Caesarean section is an abdominal operation. Caesarean section: a modern approach

Today, many children are born by caesarean section. This happens because something is wrong with the mother's health. Or some other emergency situation arose.

Preparing for a caesarean section

Firstly, a woman must be mentally prepared. After all, when she is calm, it will be better not only for her, but also for her child. It is also necessary to collect all the things necessary for the maternity hospital in advance because you will still need to have time to conduct more than one examination before the operation. Even if the pregnant woman had been tested before, they will still take blood, urine and, in most cases, a vaginal smear. Also, very often doctors send for an ultrasound to find out the exact condition of the fetus. If any discrepancies with the norm are found, treatment with drugs will most likely be prescribed. At the same time, the date of the operation will be selected, for which the woman and child feel are taken into account. If there are no deviations. You can appear for the operation either shortly before the operation itself or on the day when it will be performed.

Day of surgery

In most cases, such operations are preferred to be done in the morning. Therefore, a woman should definitely take a shower and shave her pubic hair. Her dinner should be as light as possible, and she will have to skip breakfast altogether. Just before the operation, the nurse will help you do an enema to completely cleanse the intestines.

Next, the plan is to have a conversation with an anesthesiologist who will tell you all the details of pain management during a caesarean section. Today, spinal anesthesia is the usual choice. In this case, the woman will be able to see her baby immediately after it is removed from the uterus. But this option is only possible if the woman has no contraindications. The method of anesthesia chosen will need to be recorded in writing.

Caesarean section, how the operation works

Before entering the operating room, a woman puts on a cap, shoe covers and elastic bandages which will help avoid thrombosis. On the table where the operation will be performed, the woman in labor should lie completely naked. First, anesthesia is given, then an IV is connected and a drug is connected that will show blood pressure. The last stage of preparation will be the installation of a catheter to drain urine. When everything is ready, the doctor treats the future incision site with an antiseptic.

A screen is usually placed between the operation site and the woman's face. In some maternity hospitals, it is the practice that a woman’s relative may be behind the screen during such an operation. The entire operation takes no more than ten minutes. First, the baby is removed and the umbilical cord is cut. Then the doctor carefully cleans and examines the uterus, after which it and the abdominal wall are sutured. The seam is treated again with an antiseptic and a bandage is applied, and ice wrapped in a cloth is placed on top. In this way, bleeding can be reduced, and the uterus will contract more actively. Then the woman is transferred to the ward intensive care.

After operation

In order for a woman to recover faster, doctors use the most different drugs, even antibiotics. When the anesthesia wears off, they begin to inject painkillers and medications that promote intense contraction of the uterus and intestines. In order to normalize the amount of fluid in the body, they use saline. For the first 8 hours after the operation, the woman should only lie down and only then can she try to sit up. Mom's diet is also quite meager.

The first day you can drink only water, and on the second day you can drink low-fat chicken broth or liquid porridge, mostly oatmeal. This diet should be maintained for approximately three weeks. After a few days, if there are no complications, the mother is sent to the postpartum ward, where she can take care of the baby.

A week later, the woman is prescribed a blood and urine test, and is also sent for an ultrasound of the uterine scar and genital organs. If at this inspection If no complications are detected, then after a few days the mother and child can go home.

At home after CS

If an older child is waiting for his mother at home, then you should try to pay attention to him, but not pick him up. Also, under no circumstances should you be nervous. And of course, you shouldn’t forget about your diet, which may become more familiar, but still the use of some foods should be canceled. In just 10-14 days you will be able to take a shower, but you should forget about the bath for at least a month and a half. And for two months you should avoid strenuous physical activity. And an important issue will be contraception. After all, planning the next pregnancy is possible only in two years.

It is believed that the name of the operation is associated with the name of the Roman emperor Gaius Julius Caesar, whose mother died during childbirth, and he was removed from her womb by surgical intervention. There is information that under Caesar a law was passed indicating that in the event of a woman’s death in childbirth, an attempt must be made to save the child by cutting abdominal wall and uterus with fetal extraction. For a long time, caesarean sections were performed only when the mother died during childbirth. And only in the 16th century did reports appear of the first cases where the operation allowed not only the child, but also the mother to survive.

When is the operation performed?

In many cases, a caesarean section is performed according to absolute indications. These are conditions or diseases that represent mortal danger for the life of mother and child, for example placenta previa- a situation where the placenta closes the exit from the uterus. Most often, this condition occurs in multipregnant women, especially after previous abortions or postpartum diseases. In these cases, during childbirth or at latest dates pregnancy, bright colors appear from the genital tract bloody issues, which are not accompanied by pain and are most often observed at night. The location of the placenta in the uterus is clarified by ultrasound. Pregnant women with placenta previa are observed and treated only in an obstetric hospital.

Absolute indications also include:

Premature abruption of a normally located placenta. Normally, the placenta separates from the wall of the uterus only after the baby is born. If the placenta or a significant part of it separates before the baby is born, sharp pains in the abdomen, which may be accompanied by severe bleeding and even the development of a state of shock. In this case, the oxygen supply to the fetus is sharply disrupted; urgent measures must be taken to save the lives of mother and baby.

