What are the indications for a planned caesarean section. Complete placenta previa. Relative medical indications are

Any woman who is carrying a baby is worried about his birth. Many of them have indications for caesarean section during pregnancy. Some will be notified in advance. Others are set to natural childbirth, but in the event of problems, an operational outcome is also possible, as the only correct solution. This operation is never appointed just like that by a responsible gynecologist and always has a justification. Traditionally, planned and emergency intervention has varieties. Let's consider them.

The list of reasons is quite extensive and is aimed at the implementation of the birth of a child according to the planned schedule, or the prevention of a critical situation. From conversations with doctors, it is known that there are women in labor who turn to them with a request to make a mechanical effect without the recommendations of doctors. Some choose it because they are terrified of pain. Others find it convenient to deceive nature and choose the birthday of their choice. Still others are afraid to burst and acquire a sexual disorder.

The question is, is it safe for the baby? The exact answer involves careful observation of mother and child. To make a final decision, it is necessary to soberly assess all the circumstances as a whole.

Based on medicine, the list of indications for caesarean section is divided into two types.

Absolute indicators from the side of the woman in labor

1. Narrow pelvis- He will not allow a woman to give birth on her own. Narrowing is distinguished by degree. A planned caesarean section is done at 3-4 tbsp. Second Art. indicates a decision in the course of labor activity.

The size of the pelvis is normal or the first st. indicate the possibility of natural delivery. But if the fetus grows large, it is possible that it will become clinically narrow. The pelvic ring is then smaller in comparison to the fetal head.

The correct measurement can be carried out on an ultrasound examination, or on a radiograph.

There are times when it has a normal volume, and the baby turns. When a vaginal examination reveals the insertion of the head of the face or forehead, then spontaneous childbirth is not allowed. Because it gets bigger. This position will cause an emergency caesarean section (CS).

2. Mechanical difficulties detected on ultrasound. An example is the deformation pelvic bones, neoplasms in the ovaries, uterine fibroids in the isthmus.

3. Danger of uterine rupture for women, who had previously undergone CS or some operations on female organ. The doctor determines this probability by the presence of a scar. Having a thickness of less than three millimeters, uneven contours, inclusions connective tissue will be dangerous because it will burst along this seam. To be convinced of the reliability, it is examined beforehand and during childbirth.

Additional indications for caesarean section during pregnancy are represented by two or more similar operations in the past, severe transfer of the previous one after operating period(temperature increase, uterine inflammation, prolonged healing of the suture, multiple natural deliveries that thinned the uterine wall).

Absolute indicators to the COP on the part of the fetus

1. Placental abruption prematurely. When she is separated during childbirth or before they begin, the woman may be subjected to profuse blood loss, and the fetus - acute hypoxia (lack of oxygen).
2. Placenta previa. Threatening position, which is detected on ultrasound. Correct when it is attached to the back of the uterus. In this case, it is located in its lower third, or above the neck and closes the exit for the fetus. This situation can activate heavy bleeding. Pathology, when there is no blood discharge, is a diagnosis for a planned CS only at a later time of gestation. Previously, panic should not be bred, since the placenta is still able to take its usual position.
3. Transverse position of the fetus. Normally, the birth of a child goes head or buttocks down. Usually, the arrangement across occurs in multiparous women. Because the muscles of the uterus and abdominal wall are already weakened. Other factors are polyhydramnios and placenta previa.
4. Prolapse of the umbilical cord. It is subjected to compression between the head and the pelvic wall. This damages the blood flow between mother and child.

Thus, the testimony of mother and baby, testifying to the unreality of natural childbirth, is called absolute.

Relative indications for caesarean section during pregnancy

1. Extragenital anomalies– accompanying female diseases that are not related to her health in the field of gynecology. Existing pathologies at the birth of a baby can dangerously worsen. These include:

• various cancerous concentrations,
• heart disease,
• high myopia with the threat of retinal detachment,
• diabetes,
• disease nervous system, kidney and others (for example, genital herpes).

