In the modern world, cesarean section is no longer a risky operation. Carrying out this type of surgical intervention is very common these days. Statistics say that for 8 women giving birth on their own, there is one who does this with the help of Caesarean. In order not to be afraid to give birth in this way and be positively tuned, every pregnant woman needs to know the main indications of this manipulation, as well as how to prepare for it.
Indications for planned caesarean section
Despite the routine of this surgical intervention for gynecologist surgeons, the risks of having a baby using a cesarean section are 12 times higher than those during natural childbirth. Therefore, before you begin to consider how a cesarean section passes, it is worthwhile to figure out which conditions are indications for its conduct.
Only in cases where childbirth naturally presents a danger to the mother and the child, and the risks of an independent birth exceed the likelihood of complications during cesarean, does the obstetrician-gynecologist direct the woman to the operative birth of the child.
The following is a list of indications for caesarean section:
- conditions of severe preeclampsia and eclampsia during pregnancy;
- decompensated diabetes mellitus;
- chronic diseases of the pregnant woman;
- severe myopia, accompanied by a change in the structure of the fundus;
- malformations of the birth canal (uterus and vagina);
- anatomically narrow pelvis of a severe degree;
- the presence of infections of the internal and external genital organs, in which there is a high risk of infection of the fetus during its passage through the genital tract;
- complete placenta previa (the placenta completely blocks the external opening of the uterus, preventing the exit of the fetus);
- incorrect position of the fetus (transverse, oblique);
- fetal presentation;
- multiple pregnancy with pelvic presentation of the first fetus;
- multiple scars on the uterus ;
- pregnancy after prolonged infertility, if there are any other complications that could become a threat to natural childbirth.
Indications for emergency caesarean section
As you can see, there are many conditions in which caesarean section is recommended. It is also possible emergency cesarean during childbirth in a natural way. It is worth noting that its holding is possible only in those cases when the fetus has not yet lowered into the small pelvis. Further emergency birth is possible only with the help of the operation of applying obstetric forceps.
Why is caesarean section performed urgently after attempts have already begun? The cause of this may be the following pathological conditions:
- mismatch between the size of the mother’s pelvis and the size of the fetus (clinically narrow pelvis);
- fetal distress (impaired placental circulation);
- weakness of labor;
- prolapse of umbilical cord loops;
- premature detachment of placental tissue;
- complete cessation of labor.
Preparation for surgery
Many pregnant women are in extreme excitement before having a cesarean section. Therefore, for many it will be useful to familiarize themselves in detail with the features of a caesarean section. Where does it all start?
A woman enters the maternity hospital a few days before the appointed date for the operation. In a hospital, the state of health of the mother and fetus is examined. For this, a cardiotocogram is used, where the parameters of the heartbeat of the fetus are recorded, ultrasound diagnostics is performed. Mothers regularly measure pressure, heart rate, monitor the amount of urine excreted.
When answering the question of which week the cesarean section is the most optimal, it is worth noting that a lot depends on the state of the mother and child. As a rule, a planned operation is carried out at 38-40 weeks.
In fact, the procedure begins even before the anesthesia and placement of the pregnant woman on the operating table. After all, for successful cesarean section, preoperative preparation is extremely important.
The day before, a doctor can prescribe a woman sedatives and sedatives in case of excessive excitement.
Important! Acceptance of any medicines by pregnant women should be carried out strictly under the supervision of the attending physician.
Before the operation, after the surgeon and the anesthetist have fully explained the progress of the cesarean section, the pregnant woman signs a written consent. The choice of the type of anesthesia, the method of applying the surgical suture - all stages should be discussed with the expectant mother.
Two hours before surgery, a woman is given a cleansing enema for bowel sanitation. Immediately before the manipulation of the pregnant woman, a urinary catheter is installed, which remains with her for one day.
Operation progress
For the birth of a child with the help of this surgical intervention, a number of caesarean section conditions must be met:
- the presence of a doctor with the appropriate qualifications: surgeon, perinatologist, obstetrician-gynecologist with surgical practice;
- written consent of the woman in labor;
- the presence of a doctor’s direction is strictly indicated: the operation should not be carried out only at the request of the woman.
Stage-by-stage progress of the operation of cesarean section can be represented as follows:
- incision of the skin, subcutaneous fat, muscle fascia;
- separation of muscle fibers from each other;
- uterine cavity incision;
- removing a child;
- removal of the placenta;
- suturing the incision on the uterus;
- suturing of the anterior abdominal wall.
Thus, the phased operation of cesarean section does not pose great difficulties for the obstetrician-gynecologist. The main points are the opening of the uterine cavity and the extraction of the fetus, since it is at these stages that you need to act especially carefully so as not to injure the child.
Below is a photo of a caesarean section. We will talk about the course of this manipulation further.
Autopsy of the abdominal cavity and uterine cavity
Basically, the incision of the skin and subcutaneous fat is performed in the suprapubic area in the transverse direction. This section localization has several advantages:
- smaller thickness of subcutaneous fat;
- minimal risk of hernia development in the postoperative period;
- the possibility of greater activity of the woman in childbirth after surgery, which contributes to the prevention of postoperative complications;
- the minimum size of the suture after surgery, which looks more aesthetically pleasing.
It is also possible to carry out a longitudinal incision in cases where there is already a longitudinal scar after the previous cesarean section, with severe bleeding, as well as in cases where it may be necessary to increase the incision up or down.