Transverse position of the fetus. The baby can be born naturally birth canal, if it is in a longitudinal (parallel to the axis of the uterus) position with the head or pelvic end down towards the entrance to the pelvis. Transverse position of the fetus is more common in multiparous women due to decreased tone of the uterus and anterior abdominal wall, with polyhydramnios, and placenta previa. Usually with the beginning labor activity spontaneous rotation of the fetus occurs into the correct longitudinal position. If this does not happen and external techniques fail to turn the fetus into a longitudinal position, and also if the waters break, then childbirth through the natural birth canal is impossible.

Umbilical cord prolapse. This situation occurs during an outpouring amniotic fluid with polyhydramnios in cases where the head is not inserted into the pelvic inlet for a long time ( narrow pelvis, large fruit). With the flow of water, the umbilical cord loop slips into the vagina and may even end up outside the genital slit, especially if the umbilical cord is long. The umbilical cord is compressed between the walls of the pelvis and the fetal head, which leads to impaired blood circulation between the mother and the fetus. In order to promptly diagnose such a complication, a vaginal examination is performed after the rupture of amniotic fluid.

Preeclampsia. This serious complication second half of pregnancy, manifested by high blood pressure, the appearance of protein in the urine, edema, maybe headache, visual impairment in the form of flashing “flies” before the eyes, pain in the upper abdomen and even cramps, which requires immediate delivery, since with this complication both the condition of the mother and the condition of the fetus suffers.

However, most operations are carried out according to relative indications- like this clinical situations, in which the birth of a fetus through the natural birth canal is associated with significantly great risk for mother and fetus than during cesarean section, as well as by combination of indications- a combination of several complications of pregnancy or childbirth, which individually may not be significant, but as a whole pose a threat to the condition of the fetus during vaginal delivery. An example is breech presentation fetus Childbirth in breech are classified as pathological, because There is a high risk of injury and oxygen deprivation of the fetus during vaginal delivery. The likelihood of these complications especially increases when a combination of breech presentation of the fetus with its large size (more than 3600 g), postmaturity, excessive extension of the fetal head, and anatomical narrowing of the pelvis.

Age of primigravida more than 30 years. Age itself is not an indication for caesarean section, but in this age group Gynecological pathology is common - chronic diseases of the genital organs, leading to long-term infertility and miscarriage. Non-gynecological diseases accumulate - hypertonic disease, diabetes, obesity, heart disease. Pregnancy and childbirth in such patients occur with a large number complications, with great risk for the child and mother. Indications for caesarean section in women in late reproductive age with breech presentation of the fetus, chronic hypoxia fetus

Scar on the uterus. It remains after removal of myomatous nodes or suturing of the uterine wall after perforation during induced abortion, after a previous cesarean section. Previously, this indication was absolute, but now it is taken into account only in cases of defective scar on the uterus, in the presence of two or more scars on the uterus after cesarean section, reconstructive operations regarding uterine defects and in some other cases. It allows you to clarify the condition of the scar on the uterus ultrasound diagnostics, the study must be carried out from 36-37 weeks of pregnancy. On modern stage technique of performing the operation using high-quality suture material promotes the formation of a healthy scar on the uterus and gives a chance for subsequent births through the natural birth canal.

Also distinguished indications for caesarean section arising during pregnancy and childbirth.

Depending on the urgency of the procedure, a caesarean section can be planned or emergency. Caesarean section during pregnancy is usually performed as planned, less often - in in case of emergency(bleeding due to placenta previa or premature detachment normally located placenta and other situations).

A planned operation allows you to prepare, decide on the technique of performing it, anesthesia, as well as carefully assess the woman’s health status, and, if necessary, carry out corrective therapy. During childbirth, a caesarean section is performed for emergency reasons.

Clinically narrow pelvis. This complication occurs during childbirth when the size of the fetal head exceeds inner size mother's pelvis. The complication is manifested by the lack of progressive advancement of the fetal head along the birth canal during full disclosure cervix, despite vigorous labor. In this case, there may be a threat of uterine rupture, acute fetal hypoxia ( oxygen starvation) and even his death. This complication can occur both with an anatomically narrow pelvis and with normal sizes pelvis, if the fetus is large, especially if the pregnancy is overdue, or if the fetal head is inserted incorrectly. It is possible to correctly assess the size of the mother’s pelvis and the size of the fetal head in advance. additional methods studies: ultrasound diagnostics and x-ray pelvimetry (study of x-rays of the pelvic bones), which allow predicting the outcome of childbirth. At to significant degrees narrowing of the pelvis, it is considered absolutely narrow and is an absolute indication for a cesarean section, as well as in the presence bone tumors, gross deformations in the pelvis, representing an obstacle to the passage of the fetus. Diagnosed during childbirth vaginal examination Incorrect insertion of the head (frontal, facial) is also an absolute indication for cesarean section. In these cases, the fetal head is inserted into the pelvis at its largest size, significantly exceeding the size of the pelvis, and childbirth cannot occur.

Acute fetal hypoxia(oxygen starvation). This condition occurs due to insufficient oxygen supply to the fetus through the placenta and umbilical cord vessels. The reasons can be very diverse: placental abruption, umbilical cord prolapse, protracted labor, excessive labor, etc. Diagnose dangerous condition the fetus, along with auscultation (listening) using an obstetric stethoscope, helps modern methods diagnostics: cardiotocography (registration of fetal heartbeats using a special device), ultrasonography with Doppler (study of blood movement through the vessels of the placenta, fetus, uterus), amnioscopy (study of amniotic fluid, carried out using a special optical device inserted into the cervical canal with the amniotic sac intact). If signs of impending fetal hypoxia are detected and there is no effect of treatment, urgent surgical intervention is performed.