2. Preeclampsia pregnant- a deviation threatening trouble that occurs in a pregnant woman in the second half of gestation. There is a violation in the vessels, brain activity. The expectant mother has high blood pressure, protein in the urine, swelling, headache, sometimes convulsions, the appearance of flies in front of you.
3. First birth in a woman over thirty-five.
4. A narrow pelvis in a woman in labor. The baby's head will not enter the birth canal even with active contractions and full disclosure cervix. There will be a threat of its rupture and severe suffocation of the fetus. It is impossible to accurately determine the volume of his head before childbirth, besides, it can deviate and be inserted incorrectly. Therefore, such a parameter is diagnosed along their course.
5. Scar on the uterus. Becomes a risk factor for its rupture. Always under special medical attention. Sometimes associated with a previous CS and is formed after an induced abortion, or removal of fibroids.
6. Persistent weakness of labor activity. Represents her calm. Contractions subside or disappear altogether. Medical support doesn't work. If the device shows that the baby is suffering, they resort to surgical intervention.

Relative indications for CS by the child

1. The fetus weighs more than four kilograms.
2. Breech presentation in natural childbirth. There is a risk of suffocation and injury. Everything is complicated when the newborn is large, and the mother has an anatomically narrowed pelvis.
3. Chronic or acute lack of oxygen in the baby. To identify, they use methods: they listen to an obstetrician with a stethoscope, examine the circulation of blood between the child, the uterus and the placenta, study the stirring and beating of the heart, amniotic fluid.

When hypoxia is detected, when therapeutic effect does not give a positive result, a CS is prescribed to preserve the health of the child.

A single relative indication does not become a basis for organizing a CS. But when making a decision to end the pregnancy, the doctor responsibly approaches all positive and negative points any option. And when the operation gets the most in a safe way delivery for mother and baby, then the gynecologist makes an election in her favor.

There is also combined information on the conduct of the COP. They combine several factors that together turn into a threat to life in independent childbirth. First of all, this is the detected hypoxia and overcarriage of the baby, pelvic presentation and big weight fetus, serious illness and age over thirty-five years.

Requirements for the operation

Surgery is organized subject to the following conditions:

• consent of the woman to its execution,
• resilience child,
• the presence of a highly qualified specialist and the availability of high-quality equipment;
• absence of infections.

Contraindications for caesarean section

The operation is undesirable when there is:

• purulent-septic complication in the mother,
• developmental pathology that is incompatible with the life of the baby,
• fetal death in the womb
• great prematurity,
• prolonged suffocation of the baby and the occurrence of stillbirth.

If there is a possibility of the death of the baby, then in delivery they will save the life of the mother. Medical care with risk factors can cause infectious-septic complications (for example, inflammatory processes appendages, uterus, in the peritoneum), since the dead fetus will become the focus of infection.

Now it is clear that indications for caesarean section during pregnancy are not a cause for panic. How it will be carried out - delivery is very important, but life is more important and maternal and newborn health. Only they become a priority for a competent doctor.

It's no secret that a caesarean section is an operation that ends a significant percentage of pregnancies. Some future mothers know in advance that their baby will be born by cesarean, others are preparing for natural childbirth, but problems arise in the process, and an operative outcome becomes the only possible one. A conscientious doctor will not prescribe a caesarean just like that; there must always be good reasons for such an outcome of pregnancy. In this article we will talk about indications and contraindications for caesarean section. Traditionally, indications for CS are divided into absolute and relative indications on the part of the mother and on the part of the fetus. Below are lists of indications for both planned and emergency caesarean sections.

Absolute indications for caesarean section

Need decision caesarean section on a case-by-case basis, the physician Despite the unpredictability of the birth process, in a number of situations it is known in advance what to give birth naturally a woman is not allowed, so a planned caesarean section is scheduled. Indications on the part of the mother and child, physically making natural childbirth impossible, are called absolute.

Absolute indications for caesarean section on the mother's side:

1. Absolutely narrow pelvis - this is a narrowing of the pelvic bones of a woman, through which the child cannot physically pass during natural childbirth. Obstetricians refer to the size of the pelvis as either normal or narrowed. The anatomically narrow pelvis has an objectively reduced size, and natural delivery in such a situation is impossible. Absolutely narrow is the pelvis II-IV degree of narrowing. At III-IV degree the caesarean section will be planned, and with the II degree, the decision will most likely be made already during natural childbirth.

With a normal size of the pelvis or with I degree of narrowing normal delivery are possible, but if a woman is carrying a large child, there is a possibility that her pelvis will be clinically narrow. The dimensions of the pelvic ring in this case simply do not correspond to the dimensions of the fetal head.

Careful measurement true dimensions pelvis with ultrasound examination and X-ray pelvimetry (radiography of the pelvic bones) allows you to find out whether a woman can give birth herself or whether a planned caesarean section is required.

