Operation caesarean section the course of the operation. How is a caesarean section performed?

According to statistics, more than 20% of all births are by caesarean section. This is an operation in which the baby is removed from the mother's body through an incision in the abdomen and uterus. How is a caesarean section done? How long does this operation take? What are the indications for her? What could be the consequences? All these questions worry expectant mothers.

Indications and contraindications

Without exception, all surgical interventions carry risks to health and life. That is why they are never carried out just like that, at will. Many people think that this method of delivery is much easier than natural childbirth, but this is a delusion. At some moments normal childbirth win.

There are absolute and relative indications for caesarean section.

Absolute:

• First or previous pregnancy ended with surgery and childbirth naturally may cause complications.
• The child is in a transverse or pelvic presentation.
• There is a chance that the baby will die during childbirth. The threat may arise in the case of, for example, premature detachment of the placenta.
• The size of the child's head does not allow to pass through the bones of the pelvis.
• Preeclampsia and eclampsia (late toxicosis).
• Pregnancy with twins, triplets and a large number children.

Relative:

Most often, several indications are combined. Rarely is one or two.

There are also conditions when a caesarean section is strictly contraindicated:

• When the fetus died in utero.
• The child has malformations that are incompatible with life.
• Infectious diseases of the skin and genital organs.

Contraindications are associated with the risk of sepsis and peritonitis due to the ingress of foci of infection into the blood.

Pros and cons

Don't make rash decisions. When choosing a caesarean section as a method of delivery, you need to think carefully, take into account all the pros and cons. Usually the operation is quick, and both mother and child feel great. Women in labor are spared from all the consequences that can cause childbirth with complications.

However, there are some difficulties:

1. Postpartum recovery stretches over several weeks.
2. During the recovery, the woman experiences severe pain.
3. Difficulties with breastfeeding.
4. There may be problems with subsequent pregnancies.

Preparation

Before the operation, you need to carefully prepare for it. Doctors advise to give up food and water for a while (for 12 and 5 hours, respectively). If necessary, you need to do an enema. Also, if necessary, epilation of the pubis is performed.

How is the operation

The process takes place in several stages:

How long does a caesarean section take? Near . After that, the woman in labor is sent to intensive care. When the anesthesia wears off, she is transferred to the postpartum ward.

Complications

During a caesarean section, the body experiences severe stress. Although the process does not last very long in time, some complications may arise:

Not only mother experiences difficulties in the postoperative period.

This method of childbirth also affects the child:

Recovery

Before a caesarean section is performed, the woman in labor is told about the features of postoperative recovery.

How long does rehabilitation take? This takes several months.

During rehabilitation, the uterus acquires its usual size, the seam becomes more aesthetic, the body gains strength.

What should you pay attention to?

All more women refuse natural childbirth. For what? To avoid severe pain and reduce the possible, in their opinion, the risk. However, many of them do not fully understand how a caesarean section is performed. During the operation itself, as well as during the postpartum recovery, a number of complications can occur. And although it happens faster in time, it is worthwhile to carefully weigh the pros and cons.

IN modern world Caesarean section is no longer a risky operation. This type of surgery 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 a caesarean. In order not to be afraid to give birth in this way and to be positive, every pregnant woman needs to know the main indications of this manipulation, as well as how to prepare for it.

Indications for a planned caesarean section

Despite the routine nature of this surgical intervention for gynecological surgeons, the risks of having a baby by caesarean section are 12 times higher than those during natural childbirth. Therefore, before proceeding with the consideration of how a caesarean section takes place, it is worthwhile to figure out which conditions are indications for its implementation.

Only in cases where natural childbirth poses a danger to the mother and child, and the risks of spontaneous childbirth exceed the likelihood of complications during caesarean section, the obstetrician-gynecologist directs the woman to the surgical birth of the child.

