For what indications is a caesarean section performed? Indications for caesarean section. Premature placental abruption

It should be noted that a caesarean section is considered elective when it is planned to be carried out directly during pregnancy. In this case, the woman in labor goes to the pathology department in advance in order to prepare for surgical delivery, which includes a detailed examination of the pregnant woman, as well as an assessment of the condition of the fetus. Besides, in mandatory A meeting will be held with the anesthesiologist to discuss the type of anesthesia that will be used during the operation.

What are the indications for a caesarean section?

Chronic fetal hypoxia and growth retardation; malformations of the baby, such as coccyx teratoma, gastroschisis, omphalocele; death of an infant directly related to complications during a previous delivery.

Carrying out in vitro fertilization in the past, especially repeated ones with the presence of additional complications.

What are the consequences of a caesarean section?

There is also a risk of developing anemia and thromboembolism pulmonary artery. These complications are quite dangerous for the health and life of the mother. In addition, after a cesarean section, a scar forms on the uterus, which reduces its strength and elasticity, making it functionally inferior. Therefore, when pregnant next pregnancy such a seam poses a serious threat due to possible rupture uterus.

Many expectant mothers are thinking: to give birth on their own or to have a caesarean section - an operation in which the baby is removed through an incision made in the abdominal cavity. However, there are those who are not given this choice based on indications.

Such indications can be like absolute- when childbirth is through natural ways physically impossible to carry out, if they exist, an order is issued for a planned cesarean section, and relative– when a woman can physically give birth on her own, but this will involve a risk to the health of the expectant mother or baby. If the risk is justified, you will have an emergency caesarean section. Now let's look in more detail at what the indications for caesarean section may be.

Absolute indications for caesarean section

In case of absolute indications, the doctor must carry out the birth in the only possible way - through a caesarean section. Only this way and no other way. Such indications include anatomical feature women in labor - narrow pelvis .

The fetal head will physically not be able to pass through the pelvic ring. This feature is identified by the doctor even at the stage of pregnancy based on the analysis of ultrasound results, data scheduled inspections and pelvic measurements. The pelvis of the second to fourth degree of narrowing is considered absolutely narrow.

Also absolute indication To perform a caesarean section there are any mechanical obstacles that will prevent the fetus from passing through the natural birth canal. Such obstacles can be an ovarian tumor, in some cases, uterine fibroids or deformation of the pelvic bones.

Another serious absolute indication is a reasonable threat of uterine rupture. Typically this situation occurs in two cases. First case: repeated births, provided that the previous birth was carried out by caesarean section.

Second case: any abdominal operations, carried out on the uterus, as a result of which an insolvent, that is, poorly healed, scar remained on it.

The doctor can easily determine the failure of the scar by performing an ultrasound, which is done more than once during the entire pregnancy, so if there is a threat of uterine rupture, you will definitely be prescribed a planned cesarean section.

Absolute indications for surgical delivery may be not only due to problems in the expectant mother, but also in the fetus. These include placenta previa and her unexpected premature detachment.

Placenta previa means that it is not positioned correctly. Usually the placenta should be attached to the back wall.

In case of presentation, the placenta is attached to the uterus directly above the cervix and blocks the fetus from exiting through the birth canal. If the placenta is not positioned correctly, the mother may experience profuse bleeding, which creates a serious threat to her life and the life of the baby. Therefore, placenta previa is a clear reason for a cesarean section.

Premature onset of placental abruption, that is, when the placenta begins to separate from the wall of the uterus even before the start itself labor activity, also serves as a serious reason for performing a cesarean section.

In this case, the operation is performed at 38 weeks and even earlier if the woman in labor develops bloody issues, giving a signal about placental abruption.

The urgency of the operation is due to the fact that when placental abruption occurs, oxygen ceases to flow to the fetus and, if a caesarean section is not performed urgently, the baby may suffocate and the mother may die from blood loss.