Even with the normal size of the pelvic ring, the baby may turn incorrectly during childbirth. If a frontal or facial insertion of the head is detected during vaginal examination, this means that natural childbirth is not possible, since the head cannot pass through the pelvis with its own largest size. This situation is an absolute indication for an emergency caesarean section.

1. Mechanical obstacles for natural delivery (uterine fibroids in the isthmus, ovarian tumors, deformities of the pelvic bones) are also an absolute indication for a planned caesarean section. This factor is usually diagnosed by ultrasound.
2. Threat of uterine rupture exists in women who have already undergone a caesarean section or have a history of any operations on the uterus. The doctor determines the probability of rupture according to the condition of the scar. If it has a thickness of less than 3 mm, uneven contours and inclusions of connective tissue, the risk of uterine rupture along this suture is too great for a woman to give birth on her own. For reliability, the scar is examined both before and during childbirth. Additional factors in favor of a caesarean section is the presence of two or more caesarean sections in the past; heavy postoperative period after the previous cesarean - with fever, inflammatory processes in the uterus; long healing of the seam on the skin; numerous natural childbirth, thinning the wall of the uterus.

Absolute indications for caesarean section on the part of the fetus:

1. placenta previa - extremely dangerous situation which, fortunately, is easy to diagnose during pregnancy with an ultrasound. The placenta previa is not attached to the back of the uterus, as it should be, but in its lower third and sometimes even directly above the cervix, thereby blocking the exit for the fetus. Placenta previa can cause severe bleeding that can put both mother and baby at risk. This anomaly, in the absence of blood discharge, indicating placental abruption, becomes a diagnosis for a planned caesarean section only in late pregnancy. Earlier - there is no need to panic, the placenta can still rise to its normal position.
2. Premature detachment placenta - separation of the placenta before the onset of labor or during their process is also dangerous for a woman ( profuse blood loss), and for the fetus (acute hypoxia). It is an absolute indication for an emergency caesarean section.
3. Cord prolapse can occur during childbirth with polyhydramnios, when a large amount of amniotic fluid is poured out (water is leaving), and the baby's head has not yet been inserted into the small pelvis. The prolapsed umbilical cord is squeezed between the pelvic wall and the head, which means that the blood flow between mother and child is disturbed. If the obstetrician diagnoses such a condition during a vaginal examination after the discharge of water, this is a reason for an emergency caesarean section.
4. Transverse position of the fetus becomes an absolute indication for caesarean section already during childbirth. In a natural way, a child can be born only if it is located with the head or buttocks down, i.e. has head or pelvic presentation. Children of multiparous women are most often in the transverse position (due to weakening of the muscles of the uterus and abdominal wall), and factors contributing to the transverse position of the fetus are placenta previa and polyhydramnios. If the baby does not turn over during labor, even with the help of obstetric manipulations, doctors have no choice but to perform an emergency caesarean section.

Relative indications for caesarean section

The name “relative indications” speaks for itself: they include such conditions in which natural childbirth is physically possible, but has a theoretical risk to the health and even the life of the woman in labor and the baby.

Relative indications for caesarean section on the mother's side:

1. Extragenital pathologies – accompanying illnesses women not related to her gynecological health and pregnancy. The significant stress that a woman in labor experiences during childbirth can cause an exacerbation of existing pathologies that is dangerous for her health. Therefore, doctors attribute a number of diseases to relative indications for a caesarean section:

• cancer of any localization;
• cardiovascular diseases;
• diabetes;
• high myopia with a risk of retinal detachment;
• kidney disease;
• diseases of the nervous system and a number of others.

In addition, relative indications for caesarean section include diseases that can be transmitted from mother to child during its passage through the birth canal, for example, genital herpes.