Below is a list of indications for caesarean section:

• conditions of severe preeclampsia and eclampsia during pregnancy;
• diabetes mellitus in the stage of decompensation;
• chronic diseases of a pregnant woman;
• severe myopia, accompanied by a change in the structure of the fundus;
• malformations of the birth canal (uterus and vagina);
• severe anatomically narrow pelvis;
• 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 covers the external opening of the uterus, preventing the fetus from exiting);
• incorrect positions of the fetus (transverse, oblique);
• foot presentation of the fetus;
• multiple pregnancy with breech presentation of the first fetus;
• multiple;
• pregnancy after prolonged infertility, if there are any other complications that may threaten natural childbirth.

Indications for emergency caesarean section

As you can see, there are many conditions in which a caesarean section is recommended. It is also possible to have an emergency cesarean during vaginal delivery. It is worth noting that its implementation is possible only in cases where the fetus has not yet descended into the small pelvis. Further, an emergency birth is possible only with the help of the operation of applying obstetric forceps.

Do they perform urgently after the attempts that have already begun? The reason for this may be the following pathological conditions:

• discrepancy between the size of the mother's pelvis and the size of the fetus (clinically narrow pelvis);
• fetal distress (impaired placental circulation);
• weakness labor activity;
• prolapse of umbilical cord loops;
• premature detachment of placental tissue;
• complete cessation of labor.

Preparing for the operation

Many pregnant women are extremely anxious before having a caesarean section. Therefore, for many it will be useful to familiarize yourself in detail with the features of the caesarean section operation. Where does it all begin?

A woman enters the maternity hospital a few days before the scheduled date of the operation. In the hospital, the state of health of the mother and fetus is examined. For this, a cardiotocogram is used, where the parameters of the fetal heartbeat are recorded, ultrasound diagnostics are performed. Mothers regularly measure pressure, heart rate, monitor the amount of urine released.

When answering the question of which week the caesarean section is most optimal, it is worth noting that a lot depends on the condition 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 anesthesia and the placement of the pregnant woman on the operating table. After all, preoperative preparation is extremely important for a successful caesarean section.

The day before, the doctor may prescribe sedatives to the woman and sedatives with excessive excitement.

Important! Pregnant women should take any medications strictly under the supervision of the attending physician.

Before the operation, after full explanations by the surgeon and anesthesiologist about the progress of the caesarean 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 the operation, a woman is given a cleansing enema to sanitize the intestines. Immediately before the manipulation of the pregnant woman, urinary catheter, 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 conditions for a caesarean section must be met:

• the presence of a doctor with appropriate qualifications: a surgeon, perinatologist, obstetrician-gynecologist with surgical practice;
• written consent of the mother;
• the presence of a doctor's referral is strictly according to indications: the operation should not be carried out only at the request of the woman.

The stages of the caesarean section operation can be represented as follows:

• skin incision, subcutaneous fat, muscle fascia;
• separation of muscle fibers from each other;
• incision of the uterine cavity;
• removal of the child;
• removal of the placenta;
• suturing the incision on the uterus;
• suturing of the anterior abdominal wall.

Thus, the phased course of the caesarean section does not present 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.

Opening of the abdominal cavity and uterine cavity

Basically, the incision of the skin and subcutaneous adipose tissue is carried out in the suprapubic area in the transverse direction. This localization of the incision has a number of advantages:

• less thickness of subcutaneous fat;
• minimal risk of hernia development in the postoperative period;
• the possibility of greater activity of the woman in labor, which contributes to the prevention of postoperative complications;
• the minimum size of the seam after the operation, which looks more aesthetically pleasing.

It is also possible to make a longitudinal incision in cases where there is already a longitudinal scar after a previous caesarean section, with heavy bleeding, and also 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.

Extraction of the child and the last stages of the operation

The most crucial moment in the operation of caesarean section is the extraction of the fetus. It must be done carefully and 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 the other hand, he should at this time support the neck and head of the child in order to prevent damage to the cervical spine.