Relative indications for caesarean section

In addition to absolute indications for caesarean section, there are also those in the presence of which a normal birth is possible, but with a probability of risk to the health of the mother and baby. They are called relative indications.

With relative indications, the question of operative delivery is being considered individually. Carefully pay attention to all circumstances and contraindications.

During a natural birth, if the doctor notices a threat, you may be immediately prescribed an emergency caesarean section, so as not to risk your health and the health of the unborn baby.

The most common relative indication for cesarean section in some cases is poor vision - myopia with a high degree of fundus changes.

Because during natural childbirth, when future mommy pushes, pushing the baby out, there is a lot of strain on the eyes, in women with poor eyesight there is a risk of going blind. Therefore, a woman in labor may be offered surgical delivery.

Relative indications also include diseases that are not associated with pregnancy at all, but if present, natural childbirth can threaten the health of the expectant mother.

These diseases include:

• kidney diseases;
• cardiovascular pathology;
• diseases nervous system;
• diabetes mellitus and other diseases.

It may also be an exacerbation of chronic diseases of the genital organs, for example, genital herpes. This is dangerous because the infection can be transmitted to the child during natural birth.

Complications during pregnancy are a fairly serious relative indication for surgical delivery.

First of all, such an indication is gestosis. This is a complication that occurs during later pregnancy, which results in a vital disorder important functions vascular system and blood flow.

The article lists all the absolute and relative indications for cesarean section, and also discusses the most common reasons for surgical delivery.

If for any reason a vaginal birth is not recommended, doctors suggest a cesarean section, however expectant mother in some cases, she can determine the way her child is born. But when a caesarean section is the only one safe option, the woman is left with no choice.

Indications for cesarean section may be:

• absolute– circumstances on the part of the mother or fetus that exclude the possibility of vaginal birth
• conditional– when, despite the indications, the doctor can perform a vaginal birth at his discretion

IMPORTANT: A caesarean section, like any other operation, can be performed with the consent of the woman in labor and her relatives. Besides mandatory conditions are the absence of infections in the mother, a living fetus, the presence of a doctor practicing this type delivery and prepared operating room.

Absolute medical indications for caesarean section: list

With absolute readings Standard childbirth is not performed due to physiological characteristics.

These include:

• narrow pelvis (2-4 degrees)
• defects and injuries of the musculoskeletal system
• mechanical obstacles that will prevent the baby from being born (tumors or deformities)
• the likelihood of uterine rupture if there is incompetent scar less than 3 mm with irregular contours from recent uterine surgery
• two or more previous births by cesarean section
• thinning of the uterus due to repeated births in the past
• placenta previa, dangerous high probability emergence
• bleeding during childbirth
• placental abruption
• multiple pregnancy (three or more children)
• macrosomia – large fetus
• abnormal fetal development
• Mother's HIV positive status
• the presence of herpes rashes on the labia
• repeated entanglement of the fetus with the umbilical cord; entanglement around the neck can be especially dangerous

Medical indications for caesarean section: list

Relative readings to a cesarean section do not exclude the possibility of a vaginal birth, however they are serious reason think about their necessity.

In this case, vaginal birth may be associated with the possibility of a serious threat to the health and life of the mother and her baby, but this issue must be resolved individually.

Relative medical indications are:

• diseases and pathologies of cardio-vascular system at the mother's
• kidney disease
• myopia
• diabetes
• malignant tumors
• exacerbation of any chronic diseases
• damage to the nervous system
• gestosis
• mother's age from 30 years
• malpresentation
• large fruit
• entanglement

IMPORTANT: A combination of several relative readings can be regarded as an absolute indication. In such cases, a caesarean section is performed.

Emergency caesarean section: indications for surgery

The decision to conduct emergency caesarean section (ECS) taken during childbirth, when something has gone wrong and the current situation poses a real threat.