Weakness of labor. The complication is characterized by the fact that the frequency, intensity and duration of contractions are insufficient to complete labor naturally, despite the use of corrective drug therapy. As a result, there is no progress in dilating the cervix and moving the presenting part of the fetus along the birth canal. Labor can be protracted, and there is a risk of infection as the anhydrous gap increases and fetal hypoxia increases.

Progress of the operation

An incision in the anterior abdominal wall is usually made in the transverse direction above the pubis. In this place, the layer of subcutaneous fatty tissue is less pronounced, wound healing is better with minimal risk formation postoperative hernias, patients after surgery are more active and get up earlier. The aesthetic side is also taken into account when a small, almost invisible scar remains in the pubic area. A longitudinal incision between the pubis and the navel is performed if there was already a longitudinal scar on the anterior abdominal wall after a previous operation, or in case of massive blood loss, when examination is required upper section abdomen, with an unclear scope of the operation with a possible extension of the incision upward.

The uterus is opened in its lower segment in the transverse direction, later During pregnancy, the isthmus (the part of the uterus between the cervix and the body) increases significantly in size, forming the lower segment of the uterus. Muscle layers and blood vessels are located here in horizontal direction, the thickness of the wall of the lower segment is significantly less compared to the body of the uterus. Therefore, opening the uterus in the transverse direction in this place along the vessels and muscle bundles occurs almost bloodlessly. It is extremely rare to resort to the longitudinal method of opening the uterus in its body in cases where access to the lower segment of the uterus is difficult, for example, due to scars from previous operations, or there is a need to remove it after a cesarean section. This approach has been practiced before; it is accompanied by increased bleeding due to the intersection large number blood vessels and the formation of a less complete scar, as well as a large number of postoperative complications.

The fetus is removed by the head or by the pelvic end (by the inguinal fold or by the leg) in the pelvic position of the fetus, the umbilical cord is intersected between the clamps, and the child is transferred to the midwife and neonatologist. After the baby is removed, the placenta is removed.

The uterine incision is sutured, ensuring proper alignment of the wound edges with minimal use of suture material. For suturing, modern synthetic absorbable threads are used, which are sterile, durable, and do not cause allergic reactions. All this contributes optimal process healing and formation of a healthy scar on the uterus, which is extremely important for subsequent pregnancies and childbirth.

When suturing the anterior abdominal wall, separate sutures or surgical staples are usually placed on the skin. Sometimes an intradermal “cosmetic” suture is used with absorbable threads; in this case, there are no external removable sutures.

Complications of cesarean section and their prevention

A caesarean section is a serious abdominal operation and, like any surgical intervention, should be performed only if indicated, but not at the request of the woman. Before the operation, the scope of the planned operation is discussed with the pregnant woman (parturient), possible complications. Mandatory written consent of the patient for surgery is required. In vital conditions - for example, if a woman is unconscious - the operation is carried out according to vital indications or with the consent of relatives, if they accompany her.

And although caesarean section is currently considered a reliable and safe operation, surgical complications are possible: injury to blood vessels due to a prolonged incision in the uterus and associated bleeding; injury to the bladder and intestines (more common with repeated entries due to adhesive process), fetal injury. There are complications associated with anesthesia. There is a possible risk in the postoperative period uterine bleeding due to violation contractility uterus caused by surgical trauma and action narcotic drugs. Due to the change physical and chemical properties blood, an increase in its viscosity may lead to the formation of blood clots and blockage of various vessels by them.

Purulent-septic complications with caesarean section occur more often than after vaginal birth. Prevention of these complications begins during surgery with the introduction of highly effective antibiotics. wide range immediately after cutting the umbilical cord to reduce them negative impact per child. In the future, if necessary, antibiotic therapy is continued in the postoperative period with a short course. The most common are wound infection (suppuration and dehiscence of the anterior abdominal wall), endometritis (inflammation of the inner lining of the uterus), adnexitis (inflammation of the appendages), and parametritis (inflammation of the periuterine tissue).

Before and after surgery

The procedure itself for preparing for surgery, as well as postoperative period They promise some discomfort, some restrictions, and will require effort and work on oneself.

During a planned operation, a cleansing enema is performed the night before and 2 hours before the operation, which will be repeated again on the 2nd day after the operation in order to activate peristalsis ( motor activity) intestines. Taking tranquilizers at night, prescribed by a doctor, helps to cope with anxiety and fear. Immediately before the operation it is established urinary catheter, which will remain in the bladder for 24 hours.

After abdominal delivery, a woman is both a postpartum woman and a postoperative patient. During the first 24 hours, she will be in the intensive care ward under the close supervision of an anesthesiologist and an obstetrician-gynecologist. Possible discomfort during recovery from general anesthesia: sore throat, nausea, vomiting; after epidural anesthesia there may be dizziness, headache, back pain. Within 2-3 days after the operation, infusion therapy is carried out with intravenous infusion of solutions in order to compensate for blood loss, which during the operation is 600-800 ml, i.e. 2-3 times more than with vaginal birth. The surgical wound will be a source pain in the area of the sutures and in the lower abdomen, which will require the administration of painkillers.