Next, two clamps are placed on the umbilical cord and crossed between them. The child is referred to a neonatologist for evaluation vital functions. Since it is not possible to put the baby on the mother's chest, and according to the latest recommendations, this is a necessary stage immediately after the birth of the baby, it is advised to put it on the father's chest.

But back to the course of the caesarean section, a detailed analysis of the last stages. After that, the placenta is carefully removed by the manual method, while it is necessary to check 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, which dissolve after tissue fusion.

The anterior abdominal wall is sutured with a suture or surgical staples. To minimize the postoperative scar, the surgeon can do inseam absorbable threads. With this method, there are no external threads, which then need to be removed. Unfortunately, the aesthetic suture has a higher cost, so surgeons should discuss this point with women separately.

On average, the duration of the operation is 30-40 minutes. And immediately after a caesarean section, a woman on lower part an ice pack is placed in the abdomen for one and a half to two hours, which helps to contract the uterus and reduce blood loss in the postoperative period.

Types of anesthesia

In obstetrics, the course of a caesarean section can be carried out using two types of anesthesia:

• regional - epidural;
• general - mask, parenteral, endotracheal anesthesia.

Epidural anesthesia is the most common at the moment. During the entire operation, the woman remains lucid, 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 drug exposure). In addition, such anesthesia promotes contact between mother and child in the first minutes after birth.

How is a caesarean section with epidural anesthesia performed? The anesthetic is injected directly into the spinal canal through a catheter under the solid meninges. The puncture is made between 3-4 lumbar vertebrae. This localization prevents the needle from entering the spinal cord. The introduction 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 by endotracheal administration of the drug. When using it, you must first enter the muscle relaxant intravenously. This medicine provides relaxation of all muscles. Next, a tube is inserted into the trachea, through which an anesthetic is given to the pregnant woman. This type of anesthesia is most commonly used for emergency cesarean.

Postoperative period

After a caesarean section, a woman is kept for several hours in the recovery room under the supervision of a surgeon and nurses. Then she is left in the hospital for another two or three days. These days, a woman undergoes infusion therapy - an infusion of saline solutions to replenish blood loss. Per day, intravenous administration of up to one liter of liquids (isotonic sodium chloride solution, "Disol", "Trisol") is allowed.

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 the operation);
• breathing exercises, starting 6 hours after the operation;
• self-massage;
• diet three days after cesarean.

The diet must be strict. On the first day, only the use of mineral water without gas, a small amount of tea without sugar is allowed. On the second and third days, the diet is expanded by eating low-calorie meals: soups on vegetable broth, lean meats in boiled or steamed form, jelly. A woman should return to her usual diet gradually, only after the restoration of normal bowel function, gas and stool.

Also, after surgery, you need to follow a number of rules regarding personal hygiene. It is allowed to wash only from the second day, and only careful 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 yourself in the shower.

Possible Complications

Despite the fact that the course of a caesarean section is not difficult for both the operating nurse and the surgeon, it is nevertheless a serious abdominal operation that can be accompanied by a number of complications.

The following undesirable situations most often occur:

• high blood loss;
• injury to organs surrounding the uterus: intestinal loops, Bladder(usually occurs during repeated operations);
• fetal injury;
• allergic reaction to the anesthetic.

Postoperative suture care

Now women are discharged from the hospital on the third day after a caesarean 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 caring for the suture after surgery is how the woman looks after it. 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. You need to see a doctor immediately if the following symptoms are present:

• redness and swelling of the skin in the area of ​​the seam;
• soreness when pressed;
• purulent discharge.

Within 42 days after the operation, a woman has the right to contact the hospital where she had a caesarean, for any question of interest to her. The doctor must examine the woman, conduct additional methods examination and, if necessary, prescribe appropriate treatment.

Yes, the caesarean section and the course of the operation are simple and routine for most surgeons. But we must remember that any surgical intervention is a risk, therefore, a caesarean section should be carried out strictly if there are appropriate indications.