This situation could be:

• cervical dilatation has stopped
• the baby stopped moving down
• stimulation of contractions does not bring results
• the child is experiencing a lack of oxygen
• fetal heart rate is significantly higher (lower) than normal
• baby gets tangled in the umbilical cord
• there was bleeding
• threat of uterine rupture

IMPORTANT: EX must be carried out on time. Untimely surgical actions can lead to the loss of the child and removal of the uterus.

Indications for cesarean section based on vision due to myopia

Myopia, in other words myopia, one of the most common reasons doctors recommend that pregnant women deliver by cesarean section.

For myopia eyeballs They change somewhat in size, namely, they increase. This entails stretching and thinning of the retina.

Such pathological changes lead to the formation of holes in the retina, the size of which increases as the situation worsens. Then there is a noticeable deterioration in vision, and in critical situations- blindness.

The higher the degree of myopia, the greater the risk of retinal tears during childbirth. Therefore, doctors do not recommend pregnant women with moderate and high degrees of myopia to give birth naturally.

In this case, the indications for cesarean section are:

• stable vision impairment
• myopia of 6 or more diopters
• serious pathological changes in the fundus
• retinal tear
• surgery performed due to retinal detachment in the past
• diabetes
• retinal dystrophy

IMPORTANT: It is the condition of the fundus that is decisive. If it is satisfactory or has minor deviations from the norm, you can give birth independently and with a high degree of myopia.

Conditions in which a pregnant woman can give birth on her own, regardless of the presence of myopia:

• no abnormalities in the fundus
• improvement of retinal condition
• healing of the rupture

IMPORTANT: Women with myopia during natural childbirth must undergo episiotomy.

Indications for cesarean section by age

However, if your health condition expectant mother allows you to give birth on your own, this chance is worth taking advantage of.

IMPORTANT: Age in itself is not an indication for cesarean section. Planned surgery should be carried out if there are accompanying circumstances that could interfere with the normal course of labor: narrow pelvis, immature cervix after 40 weeks, etc.

If complications arise during vaginal birth, such as weakening of labor, an emergency caesarean section is performed to eliminate the risk of further complications and deterioration of the fetus.

Indications for cesarean section due to hemorrhoids, varicose veins

Natural childbirth with hemorrhoids dangerous due to the risk of rupture of external components. This can happen when pushing, when blood overflows the cones and under strong pressure tears them up. Happening heavy bleeding, internal cones fall out.

If the obstetrician does not have time to straighten the internal nodes before the anus contracts, they will become pinched, which can lead to the disease developing into acute form. At the same time, the woman experiences severe pain.

To prevent similar situation, doctors may recommend a cesarean section for hemorrhoids. However, natural childbirth is possible even with chronic hemorrhoids.

IMPORTANT: If the decision is made to give birth vaginally, the woman should prepare for a rather painful and time-consuming process.

A similar situation is with the choice of method of childbirth when varicose veins. If during pregnancy a woman took measures to prevent thrombosis, and the doctor did not note any deterioration, a natural birth is likely.

Immediately before giving birth, a woman's legs are bandaged elastic bandage. This helps to avoid reflux of blood at moments of greatest pressure - during pushing.

A few hours before the expected birth, the woman in labor is given special drugs which will help avoid complications of varicose veins.

IMPORTANT: Varicose veins themselves are not an absolute indication for cesarean section. However, in women suffering from varicose veins, cases of premature effusion are common. amniotic fluid, placental abruption and bleeding during or after childbirth.

Then a caesarean section is the safest for both mother and child. Taking into account these factors and the woman’s condition, the doctor makes a decision and chooses the method of childbirth.

Indications for cesarean section due to a large fetus

"Large Fruit"- the concept is individual for each pregnant woman. If the expectant mother is petite and thin short stature a woman with a narrow pelvis, even a 3 kg child can be large for her. The doctor will then recommend that she give birth by caesarean section.

However, for a woman of any size, there is a danger of “feeding” the child in the womb, which will deprive her of the opportunity to give birth on her own.

