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

Any woman who is carrying a baby worries about his birth. Many of them have indications for caesarean section during pregnancy. Some people are notified about this in advance. Others are set on natural childbirth, but if problems arise, a surgical outcome is also possible, as the only correct solution. This operation is never simply prescribed by the responsible gynecologist and always has a justification. Traditionally, there are different types of planned and emergency interventions. Let's look at them.

The list of reasons is quite extensive and is aimed at carrying out the birth of a child according to the planned schedule, or preventing a critical situation. From conversations with doctors, it is known that there are women in labor who turn to them with a request to perform mechanical action without the recommendations of doctors. Some choose it because they are terrified of pain. Others find it convenient to deceive nature and choose a birthday of their own choosing. Still others are afraid of breaking up and acquiring a sexual disorder.

The question arises, is it safe for the baby? An accurate answer requires careful monitoring of mommy and baby. To make a final decision, you need 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 parturient woman

1. Narrow pelvis– he will not allow a woman to give birth on her own. Narrowing is differentiated by degree. A planned cesarean section is performed at 3–4 tbsp. Second Art. indicates that a decision has been made regarding the course of labor.

The dimensions of the pelvis are normal or the first stage. 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 with the fetal head.

The correct measurement can be made using an ultrasound examination or an x-ray.

There are times when it has a normal volume, but the baby turns. When a vaginal examination reveals insertion of the head with the face or forehead, then spontaneous childbirth is unacceptable. Because it acquires the largest dimensions. This position will cause an emergency caesarean section (CS).

2. Mechanical difficulties identified by ultrasound. An example would be deformation pelvic bones, neoplasms in the ovaries, uterine fibroids in the isthmus.

3. The danger of uterine rupture for women who have previously undergone a CS or some kind of surgery 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 tear along this seam. To ensure its authenticity, it is examined before and during childbirth.

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

Absolute indicators for CS from the fetus

1. Placental abruption prematurely. When it is separated during labor or before it begins, the woman may be subject to heavy blood loss, and the fetus may experience acute hypoxia (lack of oxygen).
2. Placenta previa. A threatening situation that is detected on ultrasound. Correctly, when it is attached to the posterior region of the uterus. In this case, it is located in its lower third, or above the cervix and closes the exit for the fetus. This situation can intensify heavy bleeding. Pathology, when there is no bleeding, is a diagnosis for a planned CS only at a later time in pregnancy. Before, there should be no panic, since the placenta is still able to take its normal position.
3. Transverse position of the fetus. Normally, a baby is born with the head or buttocks down. Typically, a transverse position occurs in multiparous women. Because the muscles of the uterus and abdominal wall are already weakened. Other factors include polyhydramnios and placenta previa.
4. Umbilical cord prolapse. It is subject to compression between the head and the pelvic wall. This damages the blood flow between mother and baby.

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

Relative indications for cesarean section during pregnancy

1. Extragenital anomalies– accompanying women's diseases, which 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 cancer concentrations,
• heart disease,
• high myopia with risk of retinal detachment,
• diabetes,
• illnesses nervous system, kidneys and others (for example, genital herpes).

2. Gestosis in a pregnant woman- a deviation that threatens disaster, which occurs in a pregnant woman in the second half of gestation. There is a disturbance in the blood vessels, brain activity. The expectant mother has high blood pressure, protein in urine, swelling, headache, sometimes convulsions, the appearance of spots in front of you.
3. First birth in a woman over thirty-five years of age.
4. 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 birth; moreover, it may deviate and be inserted incorrectly. Therefore, this parameter is diagnosed according to their progress.
5. Scar on the uterus. Becomes a risk factor for its rupture. Always under special medical attention. Sometimes it is associated with a previous CS and is formed after an induced abortion or removal of fibroids.
6. Persistent weakness of labor. Represents its attenuation. Contractions begin to subside or disappear altogether. Medical support does not work. If the device shows that the baby is suffering, they resort to surgery.

Relative indications for CS on the part of the child

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

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

A single relative indication does not become the basis for organizing a CS. But when making a decision to end pregnancy, the doctor takes a responsible approach to all positive and negative points any option. And when the operation becomes 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 conducting a CS. They combine several factors that together become a threat to life in independent childbirth. First of all, this is the detected hypoxia and postmaturity of the baby, breech presentation and heavy weight fetus, serious illness and age greater than thirty-five years.