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 through surgical intervention. There is evidence that under Caesar a law was passed indicating that in the event of the death of a woman in childbirth, an attempt must be made to save the child by dissecting the abdominal wall and uterus with the extraction of the fetus. For a long time, caesarean sections were performed only when the mother died during childbirth. And only in the XVI century there were reports of the first cases when 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 in absolute terms. These are conditions or diseases that pose a mortal danger to the life of the mother and child, for example placenta previa- a situation where the placenta closes the exit from the uterus. Most often, this condition occurs in multi-pregnant women, especially after previous abortions or postpartum diseases. In these cases, during childbirth or on last dates pregnancy from the genital tract appear bright 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 detachment normally located placenta. Normally, the placenta separates from the uterine wall only after the baby is born. If the placenta or a significant part of it is separated before the birth of the child, then there are sharp pains in the abdomen, which can be accompanied by severe bleeding and even the development of a state of shock. At the same time, the supply of oxygen to the fetus is sharply disrupted, it is necessary to urgently take measures to save the life of the mother and baby.

Transverse position of the fetus. A child can be born through the natural birth canal if it is in a longitudinal (parallel to the axis of the uterus) position with the head or pelvic end down to the entrance to the pelvis. The transverse position of the fetus is more common in multiparous women due to a decrease in the tone of the uterus and the anterior abdominal wall, with polyhydramnios, placenta previa. Usually, with the onset of labor, the fetus spontaneously rotates into the correct longitudinal position. If this does not happen and external methods fail to turn the fetus into a longitudinal position, and if the waters break, then childbirth through the natural birth canal is impossible.

Cord prolapse. This situation occurs during the outflow of 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 loop of the umbilical cord slips into the vagina and may even be outside the genital gap, especially if the umbilical cord is long. There is a compression of the umbilical cord between the walls of the pelvis and the head of the fetus, which leads to impaired blood circulation between the mother and fetus. In order to timely diagnose such a complication, after the outflow of amniotic fluid, a vaginal examination is performed.

Preeclampsia. This is a serious complication of the second half of pregnancy, manifested by high blood pressure, the appearance of protein in the urine, edema, there may be a headache, blurred vision in the form of flickering "flies" before the eyes, pain in the upper abdomen and even convulsions, which requires immediate delivery, so how, with this complication, both the condition of the mother and the condition of the fetus suffer.

However, most operations are according to relative indications- such clinical situations in which the birth of the fetus through the natural birth canal is associated with a significantly greater risk to the mother and fetus than with a caesarean section, as well as by combination of indications- a combination of several complications of pregnancy or childbirth, which individually may not be significant, but in general pose a threat to the condition of the fetus during vaginal delivery. An example is breech presentation fetus. Births in the breech presentation are pathological, because. there is a high risk of injury and oxygen starvation of the fetus during childbirth through the natural birth canal. The likelihood of these complications increases especially when the breech presentation of the fetus is combined with its large size (more than 3600 g), overmaturity, excessive extension of the head of the fetus, with anatomical narrowing of the pelvis.

Age of nulliparous over 30 years. Age itself is not an indication for caesarean section, but in this age group often there is a gynecological pathology - chronic diseases of the genital organs, leading to prolonged infertility, miscarriage. Accumulating non-gynecological diseases - hypertonic disease, diabetes, obesity, heart disease. Pregnancy and childbirth in such patients occur with a large number of complications, with a high risk for the child and mother. Expanding indications for caesarean section in women in the late reproductive age with breech presentation of the fetus, chronic hypoxia fetus.

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

Allocate also indications for caesarean section during pregnancy and childbirth.

According to the urgency of performing a caesarean section, it can be planned and emergency. Caesarean section during pregnancy is usually carried out in a planned manner, less often in emergency cases (bleeding with placenta previa or premature detachment of a normally located placenta and other situations).

A planned operation allows you to prepare, decide on the technique of its implementation, anesthesia, as well as carefully assess the state of a woman’s health, and, if necessary, conduct corrective therapy. In childbirth, a caesarean section is performed according to emergency indications.