Development macrosomia possible for the following reasons:

• the expectant mother moves little
• a pregnant woman receives the wrong high-carbohydrate diet and quickly gains weight
• second and subsequent pregnancies - often each child is born larger than the previous one
• diabetes mellitus in the mother, leading to the child receiving large quantity glucose
• reception medicines to improve placental blood flow
• increased nutrition of the fetus through a thickened placenta
• post-term fetus

IMPORTANT: If the doctor detects signs of the development of macrosomia at any stage, first of all he tries to find out the causes of this phenomenon and normalize the situation. If this is successful and the fetal weight returns to normal before birth, a cesarean section is not prescribed.

To normalize the weight of a pregnant fetus, you need to:

• undergo recommended examinations
• consult an endocrinologist
• donate blood for glucose
• exercise every day
• stop eating sweets, flour, fatty and fried foods

Indications for caesarean section due to a narrow pelvis

Each woman, her figure and body are unique, so it is difficult to answer the question whether a pregnant woman with certain parameters will be able to give birth normally naturally.

When prescribing a caesarean section due to a narrow pelvis, doctors focus not only on standard tabular indicators, but also on such an important factor as the size of the child’s head.

If the baby has a large skull, he will not be able to pass through the birth canal naturally, even if the cervix is ​​well prepared for childbirth, and the contractions will intensify. At the same time, if the woman’s pelvis is narrow, but the child corresponds to the size of the pelvis, natural childbirth will be quite successful.

IMPORTANT: A pathologically narrow pelvis, not intended for natural childbirth, occurs only in 5-7% of women. In other cases, the definition of “narrow pelvis” implies a discrepancy between its size and the size of the fetal skull.

In any case, when the pregnant woman is registered, pelvic measurements will be taken. The data obtained will allow us to predict the likelihood of complications.

IMPORTANT: Even a slight narrowing of the pelvis often leads to the child taking incorrect position- oblique or transverse. This position of the child in itself is an indication for a cesarean section.

Also an absolute indication for surgical intervention is the combination of the narrow pelvis with:

• postmaturity of the fetus
• hypoxia
• scar on the uterus
• over 30 years of age
• pathologies of the pelvic organs

Indications for cesarean section due to gestosis

Early and late gestosis are a complication of pregnancy. But if early gestosis is practically harmless and does not lead to pathological changes in the body of a pregnant woman, then later ones can lead to severe consequences and even the death of the mother.

IMPORTANT: Early gestosis manifested by nausea and vomiting early stages, later ones can be found by severe swelling, increased blood pressure and the appearance of protein in urine analysis.

Insidiousness late gestosis lies in the unpredictability of the development of the disease. They can be successfully suspended, or they can lead to serious complications, such as:

• kidney dysfunction
• blurred vision
• cerebral hemorrhage
• deterioration of blood clotting
• ekplamsia

IMPORTANT: Preeclampsia is treated in a hospital, where the woman is under the supervision of medical personnel around the clock.

Indications for breech caesarean section

Breech presentation- a position taken by the child in the womb that is unfavorable for natural childbirth. On ultrasound images you can see that the child seems to be sitting with his legs raised or tucked in, instead of lying head down.

Up to 33 weeks all turnings of the fetus inside the mother’s belly are quite natural and do not cause concern. However after 33 weeks the baby should roll over. If this does not happen and the child sits on his bottom even before birth, the doctor may decide to deliver by caesarean section.

Several factors influence how childbirth will be carried out in this situation:

• mother's age
• baby's weight
• gender of the child - if it is a boy, then only a cesarean section, so as not to damage the male genital organs
• type of presentation - the most dangerous - foot presentation, as there is real danger natural loss of limbs during childbirth
• pelvic size – if narrow, then cesarean

Is it possible to request a caesarean section without an indication?

Caesarean section is performed for medical reasons. But if the expectant mother has no desire to give birth on her own, she is only inclined to have an operation, the maternity hospital will most likely accommodate her.

