Planned caesarean section. Indications for delivery surgery, absolute and relative reasons for cesarean section

C-section is an operation in which a child is not born through natural birth canal, and through an incision in the anterior abdominal wall.

Almost every 3 women have to face it. Knowing the indications for surgery will not be superfluous, but even useful. This will allow you to thoroughly prepare and tune in mentally.

As your baby's cherished birthday approaches, expectant mothers start thinking about childbirth. It will not be superfluous to know in what cases a caesarean section is performed.

Reasons for surgery may be:

• relative, when refusal of surgery borders on a high risk of harm to the health of the mother and child.
• absolute. There aren't that many of them. These are cases where vaginal delivery is not possible or can lead to the death of mother and child.

IN Lately Increasingly, surgery is performed due to a combination of several factors. When each of them in itself is not a reason to undergo surgery.

But a combination of 2 or more causes an operation. For example: a primigravida woman over 30 years old and a large fetus weighing more than 4 kg. Neither a large fetus nor age alone is the reason for the operation. But together this is already an argument.

There are planned and unplanned cesarean or emergency. At elective surgery indications for it arise in advance, even during pregnancy. For example, myopia high degree. The woman and the doctor have time to prepare. Complications in such cases are rare.

Emergency surgery can be performed at any time and even during natural birth. For example, with fetal hypoxia, placental abruption.

In what cases is caesarean section performed?

• Placental abruption. At this point bleeding begins. Blood does not always come out. It can accumulate between the uterus and placenta. The placenta peels off even more. The child suffers due to hypoxia - oxygen starvation. Woman due to blood loss. It is necessary to urgently remove the child and stop the bleeding.
• Placenta previa. The placenta blocks the entrance to the uterus. Therefore, natural childbirth is not possible. When contractions begin, the cervix opens, the placenta in this place peels off and bleeding begins. Therefore, they try to operate on such women on the appointed day before labor activity.
• Loss of umbilical cord loops. Sometimes the umbilical cord loops fall out of the uterus during childbirth before it is completely open. They find themselves sandwiched between the pelvic bones and the head or buttocks of the fetus. Oxygen stops flowing to the child, he may die. It is necessary to complete the birth within a few minutes.
• Discrepancy between the pelvic sizes of mother and child. If the baby is too large, then he will not be able to be born on his own. As they say, it won’t get through. There will be a caesarean section here the best way help the woman without harming the child. Sometimes this circumstance can only be clarified during childbirth. Women begin to give birth on their own, but when signs of size discrepancy appear, they undergo C-section.
• Transverse position of the fetus. child in normal birth must lie upside down. If it lies across the uterus. Such births are not possible. After the rupture of amniotic fluid, there is a risk of prolapse of the fetal arm, leg or umbilical cord. This is dangerous for his life. In such situations, they try to plan the operation before the onset of labor.
• Eclampsia and preeclampsia. This condition is a serious complication of pregnancy. In difficult cases, the functioning of internal organs is disrupted, arterial pressure to critical numbers. The risk of hemorrhage increases during internal organs: retina, brain, liver, adrenal glands, etc. To help a woman, it is necessary to perform an emergency cesarean delivery.
• After operations on the cervix. Why? Because natural childbirth will damage the cervix.
• Obstacles that prevent childbirth through the natural birth canal. Tumors of the uterus, bladder, pelvic bones. Significant narrowing of the pelvis, as well as its deformation.
• Fistulas between the vagina and rectum or bladder. As well as rectal ruptures in previous births.
• Chronic diseases of women. These are diseases of the eyes, heart, nervous system, endocrine system, joints and bones, as well as chronic infectious diseases hepatitis C and B, HIV infection. The decision in this case is made by doctors of other specialties: ophthalmologists, surgeons, infectious disease specialists. The approach here is planned. The woman knows in advance about the upcoming operation and prepares for it.
• Breech presentation of the fetus. Natural childbirth is possible. But since there is a risk of injury to the child and mother, they often resort to caesarean section.
• Extension insertions of the head. During childbirth, the head should bend as much as possible. To get through narrow pelvis mother. But there are times when something prevents her from doing this. The head extends. In such cases, its size turns out to be too large.
• Scar on the uterus. It can remain both after a cesarean section and after operations on the uterus to remove myomatous nodes and others. Natural childbirth is possible with one scar on the uterus. 2 or more scars are an indication for cesarean section. Natural birth after cesarean is possible only if the scar is strong according to ultrasound. But the woman doesn't have nagging pain lower abdomen and bloody discharge.
• Fetal hypoxia or oxygen starvation. The child receives insufficient nutrition and oxygen. This condition can occur acutely, for example with placental abruption or umbilical cord prolapse. Or develop gradually. Umbilical cord entanglement around the neck, cysts and placental infarctions. Membranous attachment of the placenta. Sometimes a child because chronic hypoxia stunted in growth and born with low birth weight.
• If indications for childbirth occur between 28 and 34 weeks, a cesarean section should be performed. Since childbirth for a premature baby can be fatal.
• Identical twins, as well as triplets.
• fraternal twins, if the first child is in a breech position or lies transversely in the uterus.
• Weakness of generic forces. When the cervix refuses to open during labor, despite treatment.
• Pregnancy after IVF, and long-term treatment infertility in combination with other factors.
• The woman's age is over 30 years old in combination with other factors.
• Post-term pregnancy in combination with other reasons.