In order to prevent postoperative complications, it is practiced to get up early after 10-12 hours, breathing exercises and self-massage 6 hours after surgery. Compliance with the diet is mandatory for the first 3 days. It is recommended to fast for the first day, you can drink mineral water without gases, tea without sugar with lemon in small portions. On the second day, a low-calorie diet is followed: meat broth, liquid porridges, jelly. You can return to a normal diet after intestinal motility is activated and bowel movements are spontaneous. You will have to come to terms with some hygienic restrictions: washing the body in parts is carried out from the 2nd day, you can take a full shower after removing the stitches on the 5-7th day and discharge from the maternity hospital (usually on the 7-8th day after operation). Gradual recovery muscle tissue in the area of the uterine scar occurs within 1-2 years after surgery.

A woman may have to face some difficulties while breastfeeding, which are more common after a planned caesarean section. Surgical stress, blood loss, late latching of the baby to the breast due to adaptation disorders or drowsiness of the newborn are the causes of late development of lactation; In addition, it is difficult for a young mother to find a position for feeding.

If she sits, the baby puts pressure on the seam, but this problem can be dealt with by using a lying position for feeding.

During delivery by cesarean section, the process of launching adaptation mechanisms that ensure the transition of the newborn to extrauterine existence is disrupted. Breathing disorders in a newborn occur much more often during a planned caesarean section performed before the onset of labor than during vaginal birth and during caesarean section during childbirth. Therefore, a planned caesarean section should be performed as close as possible to the expected date of birth.

After a caesarean section, the baby’s heart functions differently, the level of glucose and the level of hormones that regulate activity are lower thyroid gland, in the first 1.5 hours the body temperature is usually lower. Lethargy increases, decreases muscle tone and physiological reflexes, healing umbilical wound sluggish, the immune system works worse, But currently medicine has all the necessary resources to minimize the difficulties that the baby experiences. Usually the indicators for discharge physical development the newborn returns to normal, and after a month the baby is no different from children born through the birth canal.

Caesarean section: choice of anesthesia

In modern obstetrics they use the following types anesthesia for cesarean section: regional (epidural, cerebral cerebral) and general (intravenous, mask and endotracheal anesthesia). Regional anesthesia is the most popular because... with it, the woman remains conscious during the operation, which ensures early contact with the child in the first minutes of life. The newborn is in good condition, because he is less susceptible to the influence of medications that depress his vital functions. During spinal anesthesia, an anesthetic drug is injected through a thin catheter tube directly into the canal. spinal cord, and with epidural anesthesia it is injected more superficially under the dura mater, thus blocking pain sensitivity and motor nerves that control the muscles of the lower body (during the anesthesia, the woman cannot move her legs). At general anesthesia As a rule, endotracheal anesthesia is used. An anesthetic drug is administered intravenously, and as soon as the muscles relax, a tube is inserted into the trachea and artificial ventilation lungs. This type of anesthesia is more often used during emergency operations.

Childbirth is a process for which a woman’s body is fully adapted. But sometimes, for one reason or another, natural childbirth can pose a danger to the health or even the life of both the child and the mother. In such cases, surgical delivery is performed - a caesarean section.

Caesarean section may be planned And urgent. A planned caesarean section is prescribed during pregnancy: according to indications or at will expectant mother. The decision for an emergency caesarean section is made if complications arise already during childbirth, or dangerous situations requiring urgent intervention (acute fetal hypoxia, placental abruption, etc.).

Indications for caesarean section are divided into absolute And relative. Absolute births are those on the basis of which the doctor unconditionally prescribes an operation, and natural childbirth is out of the question. Such indications include the following.

Narrow pelvis of a woman in labor. Because of this anatomical feature a woman simply will not be able to give birth on her own, as there will be problems with the passage of the child through the birth canal. This feature is revealed immediately upon registration, and the woman is prepared and prepared for operative delivery from the very beginning;

Mechanical obstruction, preventing the fetus from passing naturally. It could be:

defragmentation of the pelvic bones;
ovarian tumors;
placenta previa (the placenta is not located where it should be, blocking the fetus’s path to the cervix);
isolated cases of uterine fibroids.

Probability of uterine rupture. This indication for cesarean section occurs if there are any sutures or scars on the uterus, for example, after previous cesarean sections and abdominal surgeries.

To the testimony health threatening baby include various sexually transmitted infections in the mother, since the child can become infected while passing through the birth canal.

As for an emergency caesarean section, it is prescribed if labor is very weak or has stopped altogether.

How is a caesarean section performed and what happens before and after it?

1. At what date do I perform a planned caesarean section? The date of the operation is determined individually and depends on the condition of the woman and child. If there are no special indications, then a caesarean section is scheduled for the day closest to the expected date of birth. It also happens that the operation is performed with the onset of contractions.

2. Preparation. Typically, an expectant mother awaiting a planned cesarean section is placed in the maternity hospital in advance in order to conduct an examination to determine that the baby is full-term and ready for birth, and to monitor the woman’s condition. As a rule, a caesarean section is scheduled for the morning, and the last meal and drink is possible no later than 18 hours the night before. The patient's stomach must be empty to prevent its contents from entering the respiratory tract. In the morning, on the day of surgery, hygiene procedures: do an enema, shave the pubis. Next, the woman changes into a shirt and is taken or taken on a gurney to the operating room.

Immediately before the operation, anesthesia is administered, a catheter is inserted into the bladder(it will be removed a couple of hours after the operation), the stomach is treated disinfectant. Next, a small screen is installed in the woman’s chest area so that she cannot see the progress of the operation.