Requirements for the operation

Surgical intervention is organized subject to the following conditions:

• the woman's consent to her performance,
• vitality child,
• the presence of a highly qualified specialist and the availability of high-quality equipment;
• absence of infections.

Contraindications to 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,
• death of the fetus in the womb of a woman,
• major prematurity,
• prolonged suffocation of the baby and the occurrence of stillbirth.

If there is a possibility of the baby's death, the mother's life will be preserved during delivery. Medical care with risk factors can cause infectious and septic complications (for example, inflammatory processes appendages, uterus, peritoneum), since a dead fetus will become a source of infection.

It is now clear that indications for caesarean section during pregnancy are not a reason to panic. How it will happen - delivery is very important, but life is more important and the health of mother and newborn. Only they become a priority for a competent doctor.

It's no secret that a caesarean section is the operation that ends a significant percentage of pregnancies. Some expectant mothers know in advance that their baby will be born by cesarean section, others are preparing for a natural birth, but problems arise in the process, and a surgical outcome becomes the only possible option. A conscientious doctor will not simply prescribe a cesarean section; there must always be good reasons for such a pregnancy outcome. In this article we will talk about indications and contraindications for cesarean section. Traditionally, indications for CS are divided into absolute and relative, maternal and fetal indications. Below are lists of indications for both elective and emergency caesarean sections.

Absolute indications for caesarean section

Decision on necessity caesarean section in each specific case it is decided by a doctor. Despite the unpredictability of the birth process, in a number of situations it is known in advance that giving birth naturally the woman cannot, so a planned caesarean section is prescribed. Indications from the mother and child that physically make natural childbirth impossible are called absolute.

Absolute indications for caesarean section on the maternal side:

1. Absolutely narrow pelvis - this is a narrowing of the woman’s pelvic bones, through which the child physically cannot pass during natural childbirth. Obstetricians classify the size of the pelvis as either normal or narrowed. An anatomically narrow pelvis has objectively reduced dimensions, and natural delivery in such a situation is impossible. The pelvis is considered to be absolutely narrow if it is in degree II-IV narrowing. At III-IV degrees a cesarean section will be planned, and in stage II, the decision will most likely be made during natural childbirth.

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

Careful measurement true dimensions pelvis using ultrasound examination and X-ray pelvimetry (x-rays of the pelvic bones) make it possible to find out whether a woman can give birth on her own or whether a planned caesarean section is required.

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

1. Mechanical obstacles for natural delivery (uterine fibroids in the isthmus area, ovarian tumors, deformities of the pelvic bones) are also an absolute indication for a planned cesarean section. This factor is usually diagnosed using ultrasound.
2. Threat of uterine rupture exists in women who have already undergone a caesarean section or have a history of any uterine surgery. The doctor determines the likelihood of rupture based on 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 the woman to give birth on her own. For reliability, the scar is examined both before and during childbirth. Additional factors in favor of cesarean section is the presence of two or more cesarean sections in the past; heavy postoperative period after a previous cesarean section - with elevated temperature, inflammatory processes in the uterus; long healing of the seam on the skin; numerous natural births, which have thinned the uterine wall.

Absolute indications for caesarean section from the fetus:

1. Placenta previa – extremely dangerous situation, which, fortunately, is easy to diagnose during pregnancy using 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, which poses a risk to the life of both mother and baby. This anomaly, in the absence of blood discharge indicating placental abruption, becomes a diagnosis for a planned cesarean section only in the later stages of 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 labor is also dangerous for the woman ( heavy blood loss), and for the fetus (acute hypoxia). It is an absolute indication for emergency caesarean section.
3. Umbilical cord prolapse can occur during childbirth with polyhydramnios, when a large volume of amniotic fluid is poured out (water breaks), and the baby’s head has not yet been inserted into the pelvis. The prolapsed umbilical cord becomes compressed between the pelvic wall and the head, which means the blood flow between mother and child is disrupted. If the obstetrician diagnoses this condition during a vaginal examination after the water breaks, this is a reason for an emergency cesarean section.
4. Transverse position of the fetus becomes an absolute indication for cesarean section already during labor. A baby can be born naturally only if it is positioned with the head or buttocks down, i.e. has a cephalic or breech presentation. Children of multiparous women most often find themselves in a transverse position (due to weakening of the muscles of the uterus and abdominal wall); also 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: these include conditions in which natural childbirth is physically possible, but has a theoretical risk to the health and even the life of the mother and baby.