1. Preeclampsia of pregnant women is dangerous pathology that occurs in some women in the second half of pregnancy. With gestosis, the work of the kidneys, blood vessels and brain of the expectant mother is disrupted. This deviation is manifested by high blood pressure, the appearance of protein in the urine, swelling, headaches, flickering "flies" before the eyes and sometimes convulsions. Preeclampsia in its severe forms (preeclampsia and eclampsia) is a medical indication for emergency caesarean section, because it causes fetal hypoxia.
2. Clinically narrow pelvis - this is a discrepancy between the size of the pelvic ring of a woman and the size of the presenting part of the child (head). In this case, the baby's head does not enter the birth canal with full disclosure of the cervix and the presence of active contractions. The danger of this pathological condition is the risk of uterine rupture, acute fetal hypoxia (which can even lead to his death). The size of the baby's head cannot be absolutely accurately determined before delivery, and in addition, incorrect insertion or distortion of the head is possible, so a clinically narrow pelvis is diagnosed already in the process of childbirth and is an indication for an emergency caesarean section.
3. Woman's age over 30 or 35 and first birth . dangerous factor in this case is not age, but the state of health of the woman in labor. It is logical that a 20-25-year-old primipara is likely to be healthier than one who is already 30-35 or more. However, not everything is so simple, and doctors know about it. Age over 35 can only be a relative indication for caesarean section. If a woman is healthy at 35, and the pregnancy is easy and safe, it is likely that she will be able to give birth naturally.
4. Persistent weakness of labor activity . If the natural childbirth that has already begun for some reason has subsided, there is no intensification of contractions or they have completely disappeared, and medical care does not bring results, doctors talk about the persistent weakness of labor activity. If at the same time the child suffers (devices show the presence of hypoxia), a caesarean section will appear to doctors as a more favorable outcome than waiting for the resumption of natural childbirth.
5. Scar on the uterus in itself is only a relative indication for caesarean section. But this is a risk factor for uterine rupture, which the obstetrician always pays attention to. Scars on the uterus are not always associated with a previous caesarean section, they may be the result of an artificial abortion or removal of fibroids. The condition of the scar must be monitored, especially after 36-37 weeks of pregnancy, and if it is complete, the woman has every chance of giving birth naturally.

Relative indications for a planned caesarean section on the part of the child:

1. Breech presentation of the fetus allows a woman to give birth herself, but still it is considered pathological. Natural birth with breech presentation carries the risk of fetal hypoxia and birth trauma. The situation is aggravated if the child is large (more than 3.6 kg), and the mother is the owner of an anatomically narrowed pelvis.
2. large fruit (more than 4 kg) is an indication for caesarean section only if there are other relative indications.
3. Identified chronic or acute fetal hypoxia (oxygen starvation) can serve enough good reason for operative delivery. The causes of hypoxia can be different: chronic hypoxia usually caused by gestosis of pregnant women and leads to a delay in the development of the fetus; acute hypoxia may occur during prolonged or, on the contrary, too fast and active labor, with placental abruption or prolapse of the umbilical cord. To diagnose oxygen starvation, which is extremely dangerous for the life of a child, use:

• listening with an obstetric stethoscope,
• Doppler ultrasound (study of blood circulation between the fetus, placenta and uterus),
• cardiotocography (registration of the heartbeat and movements of the fetus using special apparatus),
• amnioscopy (examination of amniotic fluid using an optical device).

If hypoxia is detected, and the treatment does not bring results, a decision is made on the need for a caesarean section to preserve the health of the child.

Each of the relative indications separately cannot serve as a reason for prescribing a caesarean section, however, when deciding on the outcome of a pregnancy, the doctor weighs all the pros and cons of each option. If the operation is presented to the doctor as a safer method of delivery for the health of the woman and the child, the choice will be made in her favor, taking into account only relative indications. In addition, there are so-called combined indications for caesarean section. They are a combination of factors, each of which in itself is not an indication for caesarean section, but together they turn into a real threat to life and health during natural childbirth. For example, this is a post-term pregnancy and identified hypoxia; large fetus and breech presentation; over 35 years of age and a serious illness.

Conditions for a caesarean section

A caesarean section can only be performed if a number of conditions are met. These include:

• fetal viability;
• the consent of the woman or her legal representatives (relatives) to the operation;
• availability of an operating room equipped with all necessary instruments and a qualified surgeon;
• no infections.

Contraindications for caesarean section

Like any operation, caesarean section has a number of possible contraindications. However, they are not absolute, since the reasons for the operation are usually quite good. Operative delivery undesirable in the following cases:

• the possibility of purulent-septic complications in a woman in the postoperative period;
• intrauterine fetal death;
• the presence of deformities and malformations in the fetus that are incompatible with life;
• deep prematurity of the fetus (respectively, its non-viability outside the uterus);
• prolonged severe fetal hypoxia, when it is no longer possible to deny the possibility of stillbirth or death of the newborn.

With the probability of fetal death, the choice of the method of delivery is aimed primarily at preserving the life and health of the woman. The operation, especially in the presence of risk factors, can cause infectious and septic complications (inflammation of the uterus or appendages, purulent peritonitis - acute inflammation in the peritoneum), as the dead fetus becomes a focus of infection.