Important! Caesarean section is not performed at the request of the woman. Since this is a very serious intervention with many complications.

However, there are no contraindications to this operation if refusing it would have negative consequences for the woman. But it is undesirable to perform it if there is an infection of any localization in the body, or if the child has died.

When a cesarean section is prescribed, the doctor decides. The task of the expectant mother is to trust the doctor and tune in to a successful outcome of the birth.

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If the doctor leading the pregnancy finds serious abnormalities in the woman or the unborn child, he may decide to perform a planned caesarean section. When the operation is scheduled in advance, the patient has the opportunity to properly prepare for it, including psychologically.

Who should have a planned caesarean section and at what time?

The timing of a caesarean section is determined strictly individually, but doctors try to bring it as close as possible to the time of physiological birth, i.e. 39-40 weeks. This allows you to avoid development in a newborn caused by hypoplasia (underdevelopment) of his lungs. When setting a date for intervention, several factors are taken into account, the main ones being the health status of the pregnant woman and the development of the fetus. A pregnancy is considered full-term when the gestational age reaches 37 weeks.

It is believed that the ideal time to start a cesarean section is the period of the first contractions, but if the placenta previa is incorrect, they do not wait for them.

At multiple pregnancy or detected in the patient, surgery is performed at 38 weeks. With monoamniotic twins, cesarean section is performed much earlier - at 32 weeks.

For surgical intervention there are certain indications.

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If there is at least one absolute indication or a combination of two or more relative indications, delivery naturally excluded!

Absolute indications include:

• history of corporal caesarean section;
• previous operations on the uterus;
• large fruit (≥ 4500 g);
• monoamniotic twins;
• complete placenta previa;
• anatomically narrow pelvis;
• post-traumatic deformation of the pelvic bones;
• transverse presentation of the child;
• after 36 weeks of gestation and weight > 3600 g;
• multiple pregnancy with malpresentation of one fetus;
• growth delay of one of the twins.

Relative indications are:

A planned caesarean section is mandatory if the unborn child is diagnosed with diaphragmatic hernia, non-union of the anterior abdominal wall or teratoma, as well as in the case of fusion of twins.

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In some situations, the operation can be performed without special indications at the request of the woman. Some expectant mothers prefer a caesarean section under anesthesia because they fear pain during natural childbirth.

The process of preparing for a planned caesarean section

If your doctor has informed you that a planned cesarean section is necessary, do not hesitate to ask him any questions you may have. Check the date of hospitalization and find out if everything is in order with your tests. A number of measures to improve the condition of the body must be taken in advance, i.e. during pregnancy.