Relative indications for cesarean section on the maternal 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 to her health. Therefore, doctors classify a number of diseases as relative indications for a cesarean section:

• cancer of any location;
• 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 cesarean section include diseases that can be transmitted from mother to child as it passes through the birth canal, for example, genital herpes.

1. Preeclampsia in pregnant women is dangerous pathology, which occurs in some women in the second half of pregnancy. With gestosis, the functioning of the kidneys, blood vessels and brain of the expectant mother is disrupted. This deviation appears high blood pressure, the appearance of protein in the urine, swelling, headaches, flashing “spots” before the eyes and sometimes convulsions. Preeclampsia in its severe forms (preeclampsia and eclampsia) is a medical indication for emergency cesarean section, as it causes fetal hypoxia.
2. Clinically narrow pelvis – this is a discrepancy between the size of the woman’s pelvic ring and the size of the presenting part of the child (head). In this case, the baby's head does not enter the birth canal when the cervix is ​​fully dilated and active contractions are present. The danger of this pathological condition is the risk of uterine rupture, acute fetal hypoxia (which can even lead to its death). The size of the baby’s head cannot be absolutely accurately determined before birth, and in addition, incorrect insertion or distortion of the head is possible, so a clinically narrow pelvis is diagnosed already during childbirth and is an indication for an emergency cesarean section.
3. Woman's age over 30 or 35 years and first birth . A dangerous factor in in this case It is not the age, but the state of health of the mother in labor. It is logical that a 20-25-year-old primigravida is most likely healthier than one who is already 30-35 or more. However, not everything is so simple, and doctors know this. Age over 35 can only be a relative indication for cesarean 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 . If a natural birth that has already begun has subsided for some reason, no intensification of contractions is observed or they have completely disappeared, and medication assistance does not bring results, doctors talk about persistent weakness of labor. If the child suffers in this case (devices show the presence of hypoxia), a cesarean section will seem to doctors 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 cesarean section; they can be the result of an induced abortion or removal of fibroids. The condition of the scar must be monitored, especially after 36-37 weeks of pregnancy, and if it is full, the woman has every chance of giving birth naturally.

Relative indications for elective caesarean section on the part of the child:

1. Breech presentation of the fetus allows a woman to give birth on her own, but it is still considered pathological. Natural birth with breech presentation carries the risk of fetal hypoxia and birth injuries. The situation gets worse if the child is large (more than 3.6 kg) and the mother has 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. Detected 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 in pregnant women and leads to delayed fetal development; acute hypoxia can occur during prolonged or, on the contrary, too fast and active labor, during placental abruption or prolapse of the umbilical cord. To diagnose oxygen starvation, which is extremely dangerous for a child’s life, the following is used:

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

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

Each of the relative indications separately cannot serve as a reason for prescribing a cesarean section, however, when deciding on the outcome of the pregnancy, the doctor weighs all the pros and cons of each option. If the operation seems to the doctor to be a safer method of delivery for the health of the woman and child, the choice will be made in its favor, taking into account only relative indications. In addition, there are so-called combined indications for cesarean section. They represent a combination of factors, each of which in itself is not an indication for a cesarean 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; age over 35 years and the presence of a serious illness.

Conditions for caesarean section

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

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

Contraindications to caesarean section

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

• the possibility of a woman developing purulent-septic complications in the postoperative period;
• intrauterine fetal death;
• the presence of deformities and malformations in the fetus that are incompatible with life;
• severe prematurity of the fetus (accordingly, its non-viability outside the uterus);
• prolonged severe fetal hypoxia, when the possibility of stillbirth or death of the newborn can no longer be denied.

If there is a possibility of fetal death, the choice of delivery method 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 peritoneal area), since the dead fetus becomes a source of infection.

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

1. Varied immunodeficiency states(HIV, weakened immunity after taking potent 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 in pregnant women, anemia, hypotension and hypertension, etc.).
4. The duration of labor is more than 12 hours or the anhydrous period (after the rupture of amniotic fluid) is more than 6 hours.
5. Significant blood loss that was not replaced in a timely manner.
6. High frequency vaginal (especially instrumental) examinations.
7. The presence of a corporal incision on the uterus (across the muscle fibers).
8. Unfavorable infectious situation in the maternity hospital.