Doctors identify the following risk factors for the development of purulent-septic complications:

1. Diverse immunodeficiency states(HIV, weakening of the immune system after taking strong medicines and etc.).
2. The presence of an infectious disease in a woman in acute or chronic form(inflammatory processes in the appendages, caries, chronic pyelonephritis, cholecystitis, infections of the upper respiratory tract etc.).
3. Gynecological diseases and complications of pregnancy that worsen blood microcirculation (gestosis of pregnant women, anemia, hypotension and hypertension, etc.).
4. The duration of labor is more than 12 hours or the anhydrous period (after the discharge of amniotic fluid) is more than 6 hours.
5. Significant blood loss, not replenished in a timely manner.
6. High frequency vaginal (especially instrumental) studies.
7. The presence of a corporal incision on the uterus (across the muscle fibers).
8. Unfavorable infectious environment in the hospital.

However, in the presence of absolute indications for caesarean section, even with acute infectious process, threatening septic complications, the woman should still be operated on. Until recently, in such a situation, only one option was possible - fetal extraction with simultaneous removal of the uterus in order to avoid purulent peritonitis. However, now there is a more favorable technique that allows you to save the uterus - caesarean section with temporary isolation abdominal cavity(extraperitoneal caesarean section).

Myths about caesarean section

In modern medicine, unfortunately, there has been a dangerous trend towards an increase in the number of caesarean sections. This is especially true for developed, prosperous countries. Some women really dream of a caesarean as easy way delivery. The reason for this attitude is ignorance or misunderstanding of what a caesarean section is. Let's dispel popular myths about this operation:

1. It is painless, unlike natural childbirth . Not true. A caesarean section is an operation during which several layers of tissue are cut. Yes, general anesthesia or epidural anesthesia “turn off” the pain during the operation (by the way, not always completely). But after recovering from anesthesia, pain in the suture area can make the postoperative period, especially its first days, completely unbearable. But you need to get up to go to the shower and toilet, and take care of the baby - feed, take him in your arms. Some women experience pain for several months.

2. It's even better for the baby - he does not need to pass through the tight birth canal, risking birth trauma. Absolute delusion. Babies born by caesarean section are traumatized by default. Neurologists always refer them to the risk group for speech disorders and other developmental delays. Nature created the mechanism of natural childbirth for a reason. A sharp change in the process of the operation of the pressure acting on the child, the effect of anesthesia, the baby's passivity in birth process, less contact with mother due to restrictions after caesarean, high probability artificial feeding- all this cannot but affect the child's adaptation to environment. It is more difficult for him to learn to scream, breathe, suck. There is no way to talk about any advantages of a caesarean section for a baby (unless, of course, we are talking about saving life and health).

3. At 30 or 35, health is no longer good enough to give birth on your own, especially for the first time. . This is wrong. Age is only a relative indication for caesarean section, which cannot be decisive. The doctor must take into account the state of health of a particular patient, and not her passport age.

4. After caesarean - always caesarean . The presence of a scar on the uterus from a previous delivery operation also refers to relative indications for caesarean section. Modern diagnostics allows you to establish the viability of the scar and predict the possibility of natural childbirth.

As you can see, a caesarean section is not something to strive for at any cost. However, if there are indications for surgery, there is no need to panic. The method of delivery is undoubtedly important, but it is even more important that the mother and the newborn baby are alive and well. This is what should be the priority goal of the doctor who prescribes you a caesarean section or gives you the go-ahead for natural childbirth. We wish you good health and a happy meeting with your baby soon!

In this article:

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

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

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

Planned operation

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

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

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

Emergency caesarean section during pregnancy

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

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

caesarean section during childbirth

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

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

Possible consequences of a caesarean section

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

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

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

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

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

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

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

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

The doctor's story about when to do a caesarean

The doctors of our center are confident that the conditions and contraindications for caesarean section are taken into account only in the absence of absolute indications for caesarean section. The caesarean section in this case is performed at 38 weeks of gestation or even earlier if there are bleeding talking about placental abruption. A history of anal sphincter rupture is also a relative indication for caesarean section.

The first reliable report of a caesarean section on a living woman was in 1610. The operation was carried out by J. Trautman from Wittenborg. In Russia, the first caesarean section was performed by I. Erasmus in Pernov (1756) and by V. M. Richter (1842) in Moscow. Sometimes this happens during pregnancy, then severe bleeding begins, which threatens the life of the mother and fetus and requires immediate surgery.

