Emergency caesarean section: in what cases it is done and possible consequences. When and for what indications is a planned caesarean section performed?

Absolute and relative grounds 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 childbirth is physically impossible naturally) 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 ( children's 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. The situation when the pelvis of a woman in labor is anatomically and clinically narrowed, and the passage of the child through birth canal impossible.
Multiple uterine fibroids 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 of the 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 violation placental nutrition, lack of oxygen (hypoxia). It is determined using ultrasound and CTG diagnostics.
Placental abruption at any stage of pregnancy.
Transverse position 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, surgical resolution of childbirth 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). Emergency surgery is also performed 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. Carefully preparing your body for the most important moment in life will help your pregnancy go smoothly and your childbirth be successful.

It happens that pregnancy occurs with some disturbances, due to which it is contraindicated for a woman to give birth on her own. IN similar situations The doctor may prescribe a planned birth by caesarean 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. Such delivery operations occur quite often in obstetric practice, 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, a planned cesarean section is traditionally prescribed. Although it happens that operative delivery 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 approximation 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 like incorrect 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. To the number probable contraindications may 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 is to preserve women's health and as much as possible possible reduction likelihood of developing septic or infectious complications during operational activities, because dead child may cause a dangerous infection.

If the indications for cesarean section are absolute, although there is an infectious process, then delivery is carried out abdominal type, i.e. 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 kinds allergic reactions, it is necessary to study the presence of intolerance or hypersensitivity to the medications used.

In general, anesthesia comes in several varieties:

General. This general anesthesia, which involves immersing a woman in labor into an artificial medical sleep. Typically used in in case of emergency, because it does not require much time, although it has many undesirable consequences;
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;
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;
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 before the operation drinking water, because after a cesarean section you can’t eat anything, but after anesthesia you will definitely have extreme thirst.

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 tightened with special elastic bandages or put on compression stockings. 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 having a catheter installed skin covering The 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. Sewn in the same way abdominal wall. To avoid leaving a disfiguring scar, the doctor does cosmetic stitch, which is then processed antiseptic and is 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 it is likely postoperative complications, usually removable and passing in nature. They affect the mother herself, but may
touch the child too. The most common problems are:

Anemia due to 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 menstruation may occur more than a week, or do not come enough long time etc.;
Problems with the baby's blood circulation;
Trobophlebitis of the pelvic veins, endometritis, etc.

Irreversible complications include hysterectomy or infertility. After a cesarean section, most women lose the opportunity to give birth naturally, which also cannot be corrected. There is a theory that during cesarean delivery in babies there is a disruption in the production of hormones and proteins, which can negatively affect extrauterine adaptation and mental activity 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 stops, the woman begins to experience severe pain, to relieve 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 5th-6th day, the postpartum woman undergoes tests, does ultrasound diagnostics scar and organs of the abdominal and pelvic region. If there are no complications, on the 7th day the mother goes home with the baby.

At home you should also follow certain rules postoperative rehabilitation. 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 refusal physical activity 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.

For many decades, this operation - caesarean section - has been saving the life and health of a mother and her baby. In the old days, such surgical intervention was performed extremely rarely and only if something threatened the life of the mother in order to save the child. However, caesarean sections are now being used more and more often. Therefore, many specialists have already set themselves the task of reducing the percentage of births performed through surgical intervention.

Who should perform the operation?

First of all, you should understand how a caesarean section is performed and what consequences await the young mother. Childbirth itself surgical method safe enough. However, in some cases, surgery is simply not practical. After all, no one is protected from risk. Many expectant mothers ask for a caesarean section only out of fear of strong painful sensations. In this case, modern medicine offers epidural anesthesia, which allows a woman to give birth without pain.

Such births are performed - caesarean section - by a whole team medical workers, which includes specialists of a narrow profile:

Obstetrician-gynecologist - directly removes the baby from the uterus.
The surgeon makes an incision into the soft tissue and muscles of the abdominal cavity to reach the uterus.
A pediatric neonatologist is a doctor who delivers and examines a newborn baby. If necessary, a specialist in this profile can provide first aid to the child, as well as prescribe treatment.
Anesthesiologist - performs pain relief.
Nurse anesthetist - helps administer anesthesia.
Operating nurse - assists doctors if necessary.