3. Anesthesia. There are two types of anesthesia available today: epidural and general anesthesia. Anesthesia involves inserting a thin tube through a needle into the exit site of the spinal cord nerve roots. This sounds quite scary, but in fact, the woman experiences discomfort for only a few seconds when the puncture is performed. Then she stops feeling pain and tactile sensations in the lower part of the body.

General anesthesia. This type of anesthesia is used in emergency cases when there is no time to wait for the effects of epidural anesthesia. First, a so-called pre-anesthesia drug is injected intravenously, then a mixture of anesthetic gas and oxygen is supplied through a tube in the trachea, and lastly a drug that relaxes the muscles is injected.

4. Operation. After the anesthesia has taken effect, the operation begins. How is a caesarean section performed? First, an incision is made in the abdominal wall. During the operation, 2 types of incisions are possible: longitudinal (vertical from the pubis to the navel; done in emergency cases, because it is faster to reach the baby through it) and transverse (above the pubis). Next, the surgeon spreads the muscles, makes an incision in the uterus and opens amniotic sac. Once the baby is delivered, the placenta is removed. Then the doctor first sews up the uterus with threads, which dissolve after a few months - after the tissues have grown together, and then the abdominal wall. Superimposed sterile dressing, ice is placed on the abdomen so that the uterus contracts intensively, as well as in order to reduce blood loss.

Typically the operation takes from 20 to 40 minutes, with the baby being delivered within 10 minutes, or even earlier.

5. Postoperative period. For another day after a cesarean section, the woman remains in the intensive care unit or intensive care unit so that doctors can monitor her condition. Then the new mother is transferred to a regular ward. To reduce pain she is prescribed painkillers, drugs to contract the uterus and normalize the condition gastrointestinal tract. Sometimes antibiotics are prescribed, but this is decided on an individual basis. Gradually, the doses of medications are reduced and they are abandoned altogether.

If the operation went without complications, stand up for the first time a woman is allowed after at least 6 hours. First you need to sit on the couch, and then stand for a while. Under no circumstances should you strain yourself or experience even minimal physical exercise, as this threatens seam divergence.

It is highly advisable to purchase in advance postoperative bandage , wearing it will greatly ease movement and discomfort in the first days after a cesarean section, especially when you need to lie down or get out of bed.

On the first day after surgery, it is recommended to drink only still water, and you will need to drink a lot to replenish fluid loss. You will also need to empty your bladder on time. It is believed that full bubble prevents uterine contraction.

On the second day, liquid food (porridge, broth, etc.) is allowed. If everything is in order, then from the third day after the operation you can return to the normal diet recommended for nursing women, however, after childbirth, many mothers complain of constipation, and in order to mitigate the situation, it is advisable not to consume solid food a few days.

This problem can also be solved with enemas, suppositories (usually suppositories with glycerin are used; when you put such a suppository, try to lie down for a while) and eating foods that have a laxative effect (kefir, dried fruits, etc.).

7. After discharge from the maternity hospital. For the first month and a half after a caesarean section, you will not be allowed to take a bath, swim in the pool or reservoirs, you will only be able to wash in the shower.

Active physical exercise must be postponed for at least two months. At this time, you will need the help of relatives and husband. Although completely abandon physical activity it is forbidden. Ideally, after surgery, the doctor should tell you about exercises that will speed up the recovery of the body, at least you can ask about it yourself.

Resume sex life It is recommended no earlier than one and a half months after surgery. Be sure to take care of contraception. Experts advise you to plan next pregnancy Only after 2 years, during this time the body will fully recover and be able to ensure the full development of the unborn baby.

Is natural childbirth possible after cesarean?

Contrary to popular belief, a woman can give birth to a child herself if previous pregnancy ended with a caesarean section. If the sutures have healed, no complications have arisen, reproductive system has successfully recovered and there are no indications for another cesarean section.

Pros and cons of caesarean section

Surgical delivery is possible either by medical indications, and by at will women. However, doctors usually oppose such a decision, dissuading the expectant mother from surgery. If you are also considering surgery, provided that both normal birth are not contraindicated for you, carefully weigh all the positive and negative sides question.

Pros of caesarean section

During the operation, injuries to the genital organs, such as ruptures and incisions, are impossible;
Delivery by caesarean section takes a maximum of 40 minutes, while with natural childbirth a woman is often forced to endure contractions for several hours.

Cons of caesarean section

psychological aspect: mothers complain that at first they do not feel a connection with the child, they do not have the feeling that they gave birth to him themselves;
limitation of physical activity and pain at the suture site;
scar. Read more about this in the article

Consequences of a caesarean section

The consequences can be divided into 2 types: for mother, in connection with surgery, and for a child, due to unnatural birth.

Consequences for mom:

pain in the stitches, resulting in a scar on the abdomen;
restrictions on physical activity, inability to take a bath and resume intimate relationships within a few months;
psychological condition.

Consequences for the child:

psychological; There is an opinion that children born through surgery adapt less well to the world around them. It is worth noting that the opinions of scientists on this matter differ, and the experience of mothers shows that in most cases, fears about children falling behind in mental development are far-fetched, and there is no need to worry about this. However, one cannot deny the fact that the child does not follow the path prepared for him by nature, which helps him prepare for a new environment of existence;
the possibility of residual amniotic fluid in the lungs of the newborn;
penetration of anesthetic drugs into the child’s blood. Read more about the consequences of a caesarean section and watch the video in

Complications after caesarean section

Complications after anesthesia. If you are having a Caesarean section with an epidural, here's what you need to remember. After the operation, the catheter with an anesthetic is left in the back for some time, and drugs are injected through it to numb the sutures. Therefore, after the operation is completed, the woman may not feel both or one leg, and may not be able to move.