Every woman has her pelvis measured during pregnancy. Obstetricians have clear criteria for the normal size of the pelvis and narrow pelvis according to the degree of narrowing. Large fetus in combination with another pathology. In this case, there are severe difficulties and pain when walking. Preeclampsia is a complication of pregnancy, in which there is a disorder of the function of vital important organs, especially vascular system and blood flow.

Indications for caesarean section

In this case, the fetus receives an insufficient amount of oxygen and for him the process of childbirth is a load that can lead to birth trauma. If the condition of the fetus worsens, a caesarean section is performed. Post-term pregnancy with unprepared birth canal and in combination with other pathologies.

Normally, the placenta separates from the uterine wall after the baby is born. If a caesarean section is not performed within the next few minutes during the prolapse of the umbilical cord and head presentation of the fetus, the child may die.

In these cases, the doctor is obliged to carry out the birth through a caesarean section and nothing else, regardless of all other conditions and possible contraindications. It is clear that a doctor can determine an absolutely narrow pelvis in a woman with the help of examinations and ultrasound during pregnancy.

A mechanical obstruction can be, for example, uterine fibroids located in the isthmus, ovarian tumors, etc. Most often, this obstacle is determined by ultrasound, and on its basis, the doctor prescribes a planned caesarean. Of course, in each case, the condition of the scar is checked by ultrasound individually and repeatedly during pregnancy.

Absolute indications for caesarean section are also possible from the side of the fetus. These include placenta previa and placental abruption. This is clearly a planned situation, visible on ultrasound throughout pregnancy. Premature placental abruption, that is, a situation where the placenta separates from the uterine wall not after, but before childbirth, is also an absolute indication for caesarean section.

Detachment of the placenta makes breathing impossible for the fetus and requires an emergency caesarean section in his vital interests. On the part of the mother, these are, first of all, her diseases not associated with pregnancy, in which the burden of natural childbirth threatens the life and health of the mother.

Severe manifestations of preeclampsia - preeclampsia and eclampsia. The clinically narrow pelvis of the mother, that is, the situation when the size of the woman's pelvis does not correspond to the size of the presenting part of the child, is also a relative indication for caesarean section. A relative indication may be considered to be over 35 years of age in combination with pathology.

One thousand and one indications for caesarean section

An indication for caesarean section is also fetal hypoxia - that is, lack of oxygen. In this case, caesarean section is the safest delivery method for the baby. There are other relative indications for caesarean section, most of which appear already in childbirth and serve as a reason for an emergency caesarean section. Like any operation, a caesarean section can only be performed under certain conditions. In turn, intrauterine fetal death, fetal malformations and conditions incompatible with life, and the presence of infections in a woman in labor are contraindications for surgery.

Relative most often depend on the doctors taking delivery and the current situation in obstetrics. Many women whose babies are about to be born will be offered a caesarean section. We will try to separate absolute and relative indications for surgery. This group of indications includes prolapse of the umbilical cord. At the same time, it can be squeezed, and then the blood stops flowing to the child. More often it occurs when premature birth or during childbirth in a foot presentation.

In the case of complete placenta previa, it is located in the cervix and prevents the baby from leaving. The most striking symptoms of this condition are the discharge of scarlet blood from the genital tract, which is not accompanied by pain and most often occurs at night at the end of pregnancy.

Placental abruption can occur both before and during childbirth. This means that the placenta, or a significant part of it, separates from the uterine wall before the baby is born. In typical and obvious cases, there is sudden sharp pain in the abdomen. In general, if the doctor suggests a caesarean section due to placental abruption, this indication is better not to discuss.

This is why caesarean section rates vary so much from obstetrician to obstetrician, clinic to clinic, and country to country. Lack of progress during labor" is often cited as the reason for the first caesarean section.

Absolute indications for caesarean section are those situations in which natural childbirth is simply physically impossible. This is an undeniable indication for a caesarean section, except in cases where the birth is already at the stage when the baby is about to be born. You can often hear that for a nulliparous woman, age over 35 is also an indication for a caesarean section.

This is such a surgical operation, during which the anterior abdominal wall woman in labor, then - the wall of her uterus, after which the fetus is taken out through these incisions.

Caesarean section in modern obstetrics

In modern obstetrics, caesarean section is the most frequently performed operation. Its frequency in last years reaches 10-20% of total number childbirth.