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During the examination, the expectant mother must consult a neurologist, an ophthalmologist (or ophthalmologist), a therapist and an endocrinologist. If necessary, drug correction of diagnosed disorders is carried out.

It is advisable to attend special courses for women in labor who are preparing for a CS.

Try to eat right and go out more fresh air. Be sure to do daily walks– physical inactivity can harm both you and the baby.

Get checked regularly at the antenatal clinic. Be sure to report any changes in your condition to your doctor.

What to take with you to the maternity hospital?

List of documents and necessary things:

Don't forget to bring diapers, diapers and baby powder for your newborn.

Preoperative preparation a few days before the CS

Be sure to check whether you need to shave your pubic area yourself. It is better to entrust this manipulation to medical workers (to avoid cuts, infection and inflammation), but some institutions recommend preparing this area in advance.

After admission to the antenatal department (usually 2 weeks before the intervention), a series of tests will be required so that doctors can objectively assess the condition of their patient at the present time.

List of required tests:

• blood group and Rh factor;
• vaginal smear.

Additionally, a hardware examination is carried out - and CTG - cardiotocography.

You need to give up solid food for 48 hours. On the eve of the CS, you cannot eat after 18-00, and on the day of the operation it is extremely undesirable to even consume liquid. In the morning before the intervention, you need to cleanse the intestines, using an enema if necessary.

The method of anesthesia is discussed in advance. Local anesthesia(spinal or) is recommended for those who want to see their child in the first moments of his life. Besides, It should be taken into account that anesthesia can negatively affect the baby’s condition. In any case, the procedure will not be associated with pain.

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In most specialized maternity hospitals, mothers are allowed to hold their newborn for a short time immediately after the CS.

The patient is taken from the ward to the operating room on a gurney.

Already on the table in bladder a catheter is inserted. A dropper with a solution must be placed or a drug injection must be given.

The surgical field (lower abdomen) is carefully treated antiseptic solution. If it is expected that the patient will remain conscious, then a screen is installed in front of her at chest level, blocking the view (to avoid mental trauma).

After anesthesia, two incisions are made (most often transverse) in the lower abdomen. During the first, the skin, the layer of fiber and the abdominal wall are dissected, and during the second, the uterus. The baby is removed and, after cutting the umbilical cord, transferred to a neonatologist. The newborn's mouth and nasal passages are cleaned. His condition is assessed using the generally accepted ten-point APGAR scale.

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If a caesarean section is not being performed for the first time, the incision is usually made along the line of the old suture.

The longest stage is suturing. It requires jeweler precision from the obstetrician, since not only the degree of severity will depend on the quality of suturing cosmetic defect, but also the healing process of soft tissues. Neat transverse seams are practically invisible in the future, because they are hidden under the hair.

The advantage of a horizontal incision above the pubis is that it practically reduces to zero the likelihood that the bladder or intestinal wall will be accidentally hit. In addition, the risk of hernia formation is minimized, and healing proceeds faster. Cut in vertical direction from the navel to the pubic bone is often done during an emergency caesarean section, when the need to save the mother and child comes to the fore, rather than aesthetic considerations.

At the final stage of a planned cesarean section, which in the absence of complications lasts only 20-40 minutes, the suture is treated with an antiseptic and covered with a sterile bandage.

Postoperative period

The baby can be put to the breast immediately after the operation is completed.

At the end of the procedure, the woman is usually transferred to the intensive care unit, where she remains for 24-48 hours (provided there are no complications). However, now in many maternity hospitals, already 2 hours after the operation, a woman and a child are immediately transferred from the operating room to a shared ward.

Drugs are administered intravenously to the mother to stabilize and generally improve the condition.

A woman is allowed to get out of bed 12 hours after surgery(in the absence of complications).

Both general and spinal anesthesia negatively affect intestinal motility, so on the first day you can only drink liquids ( clean water); The recommended volume is at least 1.5 liters. On the second day you can drink low-fat kefir or yogurt without chemical colors and flavors, and also consume chicken bouillon with crackers.

