ventilator is inserted into the woman’s trachea. Such anesthesia is often combined with general anesthesia;
3. Epidural. This anesthesia is the most common and involves the introduction of an anesthetic drug into the epidural cavity. A woman is fully conscious during the process of childbirth;
4. Spinal. Such anesthesia is considered the most preferable today, as many patients note. In this case, the drug is administered into the spinal cavity.

In addition to choosing anesthesia, preparing for a planned cesarean section includes carefully collecting the necessary supplies that will be needed in the hospital after the operation. This includes hygiene items, documents, things for the mother and child, money, etc. Some mothers try to shave their pubic hair at home on their own. But doctors do not recommend doing this. The problem is that after such shaving, inflammation appears, which can lead to the development of infection. You also need to prepare drinking water before the operation, because after a cesarean section you can’t eat anything, and after anesthesia you will definitely be very thirsty.

Regardless of how many weeks the operation is performed, it is necessary to purchase a postoperative postpartum bandage in advance. Wearing such a bandage from the first days after cesarean helps eliminate pain and accelerates the healing process of the suture. The quality of preparation for caesarean section determines the favorable outcome of the operation and the absence of postoperative complications. Absolutely all mothers are worried before a planned operation, so it is recommended to discuss all concerns with your doctor in advance.

Progress of planned surgical delivery

In the operating room, the woman is given a cap and shoe covers. To avoid the development of thrombosis, the pregnant woman's legs are wrapped with special elastic bandages or compression stockings are put on. The rest of the clothing is removed and the patient is placed on the table. Then, when the anesthesia is given, the woman may be placed on her side (spinal anesthesia) or asked to sit up (epidural anesthesia). After this, the infusion is connected, and a cuff is put on the arm to control blood pressure.

A special screen is installed just below the woman’s chest to isolate the area of ​​surgical operations. A woman is given a catheter and the skin of her abdomen is treated with a special disinfectant solution and covered with a special sterile cloth.

How is a planned caesarean section performed? When the anesthetic begins to act, the pregnant woman is dissected into the peritoneum and uterine wall, after which the baby is carefully removed. The doctor cuts the umbilical cord and transfers the baby to a neonatologist for treatment, examination and assessment of vital signs. All this is done in a short period of time, taking about 10 minutes. If the woman in labor feels well, the baby is placed on her chest for a short time.

After which the placenta is removed. The surgeon carefully examines the uterine cavity and, if there are no deviations, sutures its wall with absorbable material. The abdominal wall is sutured in the same way. To avoid leaving a disfiguring scar, the doctor makes a cosmetic suture, which is then treated with an antiseptic and covered with a bandage. From the beginning to the end of surgical delivery it takes about half an hour.

Possible complications after cesarean section

In some cases, postoperative complications are likely, which are usually removable and passing. They affect the mother herself, but may
touch the child too. The most common problems are:

• Anemia caused by heavy blood loss during surgical delivery;
• Absence or difficulty with the onset of lactation;
• Adhesive processes in the abdominal cavity;
• Varied menstrual irregularities, for example, the first period may last for more than a week, or does not come for a sufficiently long time, etc.;
• Problems with the baby's blood circulation;
• Trobophlebitis of the pelvic veins, endometritis, etc.

Irreversible complications include hysterectomy or infertility. After cesarean section, most women lose the opportunity natural birth, which also cannot be corrected. There is a theory that during cesarean delivery in infants there is a disruption in the production of hormones and proteins, which can negatively affect the extrauterine adaptation and mental activity of the newborn. But this is just a theory that has not been definitively confirmed.

Rehabilitation and recovery period

About a day after a cesarean section, the postpartum woman is in the intensive care unit, where her condition is closely monitored. Immediately after surgery, cold is applied to the abdomen to speed up uterine contractions and stop bleeding. When the anesthetic effect wears off, the woman begins to feel uneasy severe pain, for the relief of which the patient is given painkillers. Additionally, saline solution is administered to replenish lost volumes of fluid, and drugs to normalize gastrointestinal activity.

During the first hours after a cesarean section is performed, the postpartum woman should lie down. Usually at this time, women note weakness and chills, mild nausea and dizziness. This is where pre-prepared water comes in handy, since patients are worried about extreme thirst. You are allowed to sit down after 6-8 hours, and when the dizziness goes away, you can go to the toilet. The newborn remains in the neonatal department all this time, from where his mother periodically brings him.

The next day, the postpartum woman is transferred from the ICU to the department, where she takes care of the baby independently. After about 3 days, the patient stops receiving pain-relieving injections, but the suture continues to be treated daily. Approximately on the 5-6th day, the postpartum woman undergoes tests, makes an ultrasound diagnosis of the scar and organs of the abdominal and pelvic area. If there are no complications, on the 7th day the mother goes home with the baby.

At home, you should also follow certain postoperative rehabilitation rules. You are allowed to wash in the shower after about one and a half to two weeks, and in the bathroom after a month and a half. Sexual rest and abstinence from physical activity are observed for 8 weeks. The next pregnancy will only be possible in a couple of years, so it is necessary to approach the issue of contraception wisely.

C-section- a type of surgical intervention during which the fetus is removed from the uterus of a pregnant woman. The baby is removed through an incision in the uterus and anterior abdominal wall.

Statistics on caesarean sections vary from country to country. Thus, according to unofficial statistics in Russia, about a quarter are born with the help of this delivery operation ( 25 percent) all babies. This figure is increasing every year due to the increase in elective caesarean sections. In the United States of America and most European countries, every third child is born by caesarean section. The highest percentage of this operation is registered in Germany. In some cities of this country, every second child is born by caesarean section ( 50 percent). The lowest percentage was recorded in Japan. In countries Latin America this percentage is 35, in Australia – 30, in France – 20, in China – 45.

These statistics go against the recommendations of the World Health Organization ( WHO). According to the WHO, the “recommended” caesarean section rate should not exceed 15 percent. This means that a caesarean section should only be performed according to medical indications when natural childbirth is impossible or involves a risk to the life of the mother and child. C-section ( from Latin “caesarea” - royal, and “sectio” - cut) is one of the most ancient operations. According to legend, Julius Caesar himself ( 100 – 44 BC) was born thanks to this operation. There is also information that during his reign a law was passed requiring that in the event of the death of a woman in labor, the child must be removed from her by dissecting the uterus and anterior abdominal wall. There are many myths and legends associated with this delivery operation. There are also many ancient Chinese engravings depicting this operation being performed on a living woman. However, most of these operations ended in death for the woman in labor. The main mistake that doctors made was that after removing the fetus, they did not stitch up the bleeding uterus. As a result of this, the woman died from blood loss.

The first official data on a successful caesarean section date back to 1500, when Jacob Nufer, who lived in Switzerland, performed this operation on his wife. His wife suffered from protracted labor for a long time and still could not give birth. Then Jacob, who was castrating pigs, received permission from city officials to remove the fetus using an incision in the uterus. The child born as a result of this lived 70 years, and the mother gave birth to several more children. The term “caesarean section” was introduced less than 100 years later by Jacques Guillemot. In his writings, Jacques described this type of delivery operation and called it a “caesarean section.”

Further, as surgery developed as a branch of medicine, this type of surgical intervention was practiced more and more often. After Morton used ether as an anesthetic in 1846, obstetrics entered a new stage of development. As antisepsis developed, mortality from postoperative sepsis fell by 25 percent. However, there remained a high percentage of deaths due to postoperative bleeding. To eliminate it, various techniques were used. Thus, the Italian professor Porro proposed to remove the uterus after removing the fetus and thereby prevent bleeding. This method of performing the operation reduced the mortality rate of women in labor by 4 times. The final point in this matter was put by Saumlnger, when for the first time in 1882 he implemented the technique of applying silver wire sutures to the uterus. After this, obstetric surgeons only continued to improve this technique.

The development of surgery and the discovery of antibiotics led to the fact that already in the 50s of the 20th century, 4 percent of children were born through cesarean section, and 20 years later - already 5 percent.