The anesthesiologist should speak with the pregnant woman before the operation to clarify which type of anesthesia is preferable for her.

Types of caesarean section

Indications for caesarean section can be completely different, and the operation is performed in certain cases differently. Today, there are two types of births performed using surgical intervention:

Emergency surgical intervention is performed if any complication occurs during childbirth that requires urgent removal of the baby from the uterus. A planned caesarean section is performed in situations where the doctor is concerned about the progress of labor due to complications that arose during pregnancy. Let's take a closer look at the differences between the two types of operations.

Planned caesarean section

Elective surgery (caesarean section) is performed with epidural anesthesia. Thanks to this method, a young mother has the opportunity to see her newborn baby immediately after the operation. When performing such a surgical procedure, the doctor makes a transverse incision. The child usually does not experience hypoxia.

Emergency caesarean section

As for an emergency caesarean section, general anesthesia is usually used during the operation, since the woman may still be having contractions, and they will not allow a puncture for epidural anesthesia. The incision for this type of surgery is mainly longitudinal. This allows you to remove the baby from the uterine cavity much faster.

It is worth noting that during emergency surgery, the child may already experience severe hypoxia. At the end of the cesarean section, the mother cannot immediately see her baby, since a cesarean section is performed in this case, as already mentioned, most often under general anesthesia.

Types of incisions for caesarean section

In 90% of cases, a transverse incision is made during the operation. As for the longitudinal one, they are currently trying to do it less often, since the walls of the uterus are greatly weakened. During subsequent pregnancies they may simply become torn. A transverse incision made in the lower part of the uterus heals much faster and the sutures do not break.

A longitudinal incision is made along midline abdominal cavity from bottom to top. To be more precise, to a level slightly below the navel from pubic bone. Making such an incision is much easier and faster. Therefore, it is usually used during an emergency caesarean section in order to remove the newborn baby as quickly as possible. The scar from such an incision is much more noticeable. If doctors have the time and opportunity, then during the operation a transverse incision can be made slightly above the pubic bone. It is practically invisible and heals well.

Concerning reoperation, then the seam from the previous one is simply excised.
As a result, only one seam remains visible on the woman’s body.

How does the operation proceed?

If an anesthesiologist performs epidural anesthesia, the surgical site (incision) is hidden from the woman by a septum. But let's look at how a caesarean section is performed. The surgeon makes an incision in the wall of the uterus and then opens amniotic sac. After which the child is removed. Almost immediately, the newborn begins to cry heavily. Children's doctor cuts the umbilical cord, and then carries out all the necessary procedures with the child.

If the young mother is conscious, the doctor immediately shows her the baby and may even let her hold it. After this, the child is taken to a separate room for further observation. The shortest period of the operation is the incision and removal of the child. It only takes 10 minutes. These are the main advantages of a cesarean section.

After this, doctors must remove the placenta, thoroughly treating all the necessary vessels so that bleeding does not start. The surgeon then stitches up the cut tissue. The woman is placed on a drip, giving a solution of oxytocin, which speeds up the process of uterine contractions. This phase of the operation is the longest. From the moment the baby is born until the end of the operation, approximately 30 minutes pass. In terms of time, this operation, a caesarean section, takes 40 minutes.

What happens after childbirth?

After the operation, the new mother is transferred from the operating room to the intensive care unit or intensive care unit, since a caesarean section is performed quickly and with anesthesia. The mother should be under the vigilant supervision of doctors. At the same time, she is constantly measured arterial pressure, breathing rate, pulse. The doctor must also monitor the rate at which the uterus contracts, how much discharge there is and what nature it has. IN mandatory The functioning of the urinary system should be monitored.

After a caesarean section, the mother is given antibiotics to prevent inflammatory process, as well as painkillers to calm down discomfort.

Of course, the disadvantages of a cesarean section may seem significant to some. However, in some situations, it is precisely such childbirth that allows a healthy and strong baby to be born. It is worth noting that the young mother will be able to get up only after six hours, and walk on the second day.

Consequences of surgery

After the operation, stitches remain on the uterus and abdomen. In some situations, diastasis and suture failure may occur. If such consequences occur, you should immediately consult a doctor. Complex treatment dehiscence of the edges of the suture located between the rectus muscles includes a set of exercises specially developed by many specialists, which can be performed after a cesarean section.