Psychological readiness is one of the important factors determining the method of childbirth. Having had a negative experience of natural childbirth in the past, a woman may be so afraid of repeating the experience that she will lose control of herself and her actions at the most inopportune moment. In such cases, a cesarean section will be the safest delivery option for mother and baby.

IMPORTANT: If a woman, despite the absence of indications, intends to give birth only by cesarean section, you need to inform the doctor about this in advance. Then the woman in labor will have time to prepare for childbirth, and doctors will have the opportunity to perform a planned, rather than emergency, operation.

Expectant mothers undergoing a caesarean section should not be afraid.

Modern technologies make it possible not to put the woman in labor to sleep, but to use spinal anesthesia and carry out childbirth in her presence, and good postpartum care and painkillers will help you get through the first few difficult days after surgery.

Video: C-section. Caesarean section operation. Indications for caesarean section

From time immemorial

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

Only in the 19th century was it proposed to remove the uterus during surgery; as a result, the mortality rate dropped to 20-25%. Five years after this, the uterus began to be sutured with a special three-layer suture. So it began new stage Caesarean section operations. They began to perform it not only on the dying person, but also in order to save the life of the woman herself. With the advent of the antibiotic era in the mid-20th century, surgical outcomes improved. deaths during it became rare. This caused the expansion of indications for caesarean section on both the maternal and fetal sides.

Conditions for the operation

There are elective, scheduled and emergency caesarean sections. A planned caesarean section is performed in advance at 38-39 weeks if there are indications for surgery from the uterus or fetus and there are no signs of labor. Emergency - in progress normal birth(for example, bleeding from the genital tract due to placental abruption), if there is a situation where childbirth must be completed urgently. A planned cesarean section is an operation performed with the onset of labor or with the rupture of amniotic fluid. It is performed if there are relative indications (the woman goes into labor on her own, but if there are any complications, the birth is completed with an operation according to a previously developed plan).

Indications for surgery

Indications for cesarean section are divided into maternal and fetal indications. There are also absolute (surgery is inevitable) and relative (the issue is resolved in favor of natural childbirth or surgery after comprehensive analysis situations).

Absolute indications from the mother:

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

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

• Myopia (myopia) of a high degree; Retinal detachment may occur during labor.
• Diseases of the cardiovascular system (heart defects), etc.

Relative indications from the mother:

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

Absolute indications from the fetus:

• Acute fetal hypoxia in the absence of conditions for immediate delivery.
• Transverse position of the fetus after rupture of amniotic fluid.
• Extensor (incorrect) insertions of the fetal head (if normally the fetal head is bent towards the chin, which ensures its advancement with the smallest size of the head, then with extensor insertions the fetal head is advanced with the forehead or face).
• Death of the mother while the fetus is alive.

Relative indications from the fetus:

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

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

How is the operation performed?

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

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

Endotracheal general anesthesia or epidural and spinal anesthesia are used as anesthesia for caesarean section. With endotracheal anesthesia, the anesthetic is delivered through a tube inserted into the trachea. The patient is asleep and does not feel anything. For epidural and spinal anesthesia, the anesthesiologist gives the woman an injection in the lumbar region, an anesthetic substance is injected into the space above the hard meninges or spreads around spinal cord. Epidural and spinal anesthesia have a number of advantages compared to anesthesia: the woman is conscious and can see her baby immediately after birth. No negative influence a drug that passes through the mother's blood into the blood of the fetus. Also missing are many negative points anesthesia, undesirable, for example, with concomitant cardiovascular pathology in a woman. In addition, recovery after general anesthesia less comfortable for a woman than after epidural and spinal anesthesia.

In the postoperative period, the woman spends up to 24 hours in the ward intensive care. During the first few days he receives painkillers. Already from the first days in order to reduce painful sensations in the area of ​​the scar, the woman is recommended to wear postpartum bandage. Lactation in women who have undergone surgery is practically no different from women who gave birth spontaneously. Postoperative sutures removed on the 6-7th day. Discharge is made on the 9-10th day after surgery if the postoperative period is favorable.