Despite the fact that a caesarean section is an operation with all possible post-operative complications, an increasing number of women prefer this procedure due to the fear of natural childbirth. The absence of strict regulations in the law about when a caesarean section should be performed gives the doctor the opportunity to act at his own discretion and at the request of the woman herself.

The fashion for caesarean sections was provoked not only by the opportunity to “quickly” solve the problem, but also by the financial side of the issue. More and more clinics are offering women in labor operative delivery in order to avoid pain and give birth quickly. The Berlin Charité clinic went even further in this matter. She offers the so-called “imperial birth” service. According to the doctors of this clinic, birth like an emperor makes it possible to experience the beauty of natural childbirth without painful contractions. The difference between this operation is that local anesthesia allows parents to see the moment the baby is born. At the moment the child is removed from the mother’s womb, the cloth protecting the mother and surgeons is lowered and thereby given to the mother and father ( if he's nearby) the opportunity to watch the birth of a baby. The father is allowed to cut the umbilical cord, after which the baby is placed on the mother's chest. After this touching procedure, the sheet is lifted and the doctors complete the operation.

When is a caesarean section necessary?

It should be noted that these indications may change during pregnancy. Thus, a low-lying placenta can migrate to the upper parts of the uterus and then the need for surgery disappears. A similar situation occurs with the fetus. It is known that the fetus changes its position throughout pregnancy. So, from a transverse position it can move into a longitudinal one. Sometimes such changes can occur literally a couple of days before birth. Therefore, it is necessary to constantly monitor ( carry out continuous surveillance) the condition of the fetus and mother, and before the scheduled operation, undergo an ultrasound examination again.

A caesarean section is necessary if the following pathologies are present:

• history of cesarean section and failure of the scar after it;
• abnormalities of placenta attachment ( total or partial placenta previa);
• deformation of the pelvic bones or anatomically narrow pelvis;
• fetal position anomalies ( breech presentation, transverse position);
• large fruit (more than 4 kg) or giant fruit ( more than 5 kg), or multiple pregnancy;
• severe pathologies on the part of the mother, related and not related to pregnancy.

Previous cesarean section and scar failure after it

How the scar is formed is determined by the postoperative period. If after the first caesarean section the woman had any inflammatory complications ( which are not uncommon), then the scar may not heal well. The condition of the scar before next births determined using ultrasound ( Ultrasound). If on ultrasound the thickness of the scar is determined to be less than 3 centimeters, its edges are uneven, and connective tissue is visible in its structure, then the scar is considered invalid and the doctor decides in favor of a repeat cesarean section. Many other factors also influence this decision. For example, a large fetus, multiple pregnancies ( twins or triplets) or pathologies in the mother will also be in favor of a cesarean section. Sometimes a doctor, even without contraindications, but in order to eliminate possible complications, resorts to a caesarean section.

Sometimes, already during childbirth, signs of scar deficiency may appear, and there is a threat of uterine rupture. An emergency caesarean section is then performed.

Abnormalities of placenta attachment

The prevalence of complete placenta previa is less than 1 percent of total quantities childbirth Natural childbirth becomes impossible, since the internal os, through which the fetus must pass, is blocked by the placenta. Also, when the uterus contracts ( which occur most intensively in the lower sections) the placenta will detach, which will lead to bleeding. Therefore, with complete placenta previa, delivery by cesarean section is mandatory.

With partial placenta previa, the choice of delivery is determined by the presence of complications. So, if pregnancy is accompanied by abnormal position of the fetus or there is a scar on the uterus, then childbirth is allowed surgical intervention.

In case of incomplete presentation, cesarean section is performed in the presence of the following complications:

• transverse position of the fetus;
• incompetent scar on the uterus;
• polyhydramnios and oligohydramnios ( polyhydramnios or oligohydramnios);
• discrepancy between the size of the pelvis and the size of the fetus;
• multiple pregnancy;
• woman's age over 30 years.

Deformation of the pelvic bones or narrow pelvis

The most common causes of deformation of the pelvic bones are:

• rickets or polio suffered in childhood;
• poor nutrition in childhood;
• spinal deformity, including the coccyx;
• damage to the pelvic bones and their joints as a result of trauma;
• damage to the pelvic bones and their joints due to neoplasms or diseases such as tuberculosis;
• congenital anomalies of the development of the pelvic bones.

In the presence of a narrow pelvis, the baby's head initially cannot enter the small pelvis. There are two variants of this pathology - anatomically and clinically narrow pelvis.

A narrow pelvis from an anatomical point of view is one whose dimensions are more than 1.5 - 2 centimeters smaller than the dimensions of a normal pelvis. Moreover, even a deviation from the norm in at least one of the pelvic sizes leads to complications.

The dimensions of a normal pelvis are:

• external conjugate– the distance between the suprasacral fossa and the upper border of the pubic symphysis is at least 20–21 centimeters;
• true conjugate- 9 centimeters are subtracted from the outer length, which will correspondingly equal 11 - 12 centimeters.
• interosseous size– the distance between the superior iliac spines should be 25–26 centimeters;
• length between the most distant points of the iliac crests should be at least 28 - 29 centimeters.

Degrees of narrow pelvis

Fetal position anomalies

Fetal presentation characterizes which end, cephalic or pelvic, is located at the entrance to the pelvis. In 95–97 percent of cases, a cephalic presentation of the fetus is observed, in which the fetus’s head is located at the entrance to the woman’s pelvis. With this presentation, when the baby is born, the head appears first, and then the rest of the body. With breech presentation, birth occurs in reverse ( first the legs and then the head), since the pelvic end of the child is located at the entrance to the pelvis. Breech presentation is not an absolute indication for caesarean section. If the pregnant woman has no other pathologies, her age is less than 30 years, and the size of the pelvis corresponds to the expected size of the fetus, then natural childbirth is possible. Most often, with breech presentation, the decision in favor of a cesarean section is made by the doctor on an individual basis.

Large fetus or multiple pregnancy

Approaches to childbirth in the presence of a fetus weighing more than 4 kilograms are not the same in different countries. In European countries, such a fetus, even in the absence of other complications and successfully resolved previous births, is an indication for cesarean section.

Specialists approach labor management during multiple pregnancies in a similar way. Such a pregnancy itself often occurs with various anomalies of presentation and fetal position. Very often twins end up in a breech position. Sometimes one fetus is located in a cranial presentation, and the other in a pelvic presentation. The absolute indication for cesarean section is the transverse position of the entire twin.

At the same time, it is worth noting that both in the case of a large fetus and in the case of multiple pregnancies, natural delivery is often complicated by vaginal ruptures and premature rupture of water. One of the most serious complications during such childbirth is weakness of labor. It can occur both at the beginning of labor and during labor. If labor weakness is detected before labor, then the doctor may proceed to an emergency caesarean section. Also, the birth of a large fetus is more often than in other cases complicated by trauma to the mother and child. Therefore, as often happens, the question of the method of childbirth is determined by the doctor on an individual basis.

An unplanned caesarean section in the case of a large fetus is resorted to if:

• weakness of labor is revealed;
• oxygen starvation of the fetus is diagnosed;
• the size of the pelvis does not correspond to the size of the fetus.

Severe pathologies on the part of the mother, related and not related to pregnancy

A woman’s health can be threatened not only by pathologies caused by pregnancy, but also by diseases not related to it.

The following diseases require a caesarean section:

• severe heart failure;
• exacerbation of renal failure;
• retinal detachment in this or a previous pregnancy;
• exacerbation of genitourinary infections;
• cervical fibroids and other tumors.

Dystrophic changes in the retina are also a common indication for cesarean section. The reason for this is the changes in blood pressure that occur during natural childbirth. Because of this, there is a risk of retinal detachment in women with myopia. It should be noted that the risk of detachment is observed in cases of severe myopia ( myopia from minus 3 diopters).

An emergency caesarean section is performed unscheduled due to complications arising during the birth itself.

Pathologies that, if detected, require an unscheduled cesarean section, are:

• weak labor activity;
• premature placental abruption;
• threat of uterine rupture;
• clinically narrow pelvis.