Of course, there are consequences to this surgical intervention. The very first thing worth highlighting is the ugly seam. You can fix it by visiting a cosmetologist or surgeon. Typically, to give the seam an aesthetic appearance, procedures such as smoothing, grinding and excision are carried out. Enough a rare occurrence Keloid scars are considered - reddish growths form above the suture. It is worth noting that the treatment of this type of scars takes a very long time and has its own characteristics. It must be carried out by a professional in his field.

For a woman, the condition of the suture made on the uterus is much more important. After all, it depends on him how it will go next pregnancy and what method the woman will give birth to. A suture on the abdomen can be corrected, but a suture on the uterus cannot be corrected.

Menstruation and sex life

If no complications arise during the operation, then menstrual cycle begins and passes in the same way as after childbirth naturally. If a complication does arise, the inflammatory process can last for several months. In some cases, menstruation may be painful and heavy.

You can begin sexual activity after childbirth with a scalpel after 8 weeks. Of course, if the surgery went without complications. If there were complications, then start sex life This is possible only after a thorough examination and consultation with a doctor.

It is worth considering that after a caesarean section, a woman should use the most reliable contraceptives, since she cannot become pregnant for about two years. It is undesirable to carry out operations on the uterus within two years, as well as abortions, including vacuum ones, since such an intervention makes the walls of the organ weaker. As a result, there is a risk of rupture during a subsequent pregnancy.

Lactation after surgery

Many young mothers who have undergone surgery are worried that it is difficult to establish breastfeeding after a cesarean section. breast milk. But this is absolutely not true.

A young mother produces milk in the same time frame as women after natural childbirth. Of course, establishing breastfeeding after surgery is a little more difficult. This is primarily due to the characteristics of such genera.

Many doctors fear that the baby may receive some of the antibiotic through mother's milk. Therefore, in the first week the baby is fed formula from a bottle. As a result, the baby gets used to it and it becomes much more difficult to wean him to the breast. Although today babies are often put to the breast immediately after surgery (on the same day).

If you do not have an indication for delivery by cesarean section, then you should not insist on surgery. After all, any surgical intervention has its consequences, and it is not for nothing that nature has come up with a different way for the birth of a child.

Childbirth is not just the most important and responsible event in the life of a pregnant woman, but, what’s more, sometimes downright frightening. From the first months, especially suspicious expectant mothers study forums, looking for advice on how to give birth without pain. Read reviews from women who have experienced various techniques. And they are increasingly convinced that childbirth without pain is almost impossible. And as salvation, the following thought creeps into my head: should I choose a caesarean section? After all, it seems that it is so simple, no more dangerous than an operation to remove appendicitis. All you need to do is get on the operating table, and then... You fall asleep, wake up, receive a squeaking lump in your arms, and that’s it - you’re a mother! Miracles, and that's all. But is everything really so rosy, or is a caesarean section still serious? surgery? What are the indications for caesarean section?

There are several reasons why the operation to remove the fetus through an incision in the mother's abdomen was called a caesarean section. According to one legend, this is how Gaius Julius Caesar was born. According to another, the name comes from the Latin version “sectio caesaria”, which literally translates as “I cut what is cut.”

In any case, in those distant times it was almost impossible for a woman in labor to survive after a cesarean section. At the same time, the difficulties of natural childbirth often ended in the death of the child or mother. Therefore, in difficult cases, they tried to save at least the child. And only with the development of medicine in the 19th century did it finally become possible for both to survive, but the mortality rate even in those days was a quarter of all women undergoing surgery.

With the widespread use of antibiotics in the middle of the 20th century, mortality during surgical delivery was reduced to isolated cases, and cesarean sections began to be performed not only for strict indications, but also in some countries at the request of the woman. For example, in Brazil, according to data for 2015, more than half of children were born surgically. However, caesarean section is not as harmless as is commonly thought. It has its own causes and complications, which can be dangerous for both mother and child.

What are the indications for caesarean section?

Each operation has its own reasons - the indications that led to its need. Caesarean section is no exception in this regard. If the absence of surgical intervention carries a certain risk to the life of the mother or fetus, then this is called absolute indications. If a woman can give birth on her own, but this involves a high risk for her or the child, then such indications will be relative.