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 through the birth canal with full disclosure of the cervix, despite vigorous labor activity. In this case, there may be a threat of uterine rupture, acute fetal hypoxia (oxygen starvation), and even his death. Such a complication can occur both with an anatomically narrow pelvis, and with normal pelvic sizes, if the fetus is large, especially when overextended, with incorrect insertion of the fetal head. In advance, correctly assess the size of the mother's pelvis and the size of the fetal head allow additional research methods: ultrasound diagnostics and X-ray pelvimetry (the study of the radiograph of the pelvic bones), which allow predicting the outcome of childbirth. With significant degrees of narrowing of the pelvis, it is considered absolutely narrow and is an absolute indication for cesarean section, as well as in the presence of bone tumors, gross deformities in the small pelvis, which are an obstacle to the passage of the fetus. Diagnosed during childbirth during vaginal examination, incorrect insertion of the head (frontal, facial) is also an absolute indication for caesarean section. In these cases, the fetal head is inserted into the pelvis with 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, prolapse of the umbilical cord, prolonged labor, excessive labor activity, etc. Diagnose threatening state fetus along with auscultation (listening) with an obstetric stethoscope help modern methods diagnostics: cardiotocography (registration of fetal heartbeats using a special apparatus), ultrasound with dopplerometry (study of the movement of blood through the vessels of the placenta, fetus, uterus), amnioscopy (examination of amniotic fluid, carried out using a special optical device inserted into the cervical canal with a whole fetal bladder). If signs of threatening fetal hypoxia are detected and there is no effect from the treatment, an urgent surgical intervention is performed.

Weak labor activity. The complication is characterized by the fact that the frequency, intensity and duration of contractions is insufficient to complete the birth naturally, despite the use of corrective drug therapy. As a result, there is no progress in opening the cervix and moving the presenting part of the fetus through the birth canal. Childbirth can take a protracted nature, there is a risk of infection with an increase in the anhydrous gap and fetal hypoxia.

Operation progress

The incision of the anterior abdominal wall is carried out, as a rule, in the transverse direction above the pubis. In this place, the layer of subcutaneous adipose tissue is less pronounced, wound healing is better with minimal risk of formation incisional hernias, patients after surgery are more active, get up earlier. The aesthetic side is also taken into account, when a small, almost imperceptible 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 with massive blood loss, when an examination of the upper abdomen is required, with an unclear scope of the operation with a possible extension of the incision upwards.

The uterus is opened in its lower segment in the transverse direction. In late 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. The muscle layers and blood vessels here are located in a horizontal direction, the wall thickness of the lower segment is much less compared to the body of the uterus. Therefore, the opening of 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 after previous operations, or it becomes necessary to remove it after a caesarean section. This access was practiced earlier, it is accompanied by increased bleeding due to the intersection of a large number of 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) with the fetus in the pelvic position, the umbilical cord is crossed between the clamps, and the child is transferred to the midwife and neonatologist. After removing the child, the afterbirth is removed.

The incision on the uterus is sutured, while ensuring the correct matching of the edges of the wound 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 to the optimal healing process and the formation of a rich scar on the uterus, which is extremely important for subsequent pregnancies and childbirth.

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

Complications of caesarean section and their prevention

A caesarean section is a serious abdominal operation and, like any surgical intervention, should be performed only if there is evidence, but not at the request of the woman. Before the operation, the volume of the planned operation and possible complications are discussed with the pregnant woman (parturient woman). The written consent of the patient is required for the operation. In vital conditions - for example, if a woman is unconscious - the operation is performed according to health reasons or with the consent of relatives, if they accompany her.

And although caesarean section at the present stage is considered a reliable and safe operation, surgical complications are possible: injury to blood vessels due to an extended incision in the uterus and associated bleeding; injury to the bladder and intestines (more common with repeated entries due to adhesions), injury to the fetus. There are complications associated with anesthetic management. In the postoperative period, there is a risk uterine bleeding due to impaired uterine contractility caused by surgical trauma and action drugs. In connection with a change in the physicochemical properties of blood, an increase in its viscosity, the formation of blood clots and blockage of various vessels by them is possible.