Weak labor

Premature placental abruption

Threat of uterine rupture

Clinically narrow pelvis

Pros and cons of caesarean section

In order to evaluate all the pros and cons of a cesarean section, it is necessary to remember that in 15–20 percent of cases this type of surgical intervention is still performed for health reasons. According to WHO, 15 percent are pathologies that prevent natural childbirth.

Pros of caesarean section

Natural childbirth is not possible in the following cases:

• total placenta previa;
• transverse position of the fetus;
• narrow pelvis grade 3 and 4;
• severe, life-threatening pathologies of the mother ( tumors in the pelvis, severe gestosis).

The advantage of a cesarean section is also the ability to prevent complications of natural childbirth such as ruptures of the perineum and uterus.

A significant advantage for a woman’s sex life is the preservation of the reproductive tract. After all, by pushing the fetus through itself, the woman’s vagina stretches. The situation is worse if an episiotomy is performed during childbirth. During this surgical procedure, an incision is made in the posterior wall of the vagina in order to avoid ruptures and make it easier to push out the fetus. After an episiotomy, further sexual life becomes significantly more complicated. This is due to both the stretching of the vagina and the sutures on it that do not heal for a long time. Caesarean section will minimize the risk of prolapse and prolapse of the internal genital organs ( uterus and vagina), strains of the pelvic muscles and involuntary urination associated with sprains.

An important advantage for many women is that the birth itself is quick and painless, and it can be programmed for any time. The absence of pain is one of the most stimulating factors, because almost all women have a fear of painful natural childbirth. Caesarean section also protects the born child from possible injuries, which he can easily receive during complicated and protracted labor. The baby is at greatest risk when various third-party methods are used during natural childbirth to extract the baby. This may be forceps or vacuum extraction of the fetus. In these cases, the child often receives traumatic brain injuries, which subsequently affect his health.

Disadvantages of a cesarean section for a woman in labor

The disadvantages of surgery for a woman come down to all sorts of postoperative complications, as well as complications that may arise during the operation itself.

The disadvantages of a cesarean section for the mother are:

• postoperative complications;
• long recovery period;
• postpartum depression;
• difficulties in starting breastfeeding after surgery.

The risk of development is especially high during emergency, unscheduled operations. Due to direct contact of the uterus with a non-sterile environment, pathogenic microorganisms enter it. These microorganisms subsequently become a source of infection, most often endometritis.

In 100 percent of cases, during a caesarean section, as with other operations, a fairly large volume of blood is lost. The amount of blood that a woman loses during this process is two or even three times greater than the volume that a woman loses during natural childbirth. This causes weakness and malaise in postoperative period. If a woman suffered from anemia before giving birth ( reduced content hemoglobin), then this worsens her condition even more. In order to return this blood, they most often resort to transfusion ( transfusion of donor blood into the body), which also carries risks of side effects.
The most severe complications are associated with anesthesia and the effect of the anesthetic on mother and baby.

Long recovery period
After surgery on the uterus, her contractility decreases. This, as well as impaired blood supply ( due to vascular damage during surgery) causes long-term healing. The long recovery period is also aggravated by the postoperative suture, which very often can diverge. Muscle recovery cannot begin immediately after the operation, because any physical activity is prohibited for a month or two after it.

All this limits the necessary contact between mother and child. A woman does not immediately begin breastfeeding, and caring for the baby can be difficult.
The recovery period is delayed if a woman develops complications. Most often, intestinal motility is disrupted, which is the cause of long-term constipation.

Women who have had a caesarean section have a 3 times higher risk of being readmitted to the hospital in the first 30 days than women who have given birth vaginally. This is also associated with the development of frequent complications.

The protracted recovery period is also due to the effect of anesthesia. So, in the first days after anesthesia, a woman is bothered by severe headaches, nausea, and sometimes vomiting. Pain at the site of epidural anesthesia restricts the mother's movements and negatively affects her overall well-being.

Postpartum depression
In addition to the consequences that can harm the mother’s physical health, there is psychological discomfort and a high risk of developing postpartum depression. Many women may suffer from the fact that they did not give birth to a child on their own. Experts believe that this is due to interrupted contact with the child and lack of close proximity during childbirth.

It is known that from postpartum depression ( the frequency of which has been increasing recently) no one is insured. However, the risk of its development is higher, according to many experts, in women who have undergone surgery. Depression is associated both with a long recovery period and with the feeling that contact with the baby has been lost. Both psycho-emotional and endocrine factors are involved in its development.
During cesarean section, a high percentage of early postpartum depression has been recorded, which manifests itself in the first weeks after childbirth.

Difficulties in starting breastfeeding after surgery
After surgery, difficulties arise with feeding. This is due to two reasons. The first is that the first milk ( colostrum) becomes unsuitable for feeding a child due to the penetration of anesthesia medications into it. Therefore, the baby should not be breastfed on the first day after surgery. If a woman has undergone general anesthesia, then feeding the baby is postponed for several weeks, since the anesthetics used for general anesthesia are stronger and therefore take longer to eliminate. The second reason is the development of postoperative complications that interfere with the full care and feeding of the child.

Cons of a caesarean section for a baby

Another significant disadvantage is the baby’s poor adaptation to the external environment after surgery. During natural childbirth, the fetus, passing through the mother’s birth canal, gradually adapts to changes external environment. It adapts to new pressure, light, temperature. After all, for 9 months he has been in the same climate. During a caesarean section, when the baby is abruptly removed from the mother's uterus, there is no such adaptation. In this case, the child experiences a sharp drop in atmospheric pressure, which naturally has a negative effect on his nervous system. Some believe that such a difference is a further cause of problems with vascular tone in children ( for example, the cause of banal vascular dystonia).

Another complication for the child is fetal fluid retention syndrome. It is known that a child, while in the womb, receives the necessary oxygen through the umbilical cord. His lungs are filled not with air, but with amniotic fluid. As it passes through the birth canal, this fluid is pushed out and only a small amount is removed using an aspirator. In a baby born by Caesarean section, this fluid often remains in the lungs. Sometimes it is absorbed by the lung tissue, but in weakened children this fluid can cause pneumonia.

As with natural childbirth, with a caesarean section there is a risk of injury to the baby due to difficulty in removing it. However, the risk of injury in this case is much lower.

There are many scientific publications on the topic that children born by cesarean section are more likely to suffer from autism, attention deficit hyperactivity disorder, and are less resistant to stress. Much of this is disputed by experts, because although childbirth is important, many believe, it is still only an episode in the life of a child. After childbirth, a whole complex of care and education follows, which determines both the mental and physical health of the child.

Despite the abundance of disadvantages, a caesarean section is sometimes the only possible way to extract the fetus. It helps reduce the risk of maternal and perinatal mortality ( fetal death during pregnancy and during the first week after birth). The operation also allows you to avoid many herbs, which are not uncommon during protracted natural childbirth. At the same time, it should be carried out according to strict indications, only when all the pros and cons are weighed. After all, any birth - both natural and by cesarean section - carries possible risks.

Preparing a pregnant woman for a caesarean section

It is necessary to go to the hospital a day or two before the operation. If a woman has a repeat cesarean section, then she must be hospitalized 2 weeks before the intended operation. During this time, the woman is examined by a doctor and undergoes tests. Blood of the required type is also prepared, which will be used to replace blood loss during the operation.

Before the operation it is necessary to carry out:
General blood analysis
A blood test is done primarily to assess the level of hemoglobin and red blood cells in the blood of a woman in labor. Normally, the hemoglobin level should not be less than 120 grams per liter of blood, while the red blood cell count should be between 3.7 and 4.7 million per milliliter of blood. If at least one of the indicators is lower, this means that the pregnant woman suffers from anemia. Women with anemia tolerate surgery less well and, as a result, lose a lot of blood. The doctor, knowing about anemia, must ensure that there is a sufficient volume of blood of the required type in the operating room for emergency cases.

Attention is also paid to leukocytes, the number of which should not exceed 9x10 9

Increase in leukocytes ( leukocytosis) indicates an inflammatory process in the pregnant woman’s body, which is a relative contraindication to cesarean section. If there is an inflammatory process in a woman’s body, this increases the risk of developing septic complications tenfold.