For at least 1 week you need to abstain from fatty and fried foods, as well as seasonings and spices.

It is necessary to take measures, since excessive straining increases the risk of sutures coming apart. It is advisable to consume foods with laxative properties, and if they do not give the expected effect, you will have to resort to laxatives.

The suture is cleaned and the sterile dressing is changed daily.

If the patient complains of painful sensations, she is given analgesics as needed.

Before healing and removal of sutures physical exercise excluded. It is strictly forbidden to lift weight more than 3 kg in the next 2-3 months.

The recovery period after a CS lasts slightly longer than after a natural birth. The uterus returns to its physiological state on average after one and a half to two months.

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Resumption of sexual activity is permissible after two months from the date of surgery.

Possible complications after cesarean section

The technique of performing a CS has now been honed to perfection. The likelihood of complications when the mother in labor follows all the instructions of the attending physician is minimized.

IN in rare cases possible:

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IN severe cases(in particular, with massive bleeding), doctors have to resort to hysterectomy to save the mother’s life.

Previously, there was an opinion that a child born via CS does not produce certain hormones and protein compounds that are natural adaptogens. In this regard, disturbances in the process of the baby’s adaptation to environment and certain disorders mental sphere. This statement is now considered erroneous.

After discharge from the maternity hospital, the suture can and should be disinfected independently, using solutions of hydrogen peroxide and brilliant green. If a bloody or purulent discharge and (or) pain of a “shooting” or “jerking” nature appears, you should urgently seek help from a doctor - these may be symptoms of the onset of an infectious inflammation.

Plisov Vladimir, doctor, medical observer

The birth of a child naturally is provided for by nature itself, but due to certain circumstances such childbirth sometimes becomes impossible, then doctors decide to perform abdominal surgery, or rather, a cesarean section. Considering that this operation is a rather difficult and complex procedure, including opening the wall of the abdomen and uterus, the indications for a caesarean section must be strong. In obstetrics and gynecology, caesarean section can be planned or emergency. In what cases is a caesarean section performed, how dangerous or safe is it for the woman in labor and her child?

Indications for planned caesarean section

A planned caesarean section is performed only on women whose history of pregnancy has identified risks to the woman or fetus. If a pregnant woman is prescribed a planned abdominal surgery, then she is recommended to go to the hospital 1 - 2 weeks before the expected birth, where she will, under the supervision of specialists, prepare for the upcoming birth. The final decision on a possible caesarean section is made after the results of the latest tests and ultrasound examination. The main indications for cesarean section planned section The following pathologies and conditions are considered:

• Placenta previa. Pathological condition, in which the cervix is ​​partially or completely covered by the placenta. Characteristic symptoms and indications for caesarean section for breech presentation are considered vaginal bleeding that appear after the 7th month of pregnancy. Placenta previa in best cases can lead to premature birth, and in the worst case – hypoxia and fetal death.
• Multiple pregnancy. If a woman is carrying twins, the risk of complications increases, then doctors may decide to perform abdominal surgery.
• Internal diseases of the mother in labor. In cases where a woman has a history of chronic diseases: diabetes, hypertension, bronchial asthma, kidney pathology, then the risk of complications that may appear during childbirth increases.
• Narrow pelvis.
• Threat of uterine rupture.
• Transverse position of the fetus.
• Large fruit when its weight exceeds 4 kg.
• Pregnancy gestosis.
• Dilated veins in the vaginal area.

There are other reasons for cesarean section, but in any case the final decision remains with the attending physician, who manages the pregnancy for 9 months. Typically, a planned caesarean section is performed 1 week before the expected birth.