The increase in the number of surgical births in the world is mainly due to the reluctance of doctors to take risks in the presence of relative indications. IN controversial situation Caesarean sections are increasingly being performed to reduce the possibility of adverse consequences.

Like anyone medical intervention, cesarean section has its contraindications. These include: intra- or perinatal fetal death, fetal deformities, severe prematurity. If there is no confidence in the viability of the fetus, doctors try not to leave a scar on the uterus.

Absolute from the part of the mother in labor...

One of the absolute indications is a change in the configuration of the pelvis. If a woman in labor has reduced one or more pelvic dimensions, this is considered an anatomically narrow pelvis. With an anatomically narrow pelvis of the third or fourth degree of severity, natural delivery is impossible. This situation occurs in 5-7% of all births. Also, the reason for a caesarean section will be pelvic deformities after past diseases, bone tumors, injuries to the symphysis pubis after previous childbirth. There are five more absolute indications from the mother.

Obstacles for the child during the passage of the birth canal. These may include scar deformities cervical region of the uterus and vaginal walls, tumors of unfavorable localization (uterine fibroids large sizes, ovarian tumors), pronounced varicose veins in the genital area, fistulas in the perineal area. The main reason for surgical delivery in such cases is the threat of extensive ruptures of scar tissue, which is less elastic. Tumors, in addition, can be subject to compression during the passage of the fetus and become necrotic, and large uterine fibroids can also be a mechanical obstacle to the fetus. Varicose nodes are dangerous due to the possibility of ruptures with subsequent heavy bleeding threatening the woman in labor with death.
Premature abruption of a normally located placenta. If the detachment occupies more than a third of the entire area or rapidly progresses, while the woman cannot give birth naturally, then the fetus will quickly die under conditions of increasing hypoxia. In addition, detachment threatens the woman in labor heavy bleeding. The cause of placental abruption can be abdominal trauma, stress, gestosis, rapid emptying of the uterus when water breaks in conditions of polyhydramnios, multiple pregnancy.
Placenta previa. If the placenta completely covers the cervix in the lower part of the uterus, this is a complete presentation. Accordingly, with incomplete presentation, the cervix is partially blocked. The absolute indication is complete presentation, as well as a combination of incomplete placenta previa with any other complications of pregnancy.
Threat of uterine rupture. Very dangerous situation. In the absence of emergency surgical intervention, the mother in labor faces death. The likelihood of uterine rupture increases in the presence of risk factors: an incompetent scar after a previous cesarean section, multiple births, a large fetus, multiple pregnancies against the background of a pathologically altered muscular layer of the uterus.
Preeclampsia and exlampsia. Complications of gestosis from the central nervous system, requiring immediate delivery, regardless of the stage of pregnancy.

... and from the fetus

The need for surgery arises if the position of the fetus is disturbed. We are talking about the transverse, oblique position of the child. When the child lies with his buttocks down, a cesarean section is performed if there is a suspicion of a large fetus (estimated fetal weight more than 3500 g) or in combination with pathologies on the part of the woman in labor. There are four more indications.

Incorrect insertion of the head. In extension positions (when the baby’s neck is extended and instead of the back of the head, the forehead and crown of the head are adjacent to the birth canal), childbirth is naturally extremely dangerous, even with a small fetus and good size of the woman’s pelvis.
Presentation and prolapse of parts of the umbilical cord. The reason is extremely high risk fetal death during childbirth due to compression of the umbilical cord.
Acute respiratory failure(hypoxia) of the fetus. Diagnosed during childbirth by various reasons. For example, placental abruption, weakness of labor, malpresentation fetus and head insertion. In acute hypoxia, certain changes are observed in the fetal heartbeat on CTG and auscultation. If conservative treatment is unsuccessful, the only possibility To save the fetus, the only option left is a cesarean section.
Death or terminal state women with a living fetus. Caesarean section makes it possible to deliver a woman in a coma, in agony, who died in childbirth, thereby saving the life of the child.

Relative on the part of the mother in labor...

Relative indications for cesarean section on the maternal side include the following six conditions.