Blood chemistry
The main indicator that the doctor is most interested in before surgery is blood glucose. Increased level glucose ( popularly known as sugar) in the blood indicates that the woman may be suffering from diabetes. This disease is the second cause of complications in the postoperative period after anemia. Women with diabetes mellitus most often experience infectious complications (endometritis, wound suppuration), complications during the operation. Therefore, if the doctor detects high glucose levels, he will prescribe treatment to stabilize the levels.

Risk of large ( more than 4 kg) and giant ( more than 5 kg) of the fetus in such women is tens of times higher than in women who do not suffer from this pathology. As you know, large fetuses are more susceptible to injury.

General urine analysis
A general urine test is also carried out to exclude infectious processes in a woman’s body. Thus, inflammation of the appendages, cervicitis and vaginitis are often accompanied by an increased content of leukocytes in the urine and changes in its composition. Diseases of the genital area are the main contraindication to cesarean section. Therefore, if signs of these diseases are detected in the urine or blood, the doctor may postpone surgery due to increased risk purulent complications.

Ultrasound
Ultrasound examination is also a mandatory examination before cesarean section. The purpose of it is to determine the position of the fetus. It is very important to exclude abnormalities incompatible with life in the fetus, which are an absolute contraindication to cesarean section. In women with a history of cesarean section, an ultrasound is performed to assess the consistency of the uterine scar.

Coagulogram
A coagulogram is a laboratory test method that studies blood clotting. Coagulation pathologies are also a contraindication to cesarean section, since bleeding develops due to the fact that the blood does not clot well. The coagulogram includes such indicators as thrombin and prothrombin time, fibrinogen concentration.
The blood type and its Rh factor are also re-determined.

On the eve of the operation

On the day of surgery

Description of caesarean section operation

The operation can be performed by various techniques depending on the required access to the uterus and the fetus. There are three main options for surgical approach ( abdominal incision) to the pregnant uterus.

Surgical approaches to the uterus are:

• access along the midline of the abdomen ( classic cut);
• low transverse Pfannenstiel approach;
• suprapubic transverse approach according to Joel-Cohen.

Classic access

Pfannenstiel access

Joel-Cohen access

During a cesarean section, there are several options for accessing the fetus through the uterine wall.

Options for incision of the uterine wall are:

• transverse incision in the lower part of the uterus;
• midline section of the uterine body;
• midline section of the body and lower part of the uterus.

Methods of cesarean section surgery

• technique of transverse incision in the lower part of the uterus;
• corporate methodology;
• isthmic-corporeal technique.

Transverse incision technique in the lower part of the uterus

Variants of the transverse incision technique in the lower part of the uterus are:

• with dissection of the vesicouterine fold ( Pfannenstiel access or small classic incision);
• without dissecting the vesicouterine fold ( Joel-Cohen access).

Corporate methodology

The main indications for corporal caesarean section are:

• need for hysterectomy removal of the uterus) after delivery - for benign and malignant formations in the uterine wall;
• heavy bleeding;
• the fetus is in a transverse position;
• a living fetus from a deceased woman in labor;
• the surgeon’s lack of experience in performing caesarean sections using other methods.

Isthmic-corporeal technique

Stages of a caesarean section

Similarities and differences between the stages of a cesarean section during different methods

First stage

Then the aponeurosis is cut transversely with a scalpel ( tendon) rectus and oblique abdominal muscles. Using scissors, the aponeurosis is separated from the muscles and white ( median) belly lines. Its upper and lower edges are grabbed with special clamps and separated to the navel and pubic bones, respectively. The exposed muscles of the abdominal wall are moved apart with the help of fingers along the course of the muscle fibers. Next, a longitudinal incision of the peritoneum is carefully made ( membrane covering internal organs) from the level of the navel to the apex of the bladder and the uterus is visualized.

Second phase

Next comes the dissection of the uterus itself. Using the transverse incision technique, the surgeon determines the location of the fetal head and makes a small transverse incision with a scalpel in this area. Using the index fingers, the incision is expanded in the longitudinal direction to 10 - 12 centimeters, which corresponds to the diameter of the fetal head.

Then the fetal bladder is opened with a scalpel and the membranes are separated with fingers.

Third stage

To reduce blood loss and make it easier to remove the placenta, medications are injected into the uterus with a syringe, which leads to a contraction of the muscle layer.

Drugs that promote uterine contractions include:

• oxytocin;
• ergotamine;
• methylergometrine.

Fourth stage

The napkins are removed from the abdominal cavity and the peritoneum is sutured with a continuous suture from top to bottom. Next, the muscles, aponeurosis and subcutaneous tissue. A cosmetic suture is applied to the skin using thin threads ( from silk, nylon, catgut) or medical braces.

Methods of anesthesia for caesarean section

The choice of pain relief method depends on a number of factors:

• pregnant woman's medical history ( information about previous births, obstetrics and gynecological pathologies );
• general state body of a pregnant woman ( age, concomitant diseases, especially cardiovascular vascular system );
• condition of the fetus ( abnormal fetal position, acute placental insufficiency or fetal hypoxia);
• type of transaction ( emergency or planned);
• availability of appropriate devices and equipment for anesthesia in the obstetric department;
• experience of an anesthesiologist;
• wishes of the mother in labor ( be conscious and see the newborn baby or sleep peacefully during surgical procedures).

General anesthesia

The stages of anesthesia are:

• induction of anesthesia;
• muscle relaxation;
• aeration of the lungs using a ventilator;
• main ( supportive) anesthesia.

Complete muscle relaxation is achieved by intravenous administration of muscle relaxants ( medicines that relax muscle tissue). The main muscle relaxant used in obstetric practice is succinylcholine. Muscle relaxants relax all the muscles of the body, including the uterine muscles.
Due to complete relaxation of the respiratory muscles, the patient needs artificial aeration of the lungs ( breathing is supported artificially). To do this, a tracheal tube is inserted into the trachea and connected to a ventilator. The machine delivers a mixture of oxygen and anesthetic to the lungs.

Basic anesthesia is maintained by administering gaseous anesthetics ( nitrous oxide, desflurane, sevoflurane) and intravenous neuroleptics ( fentanyl, droperidol).
General anesthesia has a number of negative effects on the body of the mother and fetus.

Negative effects of general anesthesia

• Regional anesthesia is contraindicated for pregnant women ( especially with pathologies of the heart and nervous system);
• the life of the pregnant woman and/or the fetus is at risk, and a cesarean section is urgent ( emergency);
• The pregnant woman categorically refuses other types of anesthesia.

Regional anesthesia

Two options are used regional anesthesia:

• spinal anesthesia.

Before the operation begins, the pregnant woman undergoes a puncture ( puncture) at the lumbar level with a special needle. The needle is deepened to the epidural space, where all the nerves exit the spinal canal. A catheter is inserted through the needle ( thin flexible tube) and remove the needle itself. Painkillers are administered through the catheter ( lidocaine, marcaine), which suppress pain and tactile sensitivity from the lower back to the tips of the toes. Thanks to an indwelling catheter, anesthetic can be added during surgery as needed. After surgery is completed, the catheter is left in place for a couple of days to administer pain medications during the postoperative period.

Spinal anesthesia method
The spinal method of anesthesia, like the epidural, leads to loss of sensation in the lower part of the body. Unlike epidural, with spinal anesthesia, a needle is inserted directly into the spinal canal, where the anesthetic is delivered. In more than 97 - 98 percent of cases, it is achieved total loss any sensitivity and relaxation of the muscles of the lower body including the uterus. The main advantage of this type of anesthesia is the need for small doses of anesthetics to achieve results, which ensures less impact on the body of the mother and fetus.

There are a number of conditions under which regional anesthesia is contraindicated.

The main contraindications include:

• inflammatory and infectious processes in the area of ​​lumbar puncture;
• blood diseases with impaired coagulation;
• acute infectious process in the body;
• allergic reactions to painkillers;
• lack of an anesthesiologist who has the technique of regional anesthesia, or lack of equipment for it;
• severe pathology of the spine with its deformation;
• categorical refusal of the pregnant woman.