Indications for emergency caesarean section

An emergency caesarean section is not planned and is usually performed during labor when the life of the mother or fetus is at risk. During the operation it is used spinal anesthesia, which acts within 5 minutes after administration, allowing the doctor to quickly begin the operation. The main indications for emergency caesarean section are the following pathologies or conditions:

• Weak activity of the uterus.
• Large size of the child's head, which does not correspond to the size of the pelvis.
• Incorrect presentation of the fetus.
• Uterine rupture.
• The discharge of amniotic fluid during the absence of contractile function of the uterus.
• Fetal hypoxia (oxygen starvation).
• Premature placental abruption.
• Umbilical cord entanglement.
• Severe forms of gestosis in a woman giving birth.
• A sharp increase in blood pressure in a woman in labor.
• Edema.

When performing an emergency caesarean section, the delivery room must be equipped with all necessary materials and instruments, and an anesthesiologist must also be present.

Advantages and disadvantages of caesarean section

Many people believe that a caesarean section is quick and easy way give birth to a child, and some even with normal course pregnancy consult a doctor about possible holding operations because they are afraid of pain during childbirth. Childbirth via caesarean section will be much faster and will not bring any pain to the woman. It's important to note that cesarean birth require more significant financial costs, so for many doctors they bring Additional income. But most specialists in the field of obstetrics and gynecology recommend performing a cesarean section only when necessary, since this operation still has its risks and disadvantages, including:

• Bleeding in a woman in labor.
• Penetration of infection.
• Intolerance to anesthesia.
• Anemia due to large blood loss.
• Breathing problems in a newborn.

Complications after a cesarean section can appear both during labor and early or late postoperative period. After a caesarean section, a woman is more a long period is in the maternity hospital. Don't forget about postpartum suture which is enough long time will bring painful sensations and will not allow the young mother to begin her duties immediately after discharge from the hospital. After the operation, a scar forms not only on the abdomen, but also on the uterus. That is why doctors strongly recommend that their patients become pregnant again no earlier than after 2 to 3 years. If the first birth was carried out by caesarean section, then Great chance that subsequent births will also be carried out surgically. It is important to remember that a caesarean section is a full-fledged surgical intervention in a woman’s physiology, therefore such a procedure should only be carried out according to a doctor’s indications.

Childbirth by caesarean section – current method the birth of a child today. Despite the fact that this practice has many disadvantages (for example, low adaptability of the newborn to external environment, heavy recovery period for the mother), in some cases it is irreplaceable. We are talking about situations where, without surgical intervention, the mother and (or) her baby will inevitably die. We'll talk about indications for caesarean section later.

Natural childbirth has always been and will be a priority: according to nature’s plan, only two people should participate in the birth of a new life - mother and child. But the doctors did not hesitate to intervene in the sacred sacrament, and figured out how to help the woman, if for some reason physiological reason she cannot give birth on her own. It is reliably known that the practice of dissecting the anterior wall of the abdomen for obstetrics began to be mastered in the distant past. From myths Ancient Greece It is known that Asclepius and Dionysus were born artificially when their mothers died during childbirth. Up to the 16th century. This method of delivery was called a Caesarean operation, and the term we are familiar with appeared only in 1598.

You can often hear this operation called a royal birth. Indeed, in Latin, “caesarea” translates as “royal”, and “sectio” means “cut”. Today, the concept has been somewhat distorted: some believe that with the help of a surgical scalpel, women who imagine themselves to be queens give birth - with complete anesthesia and without the slightest effort of their own. Despite the fact that surgery is resorted to mainly when it is not possible to give birth naturally, many women ask doctors whether it is possible to use a cesarean section without indications.

In some European countries a woman independently decides how she will give birth. In Russia, doctors insist on the need to perform a caesarean section only when indicated, but there is no official law that would prohibit the “abuse” of the surgical procedure in the absence of compelling reasons. This may be why some expectant mothers choose this particular method of delivery.

List of indications for caesarean section

The grounds for carrying out an operation are absolute and relative:

• about absolute readings they say if the life of a woman in labor and her child is at stake. In this case, doctors have no choice and there is only one way out - surgical intervention;
• about relative indications We are talking about when a woman can give birth to a baby herself, but the risk of developing certain complications still exists. Then doctors weigh the pros and cons, after which they make a final decision on the method of delivery.