However, if there are absolute indications for cesarean section, even in acute infectious process threatening septic complications, the woman still has to undergo surgery. Until recently, in such a situation, only one option was possible - removing the fetus with simultaneous removal of the uterus 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 of increasing the number of cesarean sections. This is especially true for developed, prosperous countries. Some women actually dream of a caesarean as the 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 “turns off” pain during surgery (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 him, pick him up. Some women feel pain for several months.

2. It's even better for the child – he does not need to go through the narrow birth canal, risking birth trauma. Absolutely delusional. Children born as a result of cesarean section receive birth trauma by default. Neurologists always classify them as at risk for speech disorders and other developmental delays. Nature created the mechanism of natural childbirth for a reason. A sharp change in the pressure acting on the child during the operation, the effect of anesthesia, the baby’s passivity during birth process, less contact with mother due to post-cesarean restrictions, high probability artificial feeding– all this cannot but influence the child’s adaptation to environment. It is more difficult for him to learn to scream, breathe, suck. There is no 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 years old, health is no longer the same as giving birth yourself, especially for the first time . This is wrong. Age is only a relative indication for cesarean section, which cannot be decisive. The doctor must take into account the health status of a particular patient, and not her passport age.

4. After cesarean - always cesarean . The presence of a scar on the uterus from a previous delivery operation also refers to relative indications for cesarean section. Modern diagnostics make it possible to establish the consistency of the scar and predict the possibility of natural childbirth.

As you can see, a caesarean section is not something you should 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 what is even more important is that the mother and newborn baby are alive and healthy. This should be the priority goal of the doctor who prescribes a cesarean section for you or gives the go-ahead for a natural birth. We wish you health and a happy meeting with your baby soon!

In this article:

Caesarean section refers to a series of surgical medical interventions in the human body. This operation is intended to resolve labor and extract the fetus by making an incision in the woman's abdominal wall and then cutting into the wall of the uterus. Indications for caesarean section are a number of pathologies and diseases of a pregnant woman. They entail the impossibility of childbirth occurring naturally due to various kinds complications dangerous to the life and health of the mother and unborn child.

The need for this type of intervention can be determined 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 history, which has its roots in the distant past.

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

Planned surgery

A planned caesarean section is called a cesarean section, the indications for which were established by the attending physician during pregnancy. The woman is admitted to the pathology department in advance of the day of surgery and undergoes necessary examination and preparation. During this period, specialists should evaluate physiological state women, reveal everything possible violations and risks, as well as assess the condition of the fetus. The anesthesiologist will talk with the woman in labor, talk about acceptable types of anesthesia, their advantages 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 disorder is that the placenta (the location of the baby) moves to bottom part uterus and blocks the entrance to it. With this 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 possibly earlier if the appearance of bloody discharge is noticed.
2. According to the results of ultrasound, the scar on the uterus was found to be incompetent, 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 undergone surgery – elevated temperature bodies 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 similar interventions, she is usually not allowed to go into labor, as this risks uterine rupture along the scar. The operation is scheduled; there is no need to wait for natural resolution to begin.
4. Uterine fibroids. When it is multiple and characterized by the location of a node in the cervix or the presence of large nodules whose nutrition is impaired, cesarean delivery is indicated.
5. Pathologies of the pelvic organs, including tumors of the uterus or its appendages, degree II and higher narrowing of the pelvis, and others.
6. Pathologies hip joints: ankylosis, congenital dislocation, previous operations.
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 narrowings.
9. Severe symphysitis. This disease is characterized by divergence of the pubic bones to the sides. Clinical manifestations– difficulty walking, accompanied by pain.
10. Conjoined twins.
11. The number of fruits is more than two.
12. Incorrect placement of the fetus in late dates in primiparas (gluteo-leg).
13. The fruit is located transversely.
14. Cancer of the uterus and its appendages.
15. Genital herpes in the acute stage, which occurred 1-14 days before the end of pregnancy. CS is indicated when there are blistering-like rashes on the surface of the external genitalia.
16. Severe diseases of the kidneys, nervous system, cardiovascular systems, lung diseases, and sharp deterioration general condition health of a pregnant woman.
17. Chronic fetal hypoxia, its malnutrition (growth retardation), which cannot be treated with medications. In this case, the fetus does not receive the amount of oxygen it needs, and natural childbirth can result in serious injury.
18. The age of the woman at the first birth is over thirty years, combined with any other pathology.
19. Fetal malformations.
20. In vitro fertilization (especially if it happened more than once) in combination with other complications.
21. Also serious violation vision – indication for caesarean section. It is valid for myopia (diagnosis of myopia), which occurs in a woman in labor during complex form where there is a risk of retinal detachment.