Complications of caesarean section

Complications during surgery

The following complications may also occur during surgery:

• circulatory disorders;
• pulmonary ventilation disorders;
• thermoregulation disorders;
• damage to large vessels and nearby organs.

Thermoregulation disorders are manifested by hyperthermia and hypothermia. Malignant hyperthermia is characterized by an increase in body temperature of 2 degrees Celsius within two hours. With hypothermia, the body temperature drops below 36 degrees Celsius. Hypothermia, compared to hyperthermia, is more common. Disturbances in thermoregulation can be provoked by anesthetics ( for example, isoflurane) and muscle relaxants.
During a caesarean section, organs close to the uterus can also be accidentally damaged. The bladder is most often damaged.

Complications in the postoperative period are:

• complications infectious nature;
• formation of adhesions;
• severe pain syndrome;
• postoperative scar.

Infectious complications

Infection of a postoperative wound, despite all attempts to reduce the risk of infections after surgery, occurs in one to two cases out of ten. In this case, the woman experiences an increase in temperature, sharp pain and redness in the wound area. Further, discharge appears from the incision site, and the edges of the incision themselves diverge. The discharge very quickly acquires an unpleasant purulent odor.

Inflammation of the internal organs spreads to the uterus and organs urinary system. A common complication after cesarean section is inflammation of the uterine tissue or endometritis. The risk of developing endometritis during this operation is 10 times higher compared to natural childbirth. With endometritis, such general symptoms of infection as fever, chills, and severe malaise also appear. A characteristic symptom Endometritis is bloody or purulent discharge from the vagina, as well as sharp pain in the lower abdomen. The cause of endometritis is infection in the uterine cavity.

The infection may also affect urinary tract. As a rule, after cesarean ( as after other operations) infection of the urethra occurs. This is due to the placement of the catheter ( thin tube) into the urethra during surgery. This is done to empty the bladder. The main symptom in this case is painful, difficult urination.

Blood clots

The danger of a blood clot is that it can clog a blood vessel and stop blood flow to the organ that is supplied by this vessel. Symptoms of thrombosis are determined by the organ where it occurred. So pulmonary artery thrombosis ( pulmonary thromboembolism) manifested by cough, difficulty breathing; thrombosis of blood vessels of the lower extremities - sharp pain, pallor of the skin, numbness.

Prevention of blood clots during cesarean section involves prescribing special medications that thin the blood and prevent the formation of blood clots.

Formation of adhesions

The mechanism of formation of adhesions is associated with the scarring process after surgery. During this process, a substance called fibrin is released. This substance glues soft tissues together, thus restoring damaged integrity. However, gluing occurs not only where necessary, but also in those places where the integrity of the tissues has not been compromised. So fibrin affects the intestinal loops and pelvic organs, fusing them together.

After a cesarean section, the adhesive process most often affects the intestines and the uterus itself. The danger is that adhesions affecting the fallopian tubes and ovaries can later cause tubal obstruction and, as a result, infertility. Adhesions that form between intestinal loops limit its mobility. The loops become, as it were, “soldered” together. This phenomenon can cause intestinal obstruction. Even if an obstruction does not form, adhesions still disrupt the normal functioning of the intestines. The consequence of this is long-term, painful constipation.

Severe pain syndrome

Postoperative scar

Complications associated with anesthesia

The greatest danger is posed by general anesthesia. It is known that more than 80 percent of all postoperative complications are associated with anesthesia. With this type of anesthesia, the risk of developing respiratory and cardiovascular complications is maximum. Respiratory depression caused by the action of the anesthetic is most often recorded. During prolonged operations, there is a risk of developing pneumonia associated with intubation of the lungs.
With both general and local anesthesia, there is a risk of a drop in blood pressure.

How does a caesarean section affect the baby?

Effect of anesthesia

Impact on the emotional sphere

Effect on the gastrointestinal tract

Restoration of a woman ( rehabilitation) after caesarean section

Diet

Daily norms for the chemical composition and energy value of nutrition after cesarean section are:

• proteins ( 60 percent animal origin) – 1.5 grams per 1 kilogram of weight;
• fats ( 30 percent plant origin) – 80 – 90 grams;
• carbohydrates ( 30 percent easily digestible) – 200 – 250 grams;
• energy value – 2000 – 2000 kilocalories.

• for the first three days, the consistency of the dishes should be liquid or mushy;
• the menu should include foods that are easily digestible;
• recommended heat treatment– boiling in water or steaming;
• The daily food intake should be divided into 5 – 6 servings;
• The temperature of the food consumed should not be too high or low.

The stages of preparation and rules for using broth are:

• Place meat in water and bring to a boil. Then you need to drain the broth, add clean cold water and drain again after boiling.
• Pour the third water over the meat and bring to a boil. Next, add the vegetables and bring the broth to readiness.
• Divide the finished broth into 100 ml portions.
• The recommended daily intake is from 200 to 300 milliliters of broth.

Drinking regime after cesarean section
The diet of a nursing woman involves reducing the amount of fluid consumed. Immediately after the operation, doctors recommend stopping drinking water and starting drinking 6 to 8 hours later. The amount of fluid per day during the first week, starting from the second day after surgery, should not exceed 1 liter, not counting the broth. After day 7, the amount of water or drinks can be increased to 1.5 liters.

During the postpartum period, you can drink the following drinks:

• weakly brewed tea;
• rosehip decoction;
• dried fruits compote;
• fruit drink;
• apple juice diluted with water.

Products that are allowed to be included in the menu when recovering from a cesarean section are:

• yogurt ( no fruit additives);
• low fat cottage cheese;
• kefir 1 percent fat;
• potato ( puree);
• beet;
• apples ( baked);
• bananas;
• eggs ( boiled or steamed omelettes);
• lean meat ( boiled);
• lean fish ( boiled);
• cereals ( except rice).

• coffee;
• chocolate;
• hot seasonings and spices;
• raw eggs;
• caviar ( red and black);
• citrus and exotic fruits;
• fresh cabbage, radishes, raw onions and garlic, cucumbers, tomatoes;
• plums, cherries, pears, strawberries.

How to reduce pain after cesarean section?

Factors that provoke pain after cesarean section are:

• suture after surgery;
• intestinal dysfunction;
• contractions of the uterus.

Reducing the pain caused by the stitch

• During the first 24 hours, you can apply a special cool pillow to the suture area, which can be purchased at a pharmacy.
• It is worth reducing the frequency of touching the seam, and also keeping it clean to prevent infection.
• The seam should be washed every day and then dried with a clean towel.
• You should refrain from lifting heavy objects and making sudden movements.
• To prevent the baby from putting pressure on the suture during feeding, you should find a special position. A chair with low armrests for feeding, a sitting position, and pillows ( under your back) and roller ( between stomach and bed) while feeding while lying down.

Another factor that causes the suture to hurt is coughing, which occurs due to the accumulation of mucus in the lungs after anesthesia. To quickly get rid of mucus and at the same time reduce pain, a woman after a caesarean section is recommended to do deep breath, and then drawing in your stomach - a quick exhalation. The exercise should be repeated several times. First, apply a rolled up towel to the seam area.

How to reduce discomfort from poor bowel function?

Products, causing flatulence, are:

• legumes ( beans, lentils, peas);
• cabbage ( white cabbage, Beijing, broccoli, cauliflower);
• radish, turnip, radish;
• milk and dairy products;
• carbonated drinks.

The following exercise will help reduce the discomfort of bloating in the stomach. The patient should make rocking movements forward and backward while sitting in bed. Breathing while swinging should be deep. A woman can also release gases by lying on her right or left side and massaging the surface of her abdomen. If there is no bowel movement for a long time, you should ask the medical staff to give an enema.

How to reduce pain in the lower abdomen?