There are also emergency situations due to fetal or maternal reasons, when doctors quickly change the course of a natural birth to an operative one.

Absolute indications for caesarean section

Many factors can be identified as indications for elective caesarean.

Too narrow pelvic bone.

With such anatomical feature the course of labor depends on how much the bone is narrowed. So, a degree exceeding 3 – 4 is dangerous negative consequences for the mother in labor and the baby. A narrow pelvis is associated with the following complications during childbirth:

• fading of contractions;
• premature rupture of amniotic fluid;
• intrauterine infection of the fetus;
• development of endometritis and chorioamnionitis;
• oxygen starvation of the child in the womb.

As a result of pushing, a woman in labor with a narrow pelvis may experience:

• uterine rupture;
• injury to the baby during childbirth;
• damage to the pelvic joints;
• the appearance of fistulas in the genitourinary and intestinal tract;
• severe bleeding after childbirth.

Covering the internal os with the placenta.

Usually, when the placenta is located in the uterus, in its back or front wall, no problems arise. When the baby seat is attached too low, it completely covers the internal pharynx and, accordingly, prevents the baby from getting out in a natural way. The same difficulties arise if there is incomplete overlap, lateral or edge. In this case, bleeding may begin during contractions, the intensity of which doctors cannot predict.

Premature abruption of a normally located placenta.

If the placenta detaches ahead of schedule, bleeding begins, which can take various shapes. With closed bleeding, blood accumulates between the wall of the uterus and the placenta without visible signs, when open, blood is released from the genital tract. Mixed bleeding is a combination of open and closed form. A problem that threatens the life of mother and child is solved with the help of an emergency caesarean section.

Uterine rupture.

In this dangerous situation the answer to the question why a cesarean section is performed becomes obvious. Without surgical intervention, both mother and child will die. The cause of uterine rupture can be a large fetus, the actions of an inexperienced obstetrician, or improper distribution of the force with which the expectant mother pushes.

Incorrect suturing.

When after any surgery An irregular scar remains on the uterus, and a caesarean section is performed for delivery. The characteristics of the scar are learned during an ultrasound.

Two or more scars on the uterus.

Two or more operations on the uterus are a serious obstacle to having a child naturally. During normal delivery, ruptures may appear in place postoperative scars. By the way, the number of surgical deliveries is also limited. Answering the question of how many times a caesarean section can be performed, doctors are unanimous - without significant risk to health, women have two caesarean sections in their entire lives. IN isolated cases, if there are serious reasons, a third operation may be performed.

Unsuccessful treatment of seizures.

With late toxicosis, in some cases, convulsions occur, which put the woman into a comatose state. If therapy for this condition is unsuccessful, an emergency caesarean section is performed within two hours, otherwise the woman in labor will die along with the child.

Serious illnesses during pregnancy.

We list in which cases a caesarean section is performed:

• heart disease;
• diseases of the nervous system in an acute stage;
• diseases thyroid gland with severe course;
• diseases associated with blood pressure disorders;
• diabetes;
• eye surgery or high degree myopia.

Anomalies in the development of the uterus and birth canal.

Due to the weak contractile activity of the uterus and obstruction of the birth canal, the child is deprived of the opportunity to move forward, and therefore needs outside help. This situation is most often caused by the presence of tumors in the pelvic organs blocking the birth canal.

Late pregnancy.

With age, the vaginal muscles become less elastic, which can lead to serious internal ruptures during spontaneous childbirth. This is one of those cases when you can do a cesarean section, even if all the health indicators of the woman in labor are normal.

Relative indications for caesarean section

• Narrow pelvis.

This reason for performing a cesarean section is discovered during natural childbirth, when the doctor sees that the circumference of the fetal head does not correspond to the size of the pelvic inlet. This happens if the baby is very large or labor is too weak.

• Divergence of the pelvic bones.