Emergency caesarean section during pregnancy

Indications for urgent surgical intervention may include 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 wall of the uterus should occur at the end of labor. But there are cases when the placenta detaches during pregnancy and is accompanied by severe bleeding, threatening the life of the fetus and mother.
• Symptoms of uterine rupture along a scar. When there is a threat of rupture, it is important to undergo urgent surgery in time, as loss of the fetus and removal of the uterus are possible.
• Acute fetal hypoxia, when the child’s heartbeat decreases sharply and cannot be restored.
• Transition of gestosis to severe form, the occurrence of preeclampsia and eclampsia.
• Placenta previa, sudden bleeding.

Caesarean during childbirth

If pathologies and disorders are discovered during childbirth, which are indications for cesarean section during pregnancy, and 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 the correspondence between the pelvis of the woman in labor, which turned out to be clinically narrow, and the baby’s head.
• There are disturbances in uterine contractions that cannot or cannot be corrected.
• Fetal presentation feet first.
• Loss of umbilical cord loops.
• The outflow of amniotic fluid ahead of time, labor induction does not have any effect.

Possible consequences of cesarean section

Before, during and after a cesarean section, many women feel much better than if they had to undergo a vaginal 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 artificial resolution the woman does not experience pain or suffering. And due to the fact that there are no stretch marks or tears in the perineum, after discharge from the maternity hospital, the female body recovers much faster. Of course, if no unwanted complications arise.

However, do not delude yourself, because no one is immune from complications and unforeseen situations. Although this operation in combination with modern methods And medical equipment is reliable, proven and quite safe, its complications are possible.

• Surgical complications. During surgery, it is possible to accidentally hit a vascular branch when cutting the uterus, which may result in bleeding. It is also possible that the bladder or intestines may be affected, and in in rare cases The fetus itself is injured.
• Complications due to anesthesiology. There is a risk after surgery uterine bleeding. It may occur due to the fact that uterine contraction is disrupted due to surgical trauma. It can also be caused by the effects of medications. A change in the physical and chemical composition of the blood, which necessarily occurs under the influence of anesthesia, can lead to thrombus formation and blockage of blood vessels.
• Purulent complications and infection. After a cesarean section birth, the sutures may fester, and it is still possible for them to separate.

You should also beware of endometritis (occurs as a result of inflammation of the uterus), adnexitis (when the appendages become inflamed), parametritis (the periuterine tissue becomes inflamed). To prevent these diseases, treatment with antibiotics during and after surgery is necessary.

As for the child, after medical intervention he may have problems with the respiratory system and their pathologies. In order to partially prevent this threat, the date elective surgery prescribed as close as possible to the date that marks the end of pregnancy. Also, CS can be a consequence of difficulties in breastfeeding.

The onset of lactation occurs late, as it occurs significant loss blood, the mother needs to recover from surgical stress, the child’s adaptation to a new way of existence is disrupted. In addition, a woman needs to find comfortable position for feeding, since the standard one - sitting with the baby in your arms - causes pain and discomfort, as the child puts pressure on the seam.

After a CS, disturbances in the functioning of the baby’s heart may occur, it is observed reduced level glucose and hormones thyroid gland. Excessive lethargy and drowsiness of the child are noticeable, muscle tone is reduced, the wound on the navel heals more slowly, and the immune system copes with its activities worse than in children born naturally. But using achievements modern medicine leads to restoration and normalization physiological indicators baby by the day of discharge.

The question that arises quite rightly among women, which is better - childbirth or cesarean - cannot be given a definite answer. Of course, it is always better what is inherent in nature itself, what is called natural and does not require additional intervention. Therefore, a 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 section

Doctors at our center are confident that conditions and contraindications for cesarean section are taken into account only in the absence of absolute indications for cesarean section. In this case, a cesarean section is performed at 38 weeks of pregnancy or even earlier if symptoms appear. bleeding, indicating placental abruption. A history of anal sphincter rupture is also a relative indication for cesarean section.