Exercises that will help cope with pain in the lower abdomen are:

• Stroking the abdomen with the palm in a circular motion– ironing should be done in a clockwise direction, as well as up and down for 2 – 3 minutes.
• Massaging chest – the right, left and upper surfaces of the chest should be stroked from the bottom up to the armpit.
• Stroking the lumbar region– you need to place your hands behind your back and use the backs of your hands to massage your lower back from top to bottom and to the sides.
• Rotational movements of the feet– pressing your heels to the bed, you need to alternately bend your feet away from you and towards you, describing the largest possible circle.
• Leg Curl– you should alternately bend the left and right leg, sliding his heel along the bed.

Why is there discharge after a caesarean section?

What does a suture look like after a caesarean section?

If there are complications and it is impossible to perform a transverse section, the doctor may decide on a corporal caesarean section. In this case, the incision is made along the anterior abdominal wall in vertical direction from the navel to the pubic bone. After such an operation, there is a need for a strong connection of tissues, so the cosmetic suture is replaced with an interrupted suture. Such a seam looks more sloppy and may become more noticeable over time.
The appearance of the suture changes during the healing process, which can be divided into three stages.

The phases of suture scarring after cesarean section are:

• First stage ( 7 – 14 days) – the scar has a bright pink-red color, the edges of the seam are embossed with traces of threads.
• Second phase ( 3 – 4 weeks) – the seam begins to thicken, becomes less prominent, its color changes to red-violet.
• Final stage ( 1 – 12 months) – disappear painful sensations, the seam is filled with connective tissue, as a result of which it becomes less noticeable. Finished seam color of this period does not differ from the color of the surrounding skin.

Is breastfeeding possible after a caesarean section?

The reasons that hinder the establishment of breastfeeding are:

• Large blood loss during surgery– often after a caesarean section the patient needs time to recover, as a result of which the first breastfeeding is delayed, which subsequently causes difficulties with feeding.
• Medicines– in some cases, the doctor prescribes medications to the woman that are incompatible with breastfeeding.
• Stress associated with surgery– Stress can have a detrimental effect on milk production.
• Violation of the adaptation mechanism in a child– when born by caesarean section, the child does not go through the natural birth canal, which can negatively affect his sucking activity.
• Delayed milk supply– during a caesarean section in the mother’s body, the hormone prolactin, which is responsible for the production of colostrum, begins to be produced later than during natural childbirth. This fact can cause a delay in the arrival of milk by 3 to 7 days.
• Painful sensations– the pain that accompanies recovery after surgery blocks the production of the hormone oxytocin, the function of which is to separate milk from the breast.

How to remove belly fat after caesarean section?

Initial loads

Exercises that can be done a few days after surgery are:

• It is necessary to take the starting position, reclining or sitting on the sofa. Placing a pillow under your back will help increase comfort during exercise.
• Next you need to start flexing and straightening your feet. You need to perform the exercises energetically, without making jerky movements.
• The next exercise is to rotate your feet to the right and left.
• Then you should begin to tense and relax the gluteal muscles.
• After a few minutes of rest, you need to begin alternately bending and straightening your legs.

The stages of performing gymnastics for the pelvic muscles are:

• You need to tense and then relax the muscles of the anus, holding for 1 - 2 seconds.
• Next, you need to tense and relax the vaginal muscles.
• Repeat alternating tension and relaxation of the muscles of the anus and vagina several times, gradually increasing the duration.
• After a few workouts, you should try to perform the exercise separately for each muscle group, gradually increasing the strength of tension.

Abdominal exercises after cesarean section

Exercises that will help normalize the abdominal muscles after a cesarean section include:

• To perform the first exercise, you should spread your knees to the side, while clasping your stomach with your arms crosswise. As you exhale, you need to raise your shoulders and head, and press your palms onto your sides. After holding this position for a few seconds, you need to exhale and relax.
• Next, having taken the starting position, you should take a deep breath, filling your stomach with air. As you exhale, you need to pull in your stomach, pressing your back to the floor.
• The next exercise should be started gradually. Place your palms on your stomach and, while inhaling, raise your head without making any sudden movements. As you exhale, you should take the starting position. The next day, you should raise your head a little higher. After a few more days, you need to start raising your shoulders along with your head, and after a few weeks, raise your entire body to a sitting position.
• The last exercise is to alternately bring your legs bent at the knees to your chest.

How to make a scar on the skin invisible?

Quick ways to reduce the visibility of a suture after a cesarean section include:

• plastic excision of the suture;
• laser resurfacing;
• aluminum oxide grinding;
• chemical peeling;
• scar tattoo.

Excision of suture from caesarean section

Laser resurfacing

Aluminum oxide grinding ( microdermabrasion)

Chemical peeling

Tattoo on a scar

Ointments for reducing scars after caesarean section

Drugs that are used to reduce the visibility of the suture after cesarean section are:

• contractubex– slows down the growth of connective tissue;
• dermatix– improves the appearance of the scar, smoothing and softening the skin;
• clearwin– lightens damaged skin by several tones;
• kelofibrase– smoothes the surface of the scar;
• zeraderm ultra– promotes the growth of new cells;
• fermenkol– eliminates the feeling of tightness, reduces the size of the scar;
• mederma– effective in the treatment of scars whose age does not exceed 1 year.

Restoring menstruation after cesarean section

The circumstances on which the restoration of menstruation depends include:

• clinical picture of pregnancy;
• the patient’s lifestyle, quality of nutrition, availability of timely rest;
• age and individual characteristics of the mother’s body;
• presence of lactation.

The effect of breastfeeding on the restoration of menstruation

The dates for the appearance of menstruation are:

• During active breastfeeding– menstruation may begin after a long period, which often exceeds 12 months.
• When feeding mixed type– the menstrual cycle begins on average 3 to 4 months after a cesarean section.
• When introducing complementary foods– very often menstruation is restored within a fairly short time.
• In the absence of lactation– menstruation can occur 5–8 weeks after the birth of the baby. If menstruation does not occur within 2 to 3 months, the patient should consult a doctor.

Other factors influencing the restoration of the menstrual cycle

Patients who may experience a delay in menstruation after a cesarean section include:

• women whose pregnancy or childbirth had complications;
• patients giving birth for the first time, whose age exceeds 30 years;
• women in labor whose health is weakened by chronic diseases ( especially endocrine system ).

Problems in restoring menstruation after cesarean section and their causes are:

• Changed duration of menstruation– short ( 12 o'Clock in the noon) or too long periods ( exceeding 6 – 7 days) may occur due to diseases such as uterine fibroids ( benign neoplasm) or endometriosis ( endometrial growth).
• Non-standard volume of discharge– the amount of discharge during menstruation that exceeds the norm ( from 50 to 150 milliliters), can be the cause of a number of gynecological diseases.
• Continued spotting at the beginning or end of menstruation– can be triggered by various inflammatory processes internal genital organs.

After the birth of a child, the load on the mother's nervous system increases. To ensure the timely development of menstrual function, a woman should devote sufficient time to proper rest and avoid increased fatigue. Also, in the postpartum period, it is necessary to correct pathologies of the endocrine system, since exacerbation of such diseases causes a delay in menstruation after cesarean section.

How is the subsequent pregnancy after a caesarean section?

During the first two months after surgery, a woman should avoid sexual intercourse. Next, during the year she must take contraception. During this period, the woman should undergo periodic ultrasound monitoring to assess the condition of the suture. The doctor evaluates the thickness and tissue of the suture. If a suture on the uterus consists of a large amount of connective tissue, then such a suture is called incompetent. Pregnancy with such a suture is dangerous for both mother and child. When the uterus contracts, such a suture may separate, which will lead to instant death of the fetus. The condition of the suture can be most accurately assessed no earlier than 10–12 months after surgery. Full picture gives such a study as hysteroscopy. It is carried out using an endoscope, which is inserted into the uterine cavity, and the doctor visually examines the suture. If the suture does not heal well due to unsatisfactory contractility of the uterus, the doctor may recommend physiotherapy to improve its tone.

Only after the suture on the uterus has healed can the doctor “give the go-ahead” for another pregnancy. In this case, subsequent births can occur naturally. It is important that the pregnancy proceeds without difficulties. To do this, before planning a pregnancy, it is necessary to cure all chronic infections, boost immunity, and if there is anemia, then take treatment. During pregnancy, a woman should also periodically evaluate the condition of the suture, but only with the help of ultrasound.