Every expectant mother faces this phenomenon. The discrepancy of the pelvic bones is expressed by pain in the pubic region, swelling, changes in gait and clicking sounds while walking. But if the pelvic bones do not diverge enough, and in addition to this, the woman has a physiologically narrow pelvis and a large fetus, a cesarean section is inevitable.

• Weak labor.

When a woman in labor has little labor power, she is artificially pierced amniotic sac to stimulate the process. However, if even such a measure is not enough to activate natural delivery, a decision is made to perform a cesarean section. This the only way out, otherwise the baby will suffocate or be seriously injured during childbirth.

• Post-term pregnancy.

The operation is indicated for unsuccessful stimulation of labor, weak contractions, or the presence of gynecological problems and diseases in the acute stage.

• Pregnancy after artificial insemination or long-term infertility.

If a woman, after numerous unsuccessful attempts manages to get pregnant and carry a child, she passes full diagnostics indications so that doctors can make a verdict on the method of delivery. If the woman has a history of abortion, stillbirth, or miscarriage, she will have a caesarean section.

• Hypoxia or intrauterine growth retardation.

In this case, the expectant mother will also have to undergo surgery. The question of how long a planned cesarean section is performed for such indications depends on how long the child did not receive sufficient oxygen and whether this problem was solved with the help of drug treatment.

In addition, a woman in labor will certainly have to have an artificial birth if at least one of the following factors is present:

• pubic varicose veins;
• large fruit;
• immature cervix;
• multiple pregnancy.

Reasons for cesarean section dictated by the interests of the child

If the mother herself has no reason to surgical intervention, but the fetus has them, delivery will be prompt. Indications may be:

• incorrect position of the baby. If the baby is positioned head down towards pelvic bones moms - everything is fine. Any other position of the fetus is considered a deviation from the norm. This is especially dangerous for male babies: being in the wrong position and moving along the mother’s birth canal that is not yet dilated, boys can crush the testicles, which will lead to infertility. The baby's head will also suffer from excessive pressure;
• hypoxia. If oxygen deficiency is diagnosed, immediate surgery is indicated, otherwise contractions will only worsen the baby’s well-being, and he may suffocate;
• umbilical cord prolapse. With this pathology, the loops of the umbilical cord often wrap around the baby so tightly that he dies from suffocation. Only an emergency caesarean section will correct the situation, but, unfortunately, it is not always possible to save the child;
• life of the fetus after the death of the mother. When the mother dies, the child’s vital activity continues for some time, then an operation is performed to save the baby.

Restrictions on performing a caesarean section

Doctors, of course, always try to save both lives, but in some cases circumstances do not turn out as we would like, so doctors are forced to save a woman or child. There are several situations in which you have to make difficult choices:

• severe prematurity;
• intrauterine fetal death;
• serious infection of the baby;
• chorioamnionitis in combination with high temperature during childbirth;
• prolonged labor (more than one day).

How to do a caesarean section

The most optimal time to begin the operation - intensification of labor. In this case, the contractile activity of the uterus will facilitate the manipulations of specialists and will help the baby adapt to external irritating factors. At what stage a planned caesarean section is performed depends mainly on the doctor’s decision, but this does not occur earlier than 37 weeks of pregnancy. Ideally expectant mother admitted to the hospital at 38 weeks of an “interesting” situation.

Almost all artificial birth operations are accompanied by epidural anesthesia. In this case, the analgesic effect extends to bottom part body so that the mother can attach the baby to the breast immediately after his birth. An emergency caesarean section is performed under general anesthesia.

At the moment when the baby is about to be born, the doctor cuts abdominal wall and the womb of the woman in labor to help him be born. After the baby is removed, the incisions are sutured using a continuous suture and staples are placed on top for security. They are removed 6–7 days after surgery, before sending happy parents home with the heir.

How is a caesarean section performed? Video

Absolute and relative reasons for caesarean section

Pregnancy and childbirth are always exciting for a woman, even if this is not the first time. As the birth approaches, fear is added to the excitement. Emotions intensify when it turns out that the woman in labor will need a caesarean section - an incision abdominal cavity and the wall of the uterus in order to extract the child.