The opening of the uterine cavity is carried out in its lower segment using a transverse incision.
Removing the baby and the last stages of the operation
The most crucial moment in the operation of cesarean section is the extraction of the fetus. It must be carried out carefully in a strict order. With one hand, the surgeon removes the child by the pelvic end, holding him by the leg or inguinal fold. With his other hand, he should at this time support the neck and head of the child to prevent damage to the cervical spine.
Next, two clamps are applied to the umbilical cord and cross between them. The child is referred to a neonatologist to evaluate his life functions. Since it is not possible to put a baby on the mother’s chest, and according to the latest recommendations, this is a necessary step immediately after the baby’s birth, it is advised to put it on the father’s chest.
But back to the course of the operation, cesarean section, a detailed analysis of the last stages. After cutting the umbilical cord , the placenta is carefully removed by manual method, while checking that no parts of it remain in the uterus. After the uterus is sutured, carefully matching the edges of the incision. In the modern world, synthetic surgical sutures are used that dissolve after tissue fusion.
Suturing of the anterior abdominal wall is done with a suture or surgical staples. To maximize the reduction of the postoperative scar, the surgeon can make the inner suture with absorbable sutures. With this method, there are no outer threads, which then need to be removed. Unfortunately, an aesthetic suture has a higher cost, so surgeons should discuss this point separately with women.
On average, the duration of the operation is 30-40 minutes. And immediately after a cesarean, an ice bubble is placed on the lower abdomen for one and a half to two hours, which helps to reduce the uterus and reduce blood loss in the postoperative period.
Types of Anesthesia
In obstetrics, a cesarean section can be performed using two types of anesthesia:
- regional - epidural;
- general - mask, parenteral, endotracheal anesthesia.
The most common at the moment is epidural anesthesia. During the entire operation, the woman remains in clear consciousness, but does not feel anything. This is a more favorable type of anesthesia for both the mother (lower risk of complications) and the child (minimal exposure to medication). In addition, such anesthesia promotes contact between mother and baby in the first minutes after birth.
How is cesarean section with epidural anesthesia? An anesthetic is injected directly into the spinal canal through a catheter under the dura mater. A puncture is made between 3-4 vertebrae of the lumbar. This localization prevents the needle from entering the spinal cord. The administration of an anesthetic blocks the pain sensitivity of the lower body and the motor function of the lower extremities. Thus, the woman does not feel pain and cannot move her legs during the operation.
If for any reason local anesthesia is not possible, general anesthesia is done, most often through endotracheal administration of the drug. When using it, you must first enter the muscle relaxant intravenously. This medication provides relaxation of all muscles. Next, a tube is inserted into the trachea, through which they give the pregnant woman an anesthetic. This type of anesthesia is most often used for emergency cesarean.
Postoperative period
After cesarean section, the woman is in the postoperative ward for several hours under the supervision of a surgeon and nurses. Then she is left in the hospital for another two to three days. These days, a woman is given infusion therapy - an injection of saline solutions to replenish blood loss. Intravenous administration of up to one liter of fluids is allowed per day (isotonic sodium chloride solution, "Disol", "Trisol").
A certain period of time also requires the introduction of drugs to reduce pain in the postoperative scar. To do this, use "Analgin", "Baralgin".
To prevent complications in the postoperative period, it is necessary to carry out a number of preventive measures:
- getting up as early as possible (in the first 10-12 hours after surgery);
- breathing exercises starting 6 hours after surgery;
- self-massage;
- diet three days after cesarean.
Diet should be strict. On the first day, only the consumption of mineral water without gas is allowed, a small amount of tea without sugar. On the second and third days, the diet is expanded by eating low-calorie dishes: soups on vegetable broth, low-fat types of meat in boiled or steamed form, jelly. A woman should return to her normal diet gradually, only after the restoration of the normal functioning of the intestines, the passage of gases and stool.
Also, after surgery, you need to adhere to a number of rules regarding personal hygiene. Washing is allowed only from the second day, and only a gentle washing of individual parts of the body is allowed. Only after the surgeon removes the stitches (usually a week after the operation), you can completely wash in the shower.
Possible complications
Despite the fact that the course of a caesarean section for both the operating nurse and the surgeon does not seem complicated, nevertheless this is a serious abdominal operation, which can be accompanied by a number of complications.
The most common undesirable situations occur:
- high blood loss;
- trauma to the organs surrounding the uterus: loops of the intestine, bladder (usually occurs with repeated operations);
- fetal injury;
- allergic reaction to anesthetic.
Postoperative suture care
Now women are discharged from the hospital on the third day after cesarean section. This is due to the rapid healing of the wound after surgery due to the use of modern surgical suture materials. But important in the care of the suture after surgery is how the woman watches him. After all, proper care prevents the development of infectious infection.
It is not recommended to lubricate and process the seam area with anything. The main thing for a woman is to observe hygiene and carefully monitor the condition of the skin in this area. It is urgent to consult a doctor if the following symptoms are present:
- redness and swelling of the skin in the seam area;
- soreness when pressed;
- purulent discharge.
Within 42 days after the operation, the woman has the right to go to the hospital, where she underwent a cesarean, on any matter of interest to her. The doctor should examine the woman, conduct additional examination methods and, if necessary, prescribe the appropriate treatment.
Yes, a cesarean section and the course of the operation are simple and routine for most surgeons. But you need to remember that any surgical intervention is a risk, therefore, a caesarean section should be strictly followed by appropriate indications.