Features of subsequent pregnancy

After caesarean section repeat pregnancy may become complicated. Thus, every third woman faces threats of termination of pregnancy. The most common complication is placenta previa. This condition aggravates the course of subsequent childbirth with periodic bleeding from the genital tract. Frequently recurring bleeding can cause premature birth.

Another feature is the incorrect positioning of the fetus. It has been noted that in women with a uterine scar, the transverse position of the fetus is more common.
The greatest danger during pregnancy is scar failure, a common symptom of which is pain in the lower abdomen or lower back pain. Women very often do not attach importance to this symptom, assuming that the pain will go away.
25 percent of women experience fetal growth restriction, and children are often born with signs of immaturity.

Complications such as uterine rupture are less common. As a rule, they are noted when incisions were made not in the lower segment of the uterus, but in the area of ​​its body ( corporal caesarean section). In this case, uterine ruptures can reach 20 percent.

Pregnant women with a uterine scar should arrive at the hospital 2 to 3 weeks earlier than usual ( that is, at 35 - 36 weeks). Immediately before birth, premature rupture of water is likely, and in postpartum period– difficulties in separating the placenta.

The following may occur after a caesarean section: pregnancy complications:

• various abnormalities of placenta attachment ( low insertion or presentation);
• transverse position or breech presentation of the fetus;
• failure of the suture on the uterus;
• premature birth;
• uterine ruptures.

Childbirth after caesarean section

Caesarean section is a real salvation when independent childbirth is either impossible or dangerous for the woman and her baby. This operation allows the baby to appear not through natural physiological pathways, but through two incisions. Laparotomy is an opening of the abdominal wall, and hysterotomy is a dissection of the uterine wall. These two artificial openings become the outlet for the baby and the placenta.

In this article we will talk about how surgical childbirth takes place step by step, what doctors do before surgery, during surgical childbirth and after it. This information will help women be more knowledgeable as they prepare for elective surgery.

Duration of hospitalization and preparation

In modern obstetric practice, cesarean section as a method of delivery occurs in approximately 15% of all births, and in some regions the number of surgical births reaches 20%. For comparison, in 1984 the share of surgical births was no more than 3.3%. Experts tend to associate this increase in the popularity of the operation with a general decline in the birth rate, with an increase in the number of women who think about their first child only after 35 years, as well as the prevalence of IVF.

Planned operations account for approximately 85-90% of all abdominal operations. Emergency operations are performed quite rarely, only for health reasons.

If a woman is scheduled to have a caesarean section, the decision on the timing of the operation can be made both in the early stages and at the end of the pregnancy. This is due to the reasons why independent childbirth is impossible. If the indications are absolute, that is, irreparable (narrow pelvis, more than two scars on the uterus, etc.), then the question of alternatives is not raised from the very beginning. It is clear that there cannot be any other method of delivery.

In other cases, when the grounds for surgery are discovered later (large fetus, pathological presentation of the fetus, etc.), the decision to perform an operative birth is made only after the 35th week of pregnancy. By this time, the size of the fetus and its estimated weight, as well as some details of its location inside the uterus, become clear.

Many have heard that children who are born at 36-37 weeks are already quite viable. This is true, but there is a risk of slow maturation of lung tissue in a particular child, and this can cause the development of respiratory failure after birth. Therefore, the Ministry of Health, in order to avoid unnecessary risks, recommends elective surgery after the 39th week of pregnancy. By this time, the lung tissue has fully matured in almost all children.

In addition, delivery is considered more favorable if it is as close as possible to the expected date of birth - for the woman’s body, stress will be reduced, and lactation will begin, albeit with a slight delay compared to physiological childbirth, but still almost on time.

If there are no indications for more early surgery, then a referral to the maternity hospital in the antenatal clinic is issued at 38 weeks. Within a few days, the woman should go to the hospital and begin preparing for the upcoming surgical birth. Preparation - important stage, which largely determines how successful and without complications the operation and postoperative period will be.

On the day of hospitalization, the necessary tests are taken from the woman. These include general analysis blood, analysis to determine and confirm blood group and Rh factor, biochemical analysis blood, and in some cases a coagulogram to determine the rate of blood clotting and other hemostasis factors. They do a general urine test and conduct a laboratory test of a vaginal smear.

While the laboratory technicians are doing these tests, the attending physician collects a complete and detailed obstetric history of his patient - the number of births, abortions, miscarriages, a history of frozen pregnancy, and other operations on the reproductive organs.

The baby's condition is also examined. An ultrasound is performed to determine its location in the uterus, its dimensions, the main one of which is the diameter of the head, the expected weight of the baby is calculated, and the location of the placenta is determined relative to the anterior wall of the uterus, on which the incision is planned. A CTG is performed to determine the baby's heart rate, motor activity and general condition.

About 24 hours later, the woman meets with an anesthesiologist. The doctor identifies the presence of indications and contraindications for certain types of anesthesia, plans her anesthesia together with the woman, not forgetting to tell how it will work, how long it will take and what its side effects are. After the patient signs informed consent for epidural, spinal or general anesthesia, she is prescribed premedication.

It is forbidden to eat from the evening of the previous day. On the morning of the operation, it is prohibited to eat or drink. The woman is given an enema to cleanse the intestines, her pubic area is shaved, and she is dressed in a sterile shirt.

After preparatory measures, the woman is taken to the operating room. There everything is ready for the scheduled operation. The surgical team and the anesthesiologist are already waiting for her, who, in fact, begins the first stage of the operation - pain relief.

Anesthesia

Anesthesia is necessary because the operation is abdominal and lasts from 25 to 45 minutes, and sometimes longer. The first stage is adequate pain relief. It determines how comfortable the patient will feel and how easy it will be for the surgeon to work.

If it has been determined that epidural anesthesia will be used, then the operation itself will begin a little later, since approximately 15-20 minutes pass from the moment of anesthesia until the corresponding effect is achieved. The woman is placed on her side with her legs tucked in (fetal position) or she sits on the operating table with her head and shoulders bowed low and her back rounded.

The lumbar spine is treated with an antiseptic, the anesthesiologist performs a lumbar puncture - a thin special needle is used to puncture between the vertebrae, a catheter is inserted and a test dose of anesthetic is injected through it into the epidural space of the spine. After three minutes, if nothing abnormal happens, the main dose of anesthesia is administered. After 15 minutes, the woman begins to feel numbness and tingling in the lower part of the body, and ceases to feel her legs and lower abdomen.

The anesthesiologist constantly monitors the patient’s blood pressure, heartbeat and condition, and communicates with her. He conducts a sensory and motor sensitivity test, after which he gives a command to the surgical team that the patient is ready for surgery. A screen is placed in front of the woman in labor (it is completely unnecessary for the woman to contemplate what is happening), and the doctors proceed directly to the operation. The woman is conscious but does not feel pain because the medications inside the epidural space block the transmission of nerve impulses from the nerve endings to the brain.

General anesthesia requires less time. The woman is placed on the operating table, her arms are fixed, a catheter is inserted into the vein and anesthetics are injected through it. When the patient falls asleep, and this happens in a matter of seconds, the anesthesiologist inserts an endotracheal tube into the trachea and connects the patient to a ventilator. During the operation, the doctor may add or decrease the dosage of medications. Doctors can begin the operation, during which the woman in labor sleeps soundly and does not feel anything.

Progress of surgical birth step by step

It should be noted that there are many methods of performing the operation. The surgeon chooses a specific one depending on the situation, circumstances, anamnesis, indications and own preferences. There are techniques in which each layer is then cut and sutured, there are methods in which tissue dissection is minimized, and the muscle tissue is simply manually pulled aside. The incision can be either vertical or horizontal.

A low horizontal incision in the lower uterine segment is considered the best option, since such sutures heal better, allow you to endure a subsequent pregnancy without problems and even give birth to a second child naturally, if the woman wants it and there are no medical contraindications.

Whatever the method of delivery chosen by the doctor, the operation will include the main stages, which we will talk about in more detail.