Why is a caesarean section performed?

The history of caesarean section has its roots in the distant past, but also in our days primary cause surgery is the inability to give birth to a child on your own.

The reasons for a cesarean section can be both from the parturient woman and from the fetus.. Indications are divided into absolute (when natural childbirth is physically impossible) and relative (in which childbirth is possible, but with a threat to the life and health of the mother or child).

Absolute indications from the parturient woman

• Incorrect placenta previa (baby place) and other placentation disorders. When the placenta is attached low - so that it blocks the entrance to the uterus with outside– there is a risk of bleeding and pregnancy failure. Premature aging The placenta and its detachment are dangerous due to hidden and obvious bleeding, the inability to breathe and feed the fetus.
• Absolutely narrow pelvis. A situation where the pelvis of a woman in labor is anatomically and clinically narrowed, and the passage of the child through the birth canal is impossible.
• Multiple fibroids uterus and other malignant tumor diseases internal genital organs.
• The threat of rupture of the thinned uterine wall after multiple births or suture dehiscence during a repeat caesarean section.
• Complete absence labor activity that is not amenable to drug correction.

Relative indications from the parturient woman

• Pelvic narrowness is clinical. It turns out during the visit of a gynecologist during pregnancy.
• Age over 35 in a primiparous woman.
• Diseases of the woman in labor (severe visual impairment, the presence of artificial organs, genital herpes in the progressive phase, bronchial asthma, diabetes, hypertension, discrepancy pubic bones, varicose veins veins). This is about serious illnesses, in which the pregnant woman is observed by appropriate specialists.
• Complications of pregnancy that cannot be treated.
• Severe lacerations of the perineum after previous births.
• IVF, long-term infertility, history of fetal failure in combination with other pathologies.
• Previous cesarean sections.

Absolute fetal indications

The child grows and develops inside the mother’s body and depends on it, therefore the absolute indications for a cesarean section on the part of the fetus are inextricably linked with its mother.

• Severe disturbance of placental nutrition, lack of oxygen (hypoxia). It is determined using ultrasound and CTG diagnostics.
• Placental abruption at any stage of pregnancy.
• The transverse position of one or more fetuses is almost always the basis for surgical intervention.
• Umbilical cord prolapse (leads to blockage of oxygen supply to the baby).
• Incorrect entry of the baby's head into the birth canal.

Relative indications from the fetus

• Hypotrophy, FGR 2nd and 3rd degree.
• Excessively large (more than 4 kg) or small (less than 2 kg) fruit.
• Breech presentation of the fetus, especially males.
• Rhesus conflict between the blood of mother and child, which can develop hemolytic disease fetus (destruction of red blood cells). The child's body is poisoned by decay products, which results in the occurrence of jaundice in newborns.
• Defects in fetal development.

In what cases is a caesarean section performed?

In the West, childbirth is permitted operationally is becoming increasingly popular. In our country, such a measure is considered extreme and takes into account not the desire of the woman in labor herself, but medical indications. Such indications may arise during pregnancy (then a cesarean section will be planned) or during childbirth (an emergency option). Also emergency surgery done in case of unforeseen circumstances, posing a threat life and health of the mother or fetus.

Caesarean sections are almost never performed for any one indication. Usually they take into account combinations of factors that, together with each other, can cause grave consequences, including the death of a woman or child.

Before carrying out the operation, the consent of the woman in labor or, if this is not possible, her close relatives is always obtained.

Contraindications to caesarean section

Like any operation, cesarean section has its contraindications, which are:

• presence of infections;
• intrauterine fetal death or fetal condition incompatible with life.

However, contraindications are not taken into account in situations where there are absolute indications for cesarean section.

Excitement and fear during pregnancy in most cases is associated with a lack of information and the presence of myths that do not correspond to reality. All indications for surgical childbirth are very conditional and the final decision still remains with the woman. Thorough preparation of your body for the most important moment in life will help pregnancy go easily, and childbirth – successfully.