There are cases when, when a woman is transferred to the couch, her legs get tucked in, and since the operated woman does not feel anything, this fact can go unnoticed for a long time.

What does this mean? Due to the limb being in an unnatural position, it develops long-term positional compression syndrome. In other words, soft fabrics are without blood supply for a long time. After neutralization of the compression, shock, severe swelling, impaired motor activity of the limb develops and, not always, but quite often, renal failure, all this is accompanied by severe pain that lasts for several months.

Be sure to ask the maternity hospital staff to check that you were placed on the couch correctly. Remember that compartment syndrome can sometimes be fatal.

In addition, anesthesia is often accompanied by headaches and back pain.

Complications after caesarean section

One of the most common complications is adhesions. Loops of intestine or other organs abdominal cavity grow together. Treatment depends on individual characteristics women: the matter may be limited to ordinary physical procedures or may lead to the need for surgical intervention.

Endometritis- inflammatory process in the uterus. To prevent it, a course of antibiotics is prescribed immediately after surgery.

Bleeding also refer to complications after cesarean section and, in rare cases, lead to the need to remove the uterus.

Complications can also arise during the process. healing of sutures, up to their divergence.

So, a caesarean section is a guarantee of life for mother and child in cases where natural childbirth is impossible or dangerous. Every year this operation is improved, and the number of complications decreases. However, the human factor cannot be excluded, therefore, if you know about the main features of the operation and post-operative care, this will help you avoid complications and enjoy the joys of motherhood without unnecessary grief.

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In some cases, natural delivery is not possible, and doctors have to remove the baby from the mother's womb through surgery.

is a surgical intervention through the abdominal wall that results in the birth of a newborn. This operation was performed back in Ancient Rome And Ancient Greece, however, in those days it was only done for the dead.

Medieval doctors attempted to operate on living women, but this venture was not crowned with success: only the child could be saved.

Only in the 19th century did doctors learn to keep the mother alive, and in the mid-20th century, with the beginning of the era of antibiotics, cesarean section became a standard procedure that carries minimal risks for the woman.

Indications for caesarean section (list)

Despite the fact that caesarean section is quite common, it is prescribed only if there are certain indications, see the list.

Absolute readings:

Complete placenta previa suggests that children's place It was implanted so close to the entrance to the cervix that, as it enlarged, it began to block the child’s exit through the natural birth canal.
Anatomically narrow pelvis – absolute contraindication To normal childbirth. This diagnosis is made if a woman’s pelvic bones are fused in such a way that they do not allow the child to come out.
Transverse presentation of the fetus - if before the onset of labor the child was unable to get into a cephalic or at least breech position, then he will not be able to be born on his own.
A history of more than two cesarean sections. It is believed that natural childbirth in this case poses a threat of uterine rupture and intra-abdominal bleeding, which can be fatal for the expectant mother.

Relative readings:

Incomplete placenta previa - in some cases, based on ultrasound results, doctors decide that the child will be able to be born on his own, since the entrance to the uterus is not completely blocked.
Breech presentation of the fetus - caesarean section is performed if there is additional factors risk (for example, repeated entanglement with the umbilical cord).
The presence of fibroids - surgery is indicated only when the size of the tumor is large or if the fibroids are located in the cervix and block the natural birth canal.
Multiple pregnancy - the doctor decides on a caesarean section if the condition of the mother and children is alarming.
- surgical intervention is performed in mandatory in cases of preeclampsia and eclampsia. The stages of late toxicosis that precede these two conditions are not always an indication for cesarean section.
Illnesses of the mother that existed before pregnancy - the doctor must assess whether natural childbirth will lead to a worsening of the course chronic diseases the expectant mother, and if the threat to her health is obvious, then she will be prescribed obstetric surgery.

The decision on surgical intervention is made not by the patient at will, but by the doctor, based on medical indications.

Conventionally, the operation can be divided into four phases: anesthesia, dissection of the wall of the abdominal cavity, the wall of the uterus and placenta, extraction of the fetus, suturing the walls of the uterus and abdominal cavity.

Choice of anesthesia

Currently, most caesarean sections are performed under epidural anesthesia. The lower part of the body is anesthetized, and the woman in labor is conscious. If an emergency caesarean section (ECS) is performed, the woman is given general anesthesia.

Throughout the entire period of surgery, an anesthesiologist is present to monitor the effect of general or epidural anesthesia on the woman’s well-being. The question of how long a caesarean section lasts is difficult to answer definitively. It usually takes no more than 40 minutes, but can be completed earlier. The effect of anesthesia ends after the surgeon sews up the incisions.

Tissue dissection

Surgical procedures are performed in several stages:

1. A catheter is inserted into the bladder for timely drainage of urine, the pubic area is shaved - this is an additional guarantee of the hygiene of the upcoming intervention.
2. Between the top and bottom a screen is placed on the torso, thus delimiting the operable area.
3. The incision site is pre-marked, and then the edges of the marked area are manually pulled together to ensure that the skin will stretch sufficiently so that the edges of the wound can later be sutured.
4. If there is an old scar from a previous cesarean section, then first it is excised with a scalpel.
5. The surgeon makes a transverse or longitudinal incision in the abdominal wall with smooth translational movements. He has to run a scalpel along the marked lines several times, slightly deepening the instrument into the thickness of the skin and fat layer.
6. When cutting the muscles, the doctor makes efforts to manually push them apart and get to the uterus.
7. The edges of the wound are fixed by an assistant and spread apart to provide the surgeon with more complete access to the body of the uterus.
8. The same transverse incision is made on the uterus in several steps as on the abdominal cavity.