Purulent-septic complications during caesarean section are more common than after vaginal delivery. Prevention of these complications begins even during the operation with the introduction of highly effective broad-spectrum antibiotics immediately after cutting the umbilical cord in order to reduce their negative impact on the child. In the future, if necessary, antibiotic therapy continues in the postoperative period with a short course. The most common are wound infection (suppuration and divergence of the sutures of the anterior abdominal wall), endometritis (inflammation of the inner lining of the uterus), adnexitis (inflammation of the appendages), parametritis (inflammation of the periuterine tissue).

Before and after surgery

The very procedure of preparation for surgery, as well as the postoperative period, promises some discomfort, some restrictions, will require effort, work on oneself.

At planned operation the night before and 2 hours before the operation, a cleansing enema is done, which will be repeated again on the 2nd day after the operation in order to activate intestinal motility (motor activity). Taking tranquilizers at night, which the doctor will prescribe, helps to cope with excitement and fear. Immediately before the operation, a urinary catheter is placed, which will remain in the bladder for a day.

After abdominal delivery, a woman is both a puerperal and a postoperative patient. During the first day, she will be in the ward. intensive care under the close supervision of an anesthesiologist and an obstetrician-gynecologist. There may be discomfort during the 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 by 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 vaginal delivery. Operating wound will be a source of pain in the area of ​​​​the sutures and in the lower abdomen, which will require the introduction of painkillers.

In order to prevent postoperative complications, early rising is practiced after 10-12 hours, breathing exercises and self-massage 6 hours after surgery. Compliance with the diet is mandatory for the first 3 days. In the first day it is recommended to starve, you can drink mineral water without gases, tea without sugar with lemon in small portions. On the second day, a low-calorie diet is observed: meat broth, liquid cereals, jelly. You can return to normal nutrition after the activation of intestinal motility and independent stool. You will have to come to terms with some restrictions on the hygiene plan: washing the body in parts is carried out from the 2nd day, it will be possible to fully take a shower after removing the stitches on the 5-7th day and discharge from the maternity hospital (usually on the 7-8th day after operation). The gradual restoration of muscle tissue in the area of ​​the scar on the uterus occurs within 1-2 years after the operation.

A woman may have to face some of the difficulties in breastfeeding, which are more common after a planned caesarean section. Surgical stress, blood loss, late attachment of the child to the breast due to impaired adaptation or drowsiness of the newborn are the cause of late lactation; in addition, it is difficult for a young mother to find a position for feeding.

If she is sitting, then the baby presses on the seam, but this problem can be dealt with by using the prone position for feeding.

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

After a caesarean section, the baby's heart functions differently, glucose levels and levels of activity-regulating hormones are lower thyroid gland, in the first 1.5 hours the body temperature is usually lower. Lethargy increases, decreases muscle tone and physiological reflexes, umbilical wound healing is sluggish, the immune system works worse, But at present, medicine has all the necessary resources in order to minimize the difficulties experienced by the baby. Usually, by the time of discharge, the indicators of the physical development of the newborn return to normal, and after a month the baby is no different from children born through the natural birth canal.

Cesarean section: choice of anesthesia

In modern obstetrics, the following types anesthesia for caesarean section: regional (epidural, cerebro-spinal) and general (intravenous, mask and endotracheal anesthesia). The most popular is regional anesthesia, because. with it, the woman remains conscious during the operation, which ensures early contact with the child in the first minutes of life. noted good condition newborn, because he is less susceptible to the influence of drugs that depress his vital functions. With spinal anesthesia, the anesthetic is injected through a thin catheter tube directly into the spinal canal, 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 action of anesthesia, a woman cannot move her legs). With 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 is performed. This type of anesthesia is more often used in emergency operations.