Laparotomy

The abdomen is treated with an antiseptic, isolated from other parts of the body with sterile tissue, and the anterior abdominal wall is dissected. With a vertical dissection, an inferomedian laparotomy is performed - an incision is made four centimeters below the navel and brought to a point located four centimeters above the pubic symphysis. For a horizontal section, which is called a Pfannenstiel laparotomy, an arcuate incision is made along the skin fold above the pubis, 12 to 15 centimeters long, longer if necessary.

A Joel-Cohen laparotomy may also be performed, in which the incision is horizontal below the umbilicus but well above the peripubic fold. If necessary, this incision can be lengthened with special scissors.

The muscles are carefully moved aside, and the bladder is temporarily removed to the side so as not to accidentally injure it. Only the wall of the uterus separates the doctor from the child.

Uterine dissection

The reproductive organ can also be dissected in different ways. If the surgeon is a big fan of the traditional technique, he can make an incision along the body of the uterus horizontally, vertically along the midline using the Sanger method, or a pubic incision according to Fritsch, which passes through the entire uterus - from one end to the other.

The doctor uses his hand or a surgical instrument to open the amniotic sac. If the birth is premature, it is considered the best option not to open the membranes; it will be more comfortable for the baby to be born in them, and adaptation will be easier.

Fetal extraction

The most crucial moment is coming. When a child is born physiologically or during surgical procedures, doctors are equally worried, because the likelihood of injury to the fetus during a CS, although insignificant, still exists. To reduce such risks, the surgeon inserts four fingers of the right hand into the uterus. If the baby is positioned head down, the doctor's palm approaches the back of the head. Carefully cut the head into the incision on the uterus and remove the shoulders one by one. If the child is in a breech position, he is removed by the leg or inguinal fold. If the baby lies across, pull it out by the leg.

The umbilical cord is cut. The baby is given to a pediatrician, neonatologist or nurse in the children's department for weighing, placing a clothespin on the umbilical cord and other procedures. If a woman is not sleeping, then they show her the baby, tell her the gender, weight, height, and can put him to the breast immediately after birth. During surgical childbirth under general anesthesia, the meeting between mother and baby is postponed to a later time, when the woman comes to her senses and recovers from anesthesia.

Placenta extraction

The placenta is detached by hand. If it has grown in, it may be necessary to excise part of the endometrium and myometrium. In case of total ingrowth, the uterus is completely removed. The surgeon also inspects the uterine cavity, checks that there is nothing left in it, checks the patency of the cervical canal of the cervix; if it is impassable, it is dilated manually. This is necessary so that lochia (postpartum discharge) in the postpartum period can freely leave the uterine cavity without causing stagnation and inflammation.

Suturing the uterus

A single-row or double-row suture is applied to the cut edges of the uterus. Double row is considered preferable. It is more durable, although it takes a little longer to apply. Each surgeon has his own suturing technique.

The main thing is that the edges of the wound are joined as accurately as possible. Then the scar on the uterus will form smooth, uniform, and consistent, which will not interfere with the next pregnancy.

Suturing the abdominal wall

The aponeurosis is usually sutured with separate silk or vicryl threads or with a continuous suture. Separate staples or stitches are placed on the skin. Sometimes the skin is sutured with a continuous cosmetic suture, which is very neat.

Unfortunately, not in all cases pregnancy ends in physiological birth. There are a number of reasons why natural childbirth poses a serious threat to the health and even life of both the fetus and the woman in labor. In such cases, specialists prescribe a caesarean section for the woman. Let's talk about what it is, in what cases it is the only possible way to give birth to a child, and when it is contraindicated, what types there are, what anesthesia is used, etc.

What is a caesarean section

A Caesarean section is a method of delivery in which the baby is removed from the mother's body through an incision in the wall of the uterus. This is an abdominal operation, during which the doctor, using special medical instruments, makes an incision in the abdominal wall, then an incision in the uterine wall, and after that the child is delivered into the world. The history of caesarean section goes back a long way. They say that Caesar himself was the first to be born in this way... A couple of centuries ago, this operation was performed only on dead women in order to preserve the life of the child. A little later, caesarean sections began to be used for women who, during natural childbirth, encountered any complications that prevented the successful birth of a child. But if we consider that then about antibacterial drugs and people had no idea about antiseptic agents, it becomes obvious that in those days a caesarean section in the vast majority of cases led to the death of the woman in labor. Today, when medicine has developed so much that it is quite capable of curing the most various diseases and carry out the most complex operations, caesarean section has ceased to be a dangerous surgical intervention. Moreover, today it is becoming more and more popular. According to statistics, more than 15% of all pregnancies end in non-physiological birth. This can be attributed to the fact that many women opt for a cesarean section, falsely believing that this operation will be less painful than giving birth naturally. It is not right. By nature, a woman is given the opportunity to produce offspring in only one way, and if natural childbirth is not prohibited by an obstetrician, then preference should be given to it.

Caesarean section: indications

Any medical procedure is carried out if there are indications for it. And even more so for abdominal surgery, which is a caesarean section. Doctors usually divide the indications for this operation into two types:

Absolute.

Relative.

Let's take a closer look at each of these two types.

Absolute indications for caesarean section

Absolute (vital) indications include such conditions (both of the woman and the fetus) in which the management of childbirth naturally is completely excluded. TO absolute readings Caesarean section includes:

Anatomical narrowing of the pelvis to 2-4 degrees. With this pathology, the fetus will not be able to safely pass through the mother’s birth canal. This indication always leads to a planned operation, because throughout the entire period of pregnancy, the pregnant woman’s pelvis is measured, and ultrasound diagnostics determines the size of the fetal head - the most voluminous part of the body. If the fetal head is larger than is possible for safe birth, then the doctor prescribes a caesarean section.

Uterine rupture (both threatened and in progress). Rupture of the uterine wall in most cases occurs for two reasons: the second pregnancy after cesarean, which occurred earlier than two years after the operation, and abdominal interventions, as a result of which an incomplete scar was formed on the uterine wall.

Eclampsia in pregnancy. This condition is also called late toxicosis or gestosis in pregnant women. Extremely dangerous condition, in which a woman’s blood pressure rises to critical levels, and laboratory research Protein is found in the urine.

Placenta previa. Normally, the placenta is attached either to the anterior wall of the uterus or to the posterior, which is much more common. If the placenta is not attached correctly, then the birth of a child naturally is impossible, because the placenta will block the birth canal.

Placental abruption. Under normal circumstances, placental abruption begins after the baby is born, in the last stage of labor. In some cases, detachment occurs earlier than it should have happened. In such cases it is prescribed emergency surgery. This pathology can be suspected by the presence vaginal discharge Brown color.

Pronounced varicose veins of a woman in labor. During natural childbirth, the condition of the veins will suffer, which can ultimately lead to thrombosis.

The presence of formations that close the birth canal. This includes large myomatous nodes, ovarian cysts and others.

Deformation of the bone tissue of the pelvic bones due to mechanical damage or any disease.

Serious renal and/or liver failure.

Presence of a woman in labor serious illnesses such as diabetes mellitus, heart defects.

Incorrect stable position of the fetus in the uterine cavity. Towards the end of pregnancy, the fetus takes its final position. Normally, the child lies with his head down, and his face “looks” at his mother’s stomach. But when the fetus has taken a transverse position, is in a full or leg breech position, or has turned its face “outward,” the doctor prescribes a cesarean section.

Sudden death women with a living fetus.

Relative indications for caesarean section

Relative indications for cesarean section include cases where there is a risk that physiological labor will have a negative impact on the health of the mother and/or child. There is a generally accepted list relative readings, however, in any case, the choice in favor of natural childbirth or cesarean remains with the specialist.

Relative indications can be:

Narrowing of the pelvis of 1-2 degrees.

Pregnancy, the duration of which is more than 42 weeks, subject to the absence of the onset of labor and an immature cervix.

The weight of the fetus is more than 4.3 kg.

The presence of chronic diseases in a woman in labor.

Herpetic infection. Caesarean section will help prevent the baby from becoming infected.

Eye diseases. For example, myopia with serious damage to the fundus.