Until the moment of dissection reproductive organ the operation is almost bloodless and the assistant’s assistance in stopping the bleeding is minimal.

Fetal extraction

From the moment the uterus is incised until it is sutured, as little time as possible should pass. Therefore, the child is removed quickly; if there are umbilical cord loops on his neck, they are removed, and the umbilical cord itself is cut.

Doctors wait several minutes for the placenta to separate from the walls of the uterus on its own. It is then removed and accumulated blood and clots are removed.

Suturing tissues

The edges of the wound of the body of the uterus are fixed and stitched. At the same time, the assistant ensures the elimination of released blood using cotton pads.

In this case, the uterus itself is located outside the abdominal cavity; it is reduced after the suture is applied. Then the skin along with the fat layer is pulled apart and fixed, while the surgeon sutures the abdominal muscles. Unlike the uterus and skin, they are dissected vertically.

The last layer of skin is stitched, after which the operated surface is treated with an antimicrobial solution.

After the caesarean section procedure

If delivery was performed through surgery, this does not mean that the woman will not have bleeding from the uterus.

The reproductive organ, as in the situation with natural childbirth, will shrink, which will provoke the appearance of discharge after a cesarean section, but how many days it will last depends on how successful the operation was. Normally there are lochias abundant first 5 – 6 days, and then, within a month, gradually stop. If there were any postoperative complications, the duration of bleeding may increase.

6 hours after surgery, the woman is allowed to get up.

Many people are concerned about the question: how many days after a cesarean section can you be discharged from the hospital? Typically, such patients remain under observation a little longer than those who had a natural birth. But by 7–10 days, as a rule, most women are ready for discharge.

At first, you should pay special attention to the condition of the seam. If it is discovered that it has become swollen, inflamed, festered, or its pain does not decrease, but rather intensifies, you must immediately consult a doctor to avoid the development of infection.

To prevent muscle strain after a cesarean section, you should wear a bandage. The fact is that in the first few weeks it is necessary to avoid stress on the abs, so the sagging belly needs to be supported.

Pregnancy and childbirth after caesarean section

The suture on the uterus must be given time to heal. This means that the uterus should not be stretched during the first few months. Excessive load a suture that has not yet healed can result in rupture of the reproductive organ, peritonitis and the death of the woman.

Most early date, which will be relatively safe for the woman in labor, is a cesarean section performed one year after the first cesarean section. And even in this case, the woman exposes her body to serious risk - over a long period of time, the suture on the uterus may begin to separate, so the doctor must regularly monitor its condition and thickness based on ultrasound results.

In such a situation, there is no chance to give birth to a second child naturally. Doctors will not take risks and will not allow a woman in labor to have a natural birth - the risk of rupture of the reproductive organ is too great. Of course, the uterus can be amputated urgently, but the woman will not survive due to extensive internal hemorrhage.

Normally, the next pregnancy can be planned no earlier than one year after a cesarean section. The most ideal thing is in one and a half to two years. During this time, the suture will finally heal, but before planning conception, it is necessary to evaluate its condition using an ultrasound.

There are cases when the suture after surgery has fused extremely unsuccessfully, and it is very dangerous for a woman to carry another pregnancy.

IN Soviet time there was no point in thinking about natural delivery, given a history of cesarean section. Such experiments were not practiced. Now the situation has changed, and last years Many mothers, planning a second child, think about having it not at the operating room, but at the birth table.

In large clinics in Russia they take on such a difficult task; there was even a case of spontaneous birth after two obstetric operations in the anamnesis (which is a reckless risk from the point of view of doctors).

Therefore, natural childbirth after a cesarean section is now possible, however, the doctor will give permission for this only if the suture from the previous operation was in good condition, and at least 3 years passed after it.

When can you have sex after a caesarean section?

As with natural childbirth, you should have sex only 2 months after the birth of the child. Even though the vagina itself was not damaged by ruptures as a result of the baby passing through the birth canal, there is a possibility of infection, which will lead to the suture on the uterus becoming inflamed.

In addition, in the first month after childbirth, there will be spotting, which will only interfere with sexual activity. In the first weeks, the suture after a caesarean section heals: it is very painful and sensitive, so it is worth postponing intimacy until a more appropriate time.

Caesarean section is a method of delivery in which the fetus is removed through an incision in the anterior abdominal wall and uterus. Surgical intervention always entails heavy recovery period, and in some cases complications. Therefore, a caesarean section is performed only when natural childbirth becomes unsafe for mother and child.

The first caesarean section was performed by the German surgeon I. Trautmann in 1610. In those days it was emergency measure if natural childbirth is not possible. Antiseptics were not used in medicine, and the incision on the uterus was not sutured. In 100% of cases, the woman died after the operation. With the beginning of the use of broad-spectrum antibiotics, the risk of complications has decreased to a minimum.

“According to Rosstat, in 2010, 22% of pregnancies in Russia ended in caesarean section. In the West this figure is 25-28%.