The first reliable report of a caesarean section on a living woman was in 1610. The operation was performed by J. Trautman from Wittenborg. In Russia, the first caesarean section was performed by I. Erasmus in Pernov (1756) and 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 pelvic size measured during pregnancy. Obstetricians have clear criteria for normal pelvic sizes and a narrow pelvis based on the degree of narrowing. Large fetus in combination with another pathology. In this case, severe difficulties and pain appear when walking. Preeclampsia is a complication of pregnancy in which vital function is disrupted. 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 it the process of childbirth is a burden that can lead to birth trauma. If the fetal condition worsens, a caesarean section is performed. Post-term pregnancy with unprepared birth canal and in combination with other pathology.

Normally, the placenta separates from the wall of the uterus after the baby is born. If the umbilical cord prolapses and the fetus is in cephalic presentation, if a caesarean section is not performed within the next few minutes, the child may die.

In these cases, the doctor is obliged to carry out the birth through cesarean 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 even during pregnancy.

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

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

Placental abruption makes fetal breathing impossible and requires an emergency cesarean section in its vital interests. On the mother’s side, these are, first of all, her diseases not related to pregnancy, in which the burden of natural childbirth threatens the life and health of the mother.

Severe manifestations of gestosis are preeclampsia and eclampsia. A clinically narrow maternal pelvis, that is, a situation where 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 cesarean section. A relative indication can be considered age over 35 years in combination with pathology.

A thousand and one indications for caesarean section

An indication for cesarean section is also fetal hypoxia - that is, lack of oxygen. In this case, cesarean section is the safest method of delivery for the child. There are other relative indications for cesarean section, most of which appear already during labor and serve as a reason for emergency cesarean 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 ones most often depend on the doctors delivering the baby 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 umbilical cord prolapse. At the same time, it can be compressed, and then blood stops flowing to the child. It occurs more often when premature birth or during childbirth in a leg presentation.

In the case of complete placenta previa, it is located in the cervix and prevents the delivery of the baby. 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 wall of the uterus before the baby is born. In typical and obvious cases, sharp pain in the abdomen suddenly occurs. In general, if the doctor suggests a cesarean section due to placental abruption, it is better not to discuss this indication.

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 a reason for a first cesarean section.

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

This is a surgical operation during which the anterior abdominal wall the woman in labor, then the wall of her uterus, after which the fetus is removed 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 birth is fraught with serious danger to the life and health of the fetus or the woman herself.

There are absolute and relative indications for surgery

Absolute readings to a cesarean section are clinical situations in which vaginal delivery poses a danger to the woman’s life.

To the group relative readings diseases and obstetric situations that adversely affect the condition of the mother and fetus are included if childbirth is carried out naturally.

As you can see, most indications for cesarean section are due to concerns for the health of both mother and child. In one case, already at the very beginning of pregnancy, during examination, a woman is found to have the prerequisites that she may not be able to 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 cesarean section appear as the gestational age increases (for example, the fetus has established a transverse position in the uterus or placenta previa has been 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. in a planned manner, that is, upon admission to maternity ward They begin to prepare her not for childbirth, but for surgery.

Certainly, psychological aspect The “rejection” of cesarean sections by expectant mothers is understandable. Few people feel "craving" for surgical interventions into 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 surgery and calm the woman down.

But sometimes, when there seemed to be no signs of danger throughout the entire pregnancy and the woman began to give birth on her own, emergency situations(for example, the threat of uterine rupture or oxygen starvation of the fetus, persistent weakness of labor) and labor ends in urgent indications operation of caesarean section.

What clinical situations are considered a contraindication for a caesarean section?

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

What conditions are considered most favorable for the operation?

1. The optimal time for the operation is considered to be the beginning of labor, since in this case the uterus contracts well and the risk of bleeding is reduced; in addition, in the postpartum period, discharge from the uterus will receive sufficient outflow through the slightly open cervix.
2. It is better if the amniotic fluid is intact or no more than 12 hours should pass after its release.
3. Viable fetus (this condition is not always feasible: sometimes, if the mother’s life is in danger, the operation is performed on a non-viable fetus).

How does a woman prepare for a planned caesarean section?

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

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

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

What are the methods of pain relief for a caesarean section?