Condition of children born by caesarean section

In addition to the effects of drugs, in the case of general anesthesia (a certain amount of the drug from the mother’s blood enters the fetus until the umbilical cord is removed and separated), on the newborn’s body big influence The method of delivery itself also has an effect. The fetus does not pass through the mother's birth canal, no mechanical compression occurs chest, squeezing out the fluid that fills the lungs in utero. The reasons for which the operation was performed are also important (for example, fetal hypoxia). A planned cesarean section is the most favorable option for the operation, since labor triggers “birth stress” factors, as if preparing the fetus for the transition to a new environment.

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

Contraindications for surgery

There are no absolute contraindications to cesarean section. All relative contraindications associated with the development of inflammatory complications in the postoperative period. Any acute diseases or exacerbation of chronic diseases in a woman, a long period without water (more than 6 hours), duration of labor more than 12 hours, all immunodeficiency states are factors that increase the risk of developing inflammation. In these cases, during the operation, doctors monitor the condition of the young mother extremely closely and, as a rule, prescribe additional treatment, for example, antibiotic therapy, treatment aimed at stabilizing the immune system.

Pregnancy after caesarean section

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

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

Spontaneous birth after a previous cesarean section is possible if there is a full-fledged scar on the uterus, there are no absolute and relative indications for a repeat operation, and the woman herself desires to go into labor on her own. Of course, such a woman in labor requires special attention. If any complications arise, doctors should be prepared to proceed with a repeat cesarean section.

What is sterilization?

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

For many women, surgery with an incision becomes an inevitable ordeal, for which giving birth through the birth canal is impossible or dangerous for her and her baby. Like any other surgery, caesarean section is performed only for medical reasons.

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

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

Indications for caesarean section during pregnancy:

• Placenta previa. When the placenta children's place) is located in the lower part of the uterus and covers internal os(entrance to the uterus from the vagina). This threatens severe bleeding, dangerous for both the life of the mother and the fetus. The operation is performed at 38 weeks of pregnancy or earlier if bleeding occurs.
• Premature abruption of a normally located placenta. Normally, the placenta separates from the wall of the uterus after the baby is born. Sometimes this happens during pregnancy, then severe bleeding begins, which threatens the life of the mother and fetus and requires immediate surgery.
• Inconsistency of the uterine scar after an incision in a previous birth or other operations on the uterus.

  A uterine scar is considered invalid if, according to ultrasound, its thickness is less than 3 mm, its contours are uneven and there are inclusions connective tissue. If the postoperative period after the first operation was difficult (fever, inflammation of the uterus, prolonged healing of the suture on the skin), this also indicates the failure of the scar on the uterus.