Clinically narrow pelvis. In 1-2% of births, there may be a discrepancy between the size of the presenting part of the fetus and the pelvis of the woman in labor. This situation is called a clinically narrow pelvis. The prognosis is possible by ultrasound at the end of pregnancy after examining the size of the fetus, but the final diagnosis is made during childbirth. If the tactics of labor management are incorrect, serious complications can occur for the mother and fetus, including the death of the fetus, so it is advisable to perform the operation without waiting for injuries.
Preeclampsia. Long-term atypical course, a weak effect of treatment is not the best companion for a woman during natural childbirth. The danger lies in the adverse effects of gestosis on the body of the mother and child, as well as the likelihood of developing complications - preeclampsia and eclampsia.
Presence of diseases of the reproductive system. For example, infertility, recurrent miscarriage. In addition to the fact that the underlying disease can interfere with effective labor, a woman who has not been able to get pregnant for a long time is most often afraid of the possibility of losing a child in childbirth and this does not give her the opportunity to tune in to the natural and productive course of childbirth.
Severe extragenital pathology. Decompensated diseases of the cardiovascular, respiratory, endocrine systems. Uncomplicated kidney diseases in themselves are not an indication for cesarean section, but are very often complicated by obstetric pathology (preeclampsia, fetoplacental insufficiency, premature placental abruption), so such pregnant women are often delivered promptly. Eye diseases also often progress during pregnancy. The indication for cesarean section for vision is retinal pathology. If the problem was detected early during pregnancy, then the retina can be “welded.” Then childbirth naturally is possible. If the problem has not been resolved during pregnancy, then it will be safer to give birth surgically to avoid retinal detachment and possible blindness.
Persistent weakness of labor. If she doesn't give in drug therapy and threatens protracted labor and hypoxia for the fetus.
Primipara woman over 30 years old. In reality modern world There is a strong tendency to postpone childbirth until a later age, when a career has already been built and parents can fully provide financially for their future child, so the first birth “over 30” will not surprise anyone. But physiology female body remains unchanged... Over time, tissues lose their elasticity and ability to stretch, and the risk of rupture of the birth canal is higher. How older woman, the more often chronic diseases are identified that complicate the course of pregnancy. However, no one will recommend a cesarean section based solely on age. The indication for surgery will be the presence of concomitant complications of the current pregnancy.

... and from the fetus

Contrary to popular belief, twins are not an indication for a caesarean section. If the babies are positioned well (both children are lying with their heads down), then the expectant mother may well give birth on her own. But if the babies have a problematic location or there are risk factors in the current pregnancy (mother’s age, uterine scar, abnormalities in the life activity and development of children), then the best option to give birth without problems would be surgery. There are three more conditions that can cause a cesarean section.

Large fruit. The baby's predicted body weight is more than 4000 g, together with any pregnancy pathology, will serve as a relative reason for a cesarean section.
Chronic FPI (fetoplacental insufficiency). A pathology of pregnancy in which the blood supply between the placenta and the fetus is disrupted. As a result, the child does not receive sufficient nutrition necessary for his development. About a fifth of pregnancies complicated by placental insufficiency end stillbirth child. The causes of this disease can be obstetric diseases, infectious processes (most often chlamydia), concomitant diseases kidney With severe decompensation, it is necessary to deliver the woman prematurely to give the baby a chance to develop outside the uterus.
With breech presentation of the fetus. Breech presentation combined with premature rupture amniotic fluid, a large fetus, a narrowed pelvis of the first or second degree is the reason for childbirth by cesarean section.

So, in obstetrics there are many problems when the advantages of a cesarean section are obvious: the operation helps to avoid injuries to the child and mother during childbirth, makes it possible to quickly remove the baby, stop the bleeding and save the woman’s life. If for some reason a woman in labor needs surgical delivery, then refusing it is dangerous to life and health.

Tactics of surgical delivery

At the same time, it is important to know how a caesarean section is performed and at what time it is performed.
Depending on the urgency, there are two types of surgery.