Indications for caesarean section

A caesarean section is performed only in situations where vaginal delivery is fraught with a serious danger to the life and health of the fetus or the woman herself.

Distinguish between absolute and relative indications for surgery

Absolute readings to caesarean section - these are clinical situations in which childbirth through the natural birth canal poses a danger to a woman's life.

To the group relative readings includes diseases and obstetric situations that adversely affect the condition of the mother and fetus if childbirth is carried out in a natural way.

As you can see, most of the indications for caesarean section are due to concern for the health of both mother and child. In one case, already at the very beginning of pregnancy, during examination, a woman reveals the prerequisites that she may not give birth on her own (for example, a strong narrowing of the pelvis, or a scar on the uterus from a previous operation). In another, indications for delivery by caesarean section appear as the gestational age increases (for example, the fetus has a transverse position in the uterus or placenta previa was determined by ultrasound). The doctor warns the pregnant woman about this fact immediately, explaining to her the reason. In both of these cases, the woman is prepared for a caesarean section at planned, that is, upon admission to maternity ward they begin to prepare her not for childbirth, but for surgery.

Certainly, psychological aspect"Rejection" by future mothers of a caesarean section is understandable. Few people are "drawn" to surgical interventions in the affairs of his own body. But cesarean section is an everyday reality (judge for yourself: on average, 1 out of 6-8 pregnant women give birth this way). Therefore, the doctor always tries to explain all the pros and cons upcoming operation and comfort the woman.

But, sometimes, when it would seem that nothing foreshadowed danger throughout the pregnancy and the woman began to give birth on her own, there are emergency situations(for example, the threat of uterine rupture or oxygen starvation of the fetus, persistent weakness of labor) and childbirth ends by urgent indications cesarean section operation.

What clinical situations are considered a contraindication for caesarean section?

1. Intrauterine fetal death (fetal death before birth).
2. Deep prematurity of the fetus.
3. Fetal deformities.
4. Prolonged oxygen starvation of the fetus, in which there is no certainty in the birth of a live child.
5. infectious and inflammatory diseases mother.

What conditions are considered the most favorable for the operation?

1. The optimal time for the operation is the onset of labor, since in this case the uterus contracts well and the risk of bleeding decreases; in addition, in the postpartum period, the discharge from the uterus will receive a sufficient outflow through the ajar neck.
2. It is better if the amniotic fluid is intact or after their outflow, more than 12 hours should not pass.
3. A viable fetus (this condition is not always feasible: sometimes, when the life of the mother is in danger, the operation is performed even with a non-viable fetus).

What is the preparation of a woman for a planned caesarean section?

When preparing a pregnant woman, a detailed examination is carried out, including a study of blood counts, electrocardiography, a study of vaginal smears, an examination by a general practitioner and an anesthesiologist.

In addition, a comprehensive assessment of the condition of the fetus (ultrasound, cardiotocography) is mandatory.

The night before the operation, the pregnant woman is given a cleansing enema, which is repeated in the morning on the day of the operation. At night, as a rule, sedatives are prescribed.

What are the methods of anesthesia for caesarean section?

Endotracheal anesthesia - This general anesthesia With artificial ventilation lungs; is currently the main method of anesthesia for caesarean section. It is done by an anesthesiologist and during the entire operation controls the condition of the woman.

Operation steps

An incision of the skin and subcutaneous adipose tissue is carried out along the lower fold of the abdomen in the transverse direction.

The incision on the uterus is made carefully (so as not to damage the fetus) in the lower uterine segment (the thinnest and most stretched place on the uterus). The incision is made initially small also in the transverse direction. Then the surgeon index fingers gently stretches the incision up to 10-12 cm.

The next and most crucial moment is the extraction of the fetus. The surgeon gently inserts a hand into the uterine cavity and brings the fetal head out, and then removes the entire baby. The umbilical cord is then cut and the baby is delivered pediatrician and a nurse.

The placenta with membranes (afterbirth) is removed from the uterus, the uterine incision is carefully sutured, the surgeon checks the condition of the abdominal cavity and gradually sews up its wall.

Which unpleasant moments possible after surgery?

Possible discomfort during the recovery from anesthesia (and even then not for everyone). It can be nausea and dizziness, headaches. In addition, the surgical wound can also be a source pain at first time. The doctor usually prescribes drugs that reduce or eliminate pain (taking into account the effect of drugs on the newborn if the mother is breastfeeding).