Indications for cesarean section are divided into absolute and relative. One of them is enough absolute readings to carry out the operation. If there are relative indications, the doctor makes a decision on surgery based on their combination.

Absolute readings

Complete placenta previa.
Premature placental abruption.
Anatomically narrow pelvis of III and IV degrees.
History of 2 caesarean sections or 1 corporal section.
Insolvent scar on the uterus (if it is damaged during an abortion).
Beginning uterine rupture.
Scar on the perineum III degree after a break in childbirth.
Acute fetal hypoxia.
Transverse position of the fetus after the rupture of water.

Relative readings

Severe form of gestosis.
History of pelvic and lumbar fractures.
Pelvic position of a fetus weighing more than 3500 g.
Multiple pregnancy with a single fetus in the pelvic position.
Diseases of the brain, kidneys, of cardio-vascular system, retinal detachment.
Umbilical cord prolapse.

Indications for cesarean section are identified during pregnancy. Then the woman is prepared for planned surgery. She needs to go to the hospital in advance to prepare for childbirth. But sometimes it happens that a woman is preparing for natural childbirth, but during labor complications are discovered. In this case, doctors perform an emergency caesarean section. The photo below clearly demonstrates the operation process.

Preparing for surgery

With a planned caesarean section, the mother in labor is given a referral to the hospital 1-2 weeks before the birth. During this time, she takes tests and undergoes examinations. If necessary, doctors correct the woman’s health. They also monitor the child’s condition: they check the blood flow in the mother-placenta-fetus system using Doppler ultrasound, do CTG, and ultrasound.

If desired, a woman can donate plasma to a blood bank. If necessary during the operation, the mother in labor will be infused with her own blood components, not donor ones. Usually about 300 ml of plasma is donated. The blood is restored in 2-3 days.

A planned operation is usually performed at 38-39 weeks of pregnancy, based on the indicators of the child’s condition. Although best moment For operative delivery, the onset of labor is considered. Then the cervix is open and postpartum discharge flows out better. Involution of the uterus passes faster, lactation occurs on time.

Caesarean sections are usually performed in the morning. In the evening they give a cleansing enema, shave the pubis, and give sleeping pills at night. The enema is repeated in the morning.

Schematic photo of childbirth by caesarean section

How does a caesarean section proceed in stages?

At the beginning of the operation, the body is prepared for anesthesia and a catheter is placed in the urinary canal to drain urine. During surgery, the bladder should be empty to make it easier for the doctor to access the uterus.

Anesthesia

The doctor chooses the method of pain relief based on the circumstances and health status of the woman in labor. General anesthesia is used in emergency cases. This type of anesthesia has a negative effect on the body of the mother and child: it causes respiratory depression in the child, and gastric contents can enter the mother’s respiratory tract and cause pneumonia. For a planned cesarean section, regional anesthesia is selected: spinal, epidural, or a combination of both. For pain relief in bottom part back, give an injection. During spinal anesthesia, the drug is injected into the fluid washing the spinal cord and the needle is removed. With an epidural, a tube is inserted under the skin along with a needle through which the medicine is delivered, and the needle is removed. The anesthesia procedure is painless, as the injection site is first numbed.

Spinal anesthesia during surgery

After anesthesia, the woman in labor is fenced off with a screen and the removal of the baby begins immediately. During the operation with regional anesthesia, the woman in labor is conscious. Immediately after birth, the baby is put to the breast.

Progress of the operation

The cesarean operation lasts 30-40 minutes. At 15-20 minutes, the baby is removed from the uterus.

The skin in the lower abdomen is cut into a cross section 15 cm long.
Cut subcutaneously in layers fatty tissue, muscles, peritoneum.
An incision is made in the lower segment of the uterus.
The amniotic sac is opened.
The child is taken out.
The umbilical cord is crossed.
Delete the last one.
The incision on the wall of the uterus is sutured.
Restore the layers of the abdominal cavity.
The seam is sutured on the skin with absorbable or silk threads.

The seam

Currently, caesarean sections are performed using an incision in the lower segment of the uterus. This is the thinnest place on the uterus, which has a small amount of muscle fibers. Due to this, after the involution of the uterus, this area becomes the smallest, and the scar also decreases in size. With this option of scar location, the incision on the uterus and on the anterior abdominal wall does not coincide, and the risk of adhesions of the uterus and peritoneum is minimal.

Corporal cesarean section is performed with a vertical incision in the anterior abdominal wall, which coincides with the scar on the uterus. This arrangement of incisions provokes inflammatory processes in the abdominal cavity, adhesions. It is performed only in emergency cases, when there is a question of saving the life of the mother and child.

Types of incisions for caesarean section

Possible complications

In the early postpartum period in the first days after surgery, complications such as peritonitis, endometritis, inflammation of the deep veins may occur. In the late postpartum period: suture dehiscence on the uterus,.

Spinal anesthesia often leaves unpleasant consequences. An error when placing an injection leads to a puncture of the hard meninges. Cerebrospinal fluid leaks into the epidural area. This causes headaches and back pain that can last for several months or even years.

Often difficulties arise due to the simple inattention of obstetricians. When the postpartum mother is transferred to the couch after surgery, medical staff sometimes he doesn’t straighten his legs and they remain bent. But the woman does not feel the lower part of the body after anesthesia and can spend several hours in this position. This leads to poor circulation. Tissue compression occurs, severe swelling and muscle atrophy develop. After the operation, it is better to draw the nurse’s attention to this point.