Planned caesarean section. If the indications are known during pregnancy or even before it, a specific date is selected and surgery is scheduled. It is not always possible to say exactly at what time a caesarean section is performed. Usually doctors allow pregnancy to be carried to the optimal time (39-40 weeks, ideally after the spontaneous onset of labor). But there are situations when it is impossible to wait: with gestosis, a thin scar on the uterus, fetoplacental insufficiency, the dates can be shifted four to six weeks ago, and sometimes, unfortunately, even earlier. Preparation includes a cleansing enema, food and water intake is prohibited 12 hours before surgery.
Emergency caesarean section. It is carried out in emergency situations that arise during childbirth. Emergency intervention does not leave time to prepare the woman in labor. There are also fewer options for choosing anesthesia and type of incision.

Choice of anesthesia

A team of doctors (two obstetricians-gynecologists and an anesthesiologist) and an operating room nurse are present at the operation. Choosing anesthesia for caesarean section
depends on the urgency of the operation. In case of emergency caesarean section it is often necessary to operate under general anesthesia. The wishes of the woman in labor are taken into account during planned surgery.

Until recently, endotracheal general anesthesia was predominantly used. With its convenience in relation to the woman in labor, especially in critical situations, it has a significant drawback - it has a depressing effect on the respiratory and nervous systems of the fetus. Therefore, no more than ten minutes should pass from the administration of anesthesia to the extraction of the fetus.

In conditions modern medicine more and more are increasingly being used safe look anesthesia - regional anesthesia. This includes spinal and epidural anesthesia for caesarean section. An “injection” in the back makes it possible to anesthetize a woman, while she remains conscious, sees the birth of a child, and can even breastfeed him immediately after extraction. For the child, the harm is negligible, since anesthetics act locally and only a minimal amount enters the bloodstream. The only drawback of this type of anesthesia is the speed of onset of the effect, so in critical situations general anesthesia still takes up a significant share.

Cutting method

The method of incision also depends on the reasons for the operation. For planned caesarean sections, a transverse incision in the lower segment of the uterus is preferred; absorbable incision is increasingly used suture material. In emergency difficult situation They can resort to a longitudinal incision; it gives good access to the uterus, but its disadvantage is a pronounced cosmetic defect.

A caesarean section lasts about an hour and includes the removal of the baby, inspection of the uterine cavity, and layer-by-layer suturing of tissue. After the operation, the woman is transferred to intensive care, where she is observed for 12 hours or a day in case of uncomplicated postoperative period. Then the new mother spends the next three to four days before discharge in the ward with her child.

Possible complications

There are a number of complications associated with a caesarean section. With emergency caesarean they are observed two to five times more often than with planned ones. But even in this case, their frequency does not exceed 5% of all surgical deliveries.

In the postoperative period, one should be wary of bleeding due to slow contraction of the uterus; inflammatory complications are also common - endometritis, peritonitis, inflammation of the appendages. Thrombosis and embolism are possible. Complications after anesthesia are considered separately.

Consequences of the operation

If the course of the postoperative period is favorable, the woman is discharged from the maternity hospital on the fourth or fifth day. But the long-term consequences of a cesarean section can make themselves felt years later. One of them is adhesive disease. Adhesions can form after surgery in the pelvic cavity, the degree of their prevalence depends on the genetic tendency of the woman’s tissues to scarring, as well as on the presence of inflammation in the postoperative period. In this case, a cesarean section is dangerous due to the possibility of secondary infertility, and the risk of ectopic pregnancy also increases.

In addition, a scar remains on the uterus. His condition plays a huge role in a woman’s future reproductive plans. Childbirth through the birth canal is also possible with a scar, but it is very important to take into account its consistency. Ultrasound monitoring of subsequent pregnancy allows us to determine the optimal tactics for repeat delivery of a woman with a history of cesarean section.

Complications and long rehabilitation- these are the main disadvantages of cesarean section. The task of medical personnel is to give correct recommendations, and postpartum women - to carry them out relentlessly.

Recovery period

The early postoperative period includes diet, antibiotic prophylaxis, and medications are also prescribed for better uterine contractions. It is very important to get up and try to walk within six hours after surgery - this is how to prevent the development of adhesive disease. It is equally important for recovery to start breastfeeding as early as possible. In addition to the obvious benefits for the child, prevention is achieved postpartum hemorrhage(in response to sucking, the hormone oxytocin is produced, which stimulates the contractile activity of the uterus).

After discharge, it is very important to establish regular bowel movements- through diet, rich in fiber, you also need to remember to drink plenty of water, because the fluid loss of a nursing mother is colossal.