For many decades, this operation - caesarean section - allows you to save the life and health of the mother and her baby. In the old days, such a surgical intervention was performed extremely rarely and only if something threatened the life of the mother in order to save the child. However, caesarean section is now being used more and more frequently. Therefore, many specialists have already set themselves the task of reducing the percentage of births carried out by surgical intervention.

Who should perform the operation?

First of all, you should figure out how a caesarean section is done and what consequences await a young mother. By themselves, childbirth by the surgical method is quite safe. However, in some cases, operations are simply inappropriate. After all, no one is immune from risk. Many expectant mothers ask for a caesarean section only because of fear of severe pain. modern medicine offers in this case epidural anesthesia, which allows a woman to give birth without pain.

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

• Obstetrician-gynecologist - directly extracts the baby from the uterus.
• Surgeon - performs an incision in the soft tissues and muscles of the abdominal cavity to reach the uterus.
• A pediatric neonatologist is a doctor who takes in and examines a newborn baby. If necessary, a specialist in this profile can provide the child with first aid, as well as prescribe treatment.
• Anesthesiologist - performs anesthesia.
• Nurse anesthetist - helps to administer anesthesia.
• Operating nurse - assists doctors if necessary.

The anesthesiologist should talk to the pregnant woman before the operation to determine which type of pain relief is best for her.

Types of caesarean section

Indications for caesarean section can be completely different, and the operation is performed in certain cases in different ways. To date, there are two types of childbirth carried out with the help of surgical intervention:

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

Planned caesarean section

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

emergency caesarean section

For an emergency caesarean section, general anesthesia is usually used during the operation, since the woman may still have contractions, and they will not allow an epidural puncture. The incision in this operation is mainly longitudinal. This allows you to remove the baby from the uterine cavity much faster.

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

Types of incisions for caesarean section

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

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

As for the second operation, the seam from the previous one is simply excised.
As a result, only one seam remains visible on the woman's body.

How is the operation going?

If the anesthesiologist performs epidural anesthesia, then the site of the operation (incision) is hidden from the woman by a partition. But let's see how a caesarean section is done. The surgeon makes an incision in the wall of the uterus, and then opens amniotic sac. Then the child is removed. Almost immediately, the newborn begins to cry a lot. The pediatrician cuts the umbilical cord, and then performs all the necessary procedures with the child.

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

After that, doctors must remove the placenta, while treating all the necessary vessels with high quality so that bleeding does not start. The surgeon then sews up the cut tissue. A woman is put on a drip, giving a solution of oxytocin, which accelerates the process of uterine contraction. This phase of the operation is the longest. From the moment the baby is born to the end of the operation, it takes about 30 minutes. In time, this operation, a caesarean section, takes about 40 minutes.

What happens after childbirth?

After the operation, the newly-made mother is transferred from the operating unit to the intensive care unit or intensive care unit, as a caesarean section is performed quickly and with anesthesia. The mother should be under the vigilant supervision of doctors. At the same time, it is constantly measured arterial pressure, respiratory rate, pulse. The doctor must also monitor the rate at which the uterus is contracting, how much discharge and what character they have. IN without fail the functioning of the urinary system should be monitored.

After a caesarean section, the mother is prescribed antibiotics to avoid inflammation, as well as painkillers to relieve discomfort.

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

Consequences of surgery

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

The consequences of this surgical intervention, of course, are available. The very first thing to highlight is an ugly seam. You can fix it by visiting a beautician or a surgeon. Usually, to give the seam an aesthetic appearance, procedures such as smoothing, grinding and excision are carried out. Enough a rare occurrence keloid scars are considered - reddish growths form above the seam. It should be noted that the treatment of this kind of scars lasts a very long time and has its own characteristics. It must be carried out by a professional.

Much more for a woman more important condition the suture that is made on the uterus. After all, it depends on how next pregnancy and how a woman will give birth. The suture on the abdomen can be corrected, but the suture on the uterus cannot be corrected.