Endotracheal anesthesia - This general anesthesia With artificial ventilation lungs; is currently the main method of pain relief for caesarean section. It is performed by an anesthesiologist and monitors the woman’s condition throughout the operation.

Operation stages

An incision of the skin and subcutaneous fat is made 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 distended place on the uterus). The incision is initially made small, also in the transverse direction. Then the surgeon index fingers carefully stretches the incision to 10-12 cm.

The next and most crucial moment is the extraction of the fetus. The surgeon carefully inserts his hand into the uterine cavity and brings out the fetal head, and then removes the entire baby. Afterwards the umbilical cord is cut and the baby is transferred 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 sutures its wall.

Which unpleasant moments possible after surgery?

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

Troubles can also include the need bed rest at first (days 1-2, walking is allowed on the 3rd day after surgery), the need to urinate through a catheter inserted into the bladder(not for long), a larger than usual number of prescribed medications and tests, constipation and some hygienic restrictions - a wet toilet instead of a full shower (before the stitches are removed).

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

Mainly because it will take longer for a woman to feel like she did before pregnancy, as well as the sensations and problems associated with the post-operative scar.

These patients require more rest and help with household chores and with the baby, especially in the first week after discharge, so it is helpful to think about this in advance and ask family members for help. For discharge of special pain in the area postoperative suture must not be.

The incision area may be tender for a few weeks after surgery, but this will gradually subside. After discharge, you can take a shower and you should not be afraid to wash the seam (followed by treating it with brilliant green).

During the healing process of the suture, a tingling sensation, skin tightening or itching may occur. This normal sensations, which are manifestations of healing processes and will gradually disappear.

For several months after surgery, a feeling of numbness in the skin in the scar area may persist. If you experience severe pain, redness of the scar, or brownish, yellow or bloody discharge from the suture, you should consult a doctor.

Complications after cesarean section and their treatment

Peritonitis after cesarean section occurs in 4.6 - 7% of cases. Mortality from peritonitis and sepsis after cesarean section is 26 - 45%. The development of peritonitis is caused by infection of the abdominal cavity (from complications of cesarean section - chorioamnionitis, endometritis, suppuration of the suture, acute inflammatory processes in the appendages, infections penetrated by hematogenous or lymphogenous route - with peritonsillar abscess, with soft tan abscess, pyelonephritis).

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

• spicy 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 years old.
• A long period without water (more than 12 hours), that is, an untimely cesarean section.
• Frequent vaginal examinations (more than 4).
• Peritonitis after chorioamnionitis or endometritis during childbirth

Therapy program and treatment

Diagnosis is always late, as is treatment. Developed tactics of surgical treatment (with removal of the uterus, since this is the primary source of peritonitis). The operation is most often performed on days 9-15; operations are rarely performed on days 4-6. Severity should be assessed by the progression of symptoms.

Treatment

1. Surgical intervention. The sooner it starts surgery Once the diagnosis of peritonitis is made, the fewer organ disorders will be observed after surgery. Removal of an organ as a source of infection (uterus with peritonitis after cesarean section) is etiologically targeted. The uterus and tubes are removed, the ovary is usually left if it is not in them inflammatory phenomena. Hysterectomy is more often performed than amputation. The lower segment is close to the cervix, therefore supravaginal hysterectomy 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. Metronidazole drugs - metragil intravenously (acts on gram-negative flora, fungal flora). The spectrum of sensitivity of microorganisms to antibiotics must be done.
3. Treatment and relief intoxication syndrome. Infusion therapy with drugs that have detoxification properties: rheopolyglucin, lactasol, colloidal solutions. The administration of solutions improves the patient's condition. Also prescribed are drugs that increase the oncotic pressure of the blood - plasma, aminokrovin, protein preparations, amino acid solutions. The amount of liquid is 4-5 liters. Therapy is carried out under the control of diuresis.
4. Restoration of intestinal motility: all infusion therapy crystalloid solutions and antibiotics improve motility. They also use drugs that stimulate intestinal motility (cleansing, hypertensive 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 donor blood), antianemic drugs.
6. Stimulation of immunity - use of immunomodulators - timolin, complex, vitamins, UV blood, laser irradiation blood.
7. Care and fight against physical inactivity are important, parenteral nutrition, then complete enteral nutrition - high-calorie, fortified - dried apricots, cottage cheese, raisins, dairy products. The fight against physical inactivity involves breathing exercises, early turning in bed, massage