• Two or more scars on the uterus after incision surgery. It is believed that two or more cesareans increase the risk of uterine rupture along the scar during childbirth due to the weakness of the scar tissue. Therefore, the incision is made before labor begins.
• Anatomically narrow pelvis (this is the name given to the anatomical limitation of the size of a woman’s pelvic ring, which makes it difficult for the fetal head to pass through this ring) II-IV degrees narrowing. Every woman has her pelvic size measured during pregnancy. Obstetricians have clear criteria normal sizes pelvis and narrow pelvis according to the degree of narrowing. Tumors and deformations of the pelvic bones. They can serve as an obstacle to the birth of a child.
• Malformations of the uterus and vagina. Tumors of the uterus, ovaries and other organs of the pelvic cavity, closing the birth canal.
• Large fetus in combination with another pathology. A fruit is considered large when its weight is 4 kg or more.
• Severe symphysitis. Symphysitis or symphysiopathy - discrepancy pubic bones. In this case, severe difficulties and pain appear when walking.
• Multiple uterine fibroids large sizes, nutritional disorders of myomatous nodes.
• Severe forms of gestosis and lack of effect from treatment. Preeclampsia is a complication of pregnancy in which vital function is disrupted. important organs, especially the vascular system and blood flow. Severe manifestations of gestosis are preeclampsia and eclampsia. In this case, microcirculation in the central nervous system is disrupted, which can lead to severe complications, both for mother and fetus.
• Serious illnesses. Diseases of the cardiovascular system with symptoms of decompensation, diseases of the nervous system, diabetes mellitus, high myopia with changes in the fundus, etc.
• Severe cicatricial narrowing of the cervix and vagina. May occur after previous operations or childbirth. This creates insurmountable obstacles to the opening of the cervix and the stretching of the vaginal walls necessary for the passage of the fetus.
• Condition after plastic surgery on the cervix and vagina, after suturing genitourinary and enterogenital fistulas. A fistula is an unnatural connection between two adjacent hollow organs.
• III degree perineal rupture in previous births. If during childbirth, in addition to the skin and muscles of the perineum, the sphincter (muscle that locks anus) and/or rectal mucosa, then this is a third-degree perineal rupture; a poorly sutured rupture can lead to incontinence of gases and feces.
• Pronounced dilatation of veins in the vaginal area. At spontaneous birth bleeding from such veins can become life-threatening.
• Transverse position of the fetus.
• Conjoined twins.
• Breech presentation of the fetus (especially a boy) in combination with a fetal weight of more than 3600 g and less than 1500 g, as well as with a narrowing of the pelvis. With a breech presentation, the risk of birth injury during birth of the fetal head increases.
• In Vitro Fertilization, artificial insemination in the presence of other complications from the mother and fetus.
• Chronic fetal hypoxia, fetal hypotrophy, refractory to drug therapy. In this case, the fetus receives an insufficient amount of oxygen and for it the process of childbirth is a burden that can lead to birth trauma.
• Primiparas over 30 years of age in combination with another pathology.
• Long-term infertility in combination with another pathology.
• Hemolytic disease of the fetus due to unprepared birth canal. When rhesus (less often - group) incompatibility of the blood of mother and fetus develops hemolytic disease fruit - destruction of red blood cells(erythrocytes). The fetus begins to suffer from lack of oxygen and harmful influence erythrocyte breakdown products.
• Diabetes if early delivery is necessary and the birth canal is unprepared.
• Post-term pregnancy with unprepared birth canal and in combination with other pathology. The process of childbirth is also a stress that can lead to birth injury to the fetus.
• Cancer of any location.
• Exacerbation of genital herpes. For genital herpes, the indication is the presence of blisters herpetic rashes on the external genitalia. If a woman cannot be cured of this disease by the time of birth, there is a risk of infection of the fetus (if the membranes rupture or the fetus passes through the birth canal).

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

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

Indications for cesarean section during childbirth:

• Clinically narrow pelvis. This is a discrepancy between the fetal head and the mother's pelvis.
• Premature rupture of amniotic fluid and lack of effect from induction of labor. When water breaks out before contractions begin, they try to induce them with the help of medications (prostaglandins, oxytocin), but this does not always lead to success.
• Anomalies of labor that are not amenable to drug therapy. If weakness or incoordination develops, labor is carried out drug therapy, which also does not always lead to success.
• Acute fetal hypoxia. When the heartbeat suddenly becomes rare and does not recover.
• Abruption of a normal or low-lying placenta. Normally, the placenta separates from the wall of the uterus after the baby is born. Sometimes this happens during labor, then severe bleeding begins, which threatens the life of the mother and fetus and requires immediate surgery.
• Threatening or incipient uterine rupture. It must be promptly recognized by a doctor, since a delayed operation can lead to fetal death and removal of the uterus.
• Presentation or prolapse of umbilical cord loops. If the umbilical cord prolapses and the fetus is in cephalic presentation, if an incision is not made within the next few minutes, the child may die.
• Incorrect insertion of the fetal head. When the head is in an extended state (frontal, facial presentation), as well as a high, straight position of the head.

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