Intimacy with your beloved husband is possible no earlier than two months later in the absence of contraindications. Sports activities - in six months. The pain in the incision area goes away for everyone individually, but in most cases, after a month, the discomfort stops bothering the woman. An important rule: in the postoperative period, you should not lift more weight than your child's weight. Don't be shy to ask for help, because difficult recovery- This is one of the features of a caesarean section.

The main thing is not how a new little person will be born, but that he is born healthy and the birth takes place without complications. Do not be afraid to give birth surgically, if indicated. But remember: the question of which is better - cesarean or natural birth - can only be answered based on the specific situation, and the price of a mistake is too high.

Every woman dreams of giving birth to a child on her own, as this is provided by nature. However, in some cases, natural childbirth becomes impossible. A woman has to undergo more than a simple abdominal operation - a caesarean section. There are different cases, some involve planned surgery, others require emergency surgery.

Placental abruption. As a rule, such a diagnosis is an indication for emergency surgery. Often, in such cases, we're talking about about life and death, so doctors try not to hesitate for a second. A pregnant woman may notice premature detachment placenta, due to constant cutting pain and bleeding. Having discovered such signs, you need to urgently seek help from a doctor, since this diagnosis, more often than others, is a prerequisite for intrauterine death.
Placenta previa. If the placenta blocks the birth canal, partially or completely, this makes it very difficult, and sometimes impossible, for the baby to come out naturally. Complete placental previa, is absolute indication to a caesarean section. Future mom may also notice this deviation by not too abundant bloody discharge from the genital tract, usually worsening at night, in the last trimester of pregnancy.
Incorrect (transverse) position of the fetus. Usually, the fetus is located vertically in the uterus, its head or pelvis is located towards the cervix. If the child is positioned sideways, this is relative indication to the operation. Transverse position of the fetus is usually due to decreased uterine tone, and large quantity amniotic fluid, as well as in multiparous women. The fetus may move into the correct position early in labor, but this usually occurs at 37 weeks of pregnancy. If no changes are observed, this will most likely be followed by a planned caesarean section.
Scar failure. A planned caesarean section is prescribed for women who have previously undergone the same operation if the endometrial scar has not completely healed. The incompetent scar is extremely thin and includes part connective tissue. Such abnormalities are detected by detailed ultrasound. Pregnant women with incompetent scar on the uterus, are hospitalized from the 35th week of pregnancy, and are under constant observation until surgery.
Clinical incompatibility of the size of the pelvis with the fetal head- is also a direct indication for caesarean section. Often, such a pathology is determined already during childbirth; doctors note the absence of forward movement of the fetal head during full disclosure uterus. Modern doctors, sometimes they still allow a natural birth process in this case. But such births, even with a positive outcome, always last longer than usual and are much more difficult.
Weak labor. This deviation occurs during prolonged birth process. If the woman in labor is exhausted and medications to stimulate labor are unsuccessful, the woman undergoes an emergency caesarean section. In this case, if the instruments show a deterioration in the child’s condition, doctors make an immediate decision about surgery.
Myopia, or a high risk of retinal detachment. Unfortunately, this risk also exists in women who do not have ophthalmological diseases. At the moment of pushing, especially if they are carried out incorrectly by the woman in labor, the intraocular pressure. The indication is not absolute, and many doctors still perform natural births with this risk.
Age of primigravida, mental illness. Age after 30 years is an indication for surgery, since there is a risk of possible complications and exacerbation of existing diseases during childbirth. If the pregnancy is successful and the expectant mother is healthy, they try not to resort to surgery. There are also women who are not ready for natural childbirth, with especially low pain threshold, up to fainting states. With proper examination, they are also prescribed a planned cesarean section.
Umbilical cord prolapse- occurs already during childbirth, after the rupture of amniotic fluid. Most often occurs when incorrect position fruit, and also if it is particularly large. This phenomenon threatens the life of the child, so the woman in labor is prescribed emergency surgery. If the labor process is almost over, a caesarean section is not performed.
Oxygen starvation fetus (acute hypoxia). Usually caused by one of the above pathologies, and may also be associated with excessive labor. If ultrasound and cardiotocography of the fetus during childbirth show an abnormal heartbeat in the child, urgent surgery is performed.