Another disadvantage is the need bed rest during the first time (1-2 days, on the 3rd day after the operation it is allowed to walk), the need to urinate through a catheter inserted into bladder(quite briefly), more than usual, the number of prescribed drugs and tests, constipation and some hygiene restrictions - a wet toilet instead of a full shower (until the stitches are removed).

What is the difference postpartum period for women after caesarean section?

Mainly because it will take more time before a woman feels like before pregnancy, as well as the sensations and problems associated with a postoperative scar.

These patients need more rest and help with household chores and with the baby, especially in the first week after discharge, so it is helpful to think ahead and ask family members for help. To the discharge of particular soreness in the area postoperative suture must not be.

The incision area may be tender for a few weeks after the operation, but this will gradually disappear. After discharge, you can take a shower and you should not be afraid to wash the seam (with subsequent processing of it with brilliant green).

In the process of healing the seam, a feeling of tingling, tightening of the skin or itching may occur. This normal feeling, which are manifestations of healing processes and will gradually disappear.

A feeling of numbness of the skin in the area of ​​the scar may persist for several months after the operation. If there is severe pain, reddening of the scar, or brownish, yellow, or bloody discharge from the suture, you should consult a doctor.

Complications after caesarean section and their treatment

Peritonitis after caesarean section occurs in 4.6 - 7% of cases. Mortality from peritonitis and sepsis after caesarean section is 26 - 45%. The development of peritonitis causes infection of the abdominal cavity (from complications of caesarean section - chorionamnionitis, endometritis, suppuration of the suture, acute inflammatory processes in the appendages, infections that have penetrated the hematogenous or lymphogenous route - with paratonsillar abscess, with abscess of soft tissues, pyelonephritis).

Risk factors for the development of sepsis and peritonitis are similar in clinical and management tactics:

• sharp infectious diseases during pregnancy
• chronic infectious diseases and existing foci of chronic infection.
• All vaginosis (nonspecific) and specific colpitis.
• Age: under 16 and over 35.
• A long anhydrous period (more than 12 hours), that is, an untimely caesarean section.
• Frequent vaginal examinations (more than 4).
• Peritonitis after chorionamnionitis or endometritis in childbirth

Therapy program and treatment

Diagnosis is always late, but so is treatment. Developed tactics of surgical treatment (with removal of the uterus, as it is the primary source of peritonitis). Operate most often on days 9-15, rarely operate on days 4-6. Severity should be assessed by the progression of symptoms.

Treatment

1. Surgical intervention. The earlier it started surgery after the diagnosis of peritonitis, the less organ damage will be observed after surgery. Removal of an organ as a focus of infection (uterus with peritonitis after cesarean section) is etiologically directed. The uterus with tubes is removed, the ovaries are usually left if they are not in them inflammatory phenomena. Extirpation of the uterus is more often performed than amputation. The lower segment is close to the cervix, so supravaginal extirpation of the uterus is performed with removal fallopian tubes with revision of the abdominal organs.
2. Antibiotic therapy: cephalosporins and antibiotics acting on gram-negative microorganisms - gentamicin in maximum doses better intravenously. Preparations of the metronidazole series - metragil intravenously (acts on gram-negative flora, fungal flora). The spectrum of sensitivity of microorganisms to antibiotics must be done.
3. Treatment and cupping intoxication syndrome. Infusion therapy with drugs that have detoxification properties: reopoliglyukin, lactasol, colloidal solutions. The introduction of solutions improves the patient's condition. Also prescribe drugs that increase oncotic blood pressure - plasma, amino blood, protein preparations, solutions of amino acids. The amount of liquid is 4-5 liters. The therapy is carried out under the control of diuresis.
4. Restoration of intestinal motility: all infusion therapy crystalloid solutions, antibiotics improve motility. Also use agents that stimulate intestinal motility (cleansing, hypertonic enemas), antiemetics, prozerin subcutaneously, intravenously; oxybarotherapy). The first 3 days should be a constant activation of intestinal motility.
5. Antianemic therapy - fractional blood transfusion (preferably warm donated blood), antianemic agents.
6. Stimulation of immunity - the use of immunomodulators - thymolin, complex, vitamins, UV blood, laser irradiation blood.
7. Care and struggle with physical inactivity is important, parenteral nutrition, then complete enteral nutrition - high-calorie, fortified - dried apricots, cottage cheese, raisins, dairy products. The fight against hypodynamia is to carry out breathing exercises, early turning in bed, massage