Menstruation and sexual life

If there are no complications during the operation, then the menstrual cycle begins and passes in the same way as after natural childbirth. If a complication nevertheless arose, then the inflammatory can proceed for several months. In some cases, menstruation can be painful and heavy.

You can start having sex after childbirth with a scalpel after 8 weeks. Of course, if the surgical intervention went without complications. If there were complications, then you can start having sex only after a thorough examination and consultation with a doctor.

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

lactation after surgery

Many young mothers who have undergone surgery worry that it is difficult to breastfeed after a cesarean. But this is absolutely not true.

Milk from a young mother appears at the same time as women after natural childbirth. Of course, breastfeeding after surgery is a little more difficult. This is primarily due to the characteristics of such genera.

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

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

C-section- a type of surgical intervention, during which the fetus is removed from the uterus of a pregnant woman. Extraction of the child occurs through an incision in the uterus and anterior abdominal wall.

Statistics on caesarean section vary from country to country. So, according to unofficial statistics in Russia, with the help of this delivery operation, about a quarter are born ( 25 percent) of all babies. This figure is increasing every year due to the increase in caesarean section at will. In the United States of America and most of Europe, every third child is born by caesarean section. The highest percentage of this operation is registered in Germany. In some cities of this country, every second child is born by caesarean section ( 50 percent). The lowest percentage is registered in Japan. In Latin America, this percentage is 35, in Australia - 30, in France - 20, in China - 45.

This statistic goes against the recommendations of the World Health Organization ( WHO). According to the WHO, the "recommended" proportion of caesarean sections should not exceed 15 percent. This means that a caesarean section should be carried out exclusively for medical reasons, when natural childbirth is impossible or involves a risk to the life of the mother and child. C-section ( from the Latin "caesarea" - royal, and "sectio" - cut) is one of the most ancient operations. According to legend, Julius Caesar himself ( 100 - 44 BC) was born thanks to this operation. There is also evidence that during his reign, a law was passed mandating that in the event of the death of a woman in labor, it is mandatory to remove a child from her by dissecting the uterus and anterior abdominal wall. Many myths and legends are associated with this delivery operation. There are also many ancient Chinese engravings depicting this operation, and on a living woman. However, for the most part, these operations ended fatally for the woman in labor. The main mistake that doctors made was that after removing the fetus, they did not sew up the bleeding uterus. As a result, the woman died from blood loss.

The first official data on a successful caesarean section date back to 1500, when Jacob Nufer, who lives in Switzerland, performed this operation on his wife. His wife for a long time was tormented by prolonged childbirth and still could not give birth. Then Jacob, who was engaged in the castration of pigs, received permission from the city authorities to extract the fetus using an incision in the uterus. The child born into the world as a result of this lived 70 years, and the mother gave birth to several more children. The very term "caesarean section" was introduced less than 100 years later by Jacques Guillimo. In his writings, Jacques described this type of delivery operation and called it "caesarean section."

Further, with the development of surgery as a branch of medicine, this type of surgical intervention was practiced more and more often. After Morton used ether as an anesthetic in 1846, midwifery went into new stage development. With the development of antiseptics, mortality from postoperative sepsis has decreased by 25 percent. However, there remained a high percentage of deaths due to postoperative bleeding. Various methods have been used to eliminate it. So, the Italian professor Porro proposed to remove the uterus after the extraction of the fetus and thereby prevent bleeding. This method of carrying out the operation reduced the mortality of women in labor by 4 times. Saumlnger put the final point on this issue when, for the first time in 1882, he carried out the technique of applying silver wire sutures to the uterus. After that, obstetric surgeons only continued to improve this technique.

The development of surgery and the discovery of antibiotics led to the fact that already in the 50s of the 20th century, 4 percent of children were born by caesarean section, and 20 years later - already 5 percent.

Despite the fact that caesarean section is an operation, with all the possible postoperative complications, an increasing number of women prefer this procedure due to fear of natural childbirth. The absence of strict regulations in the legislation on when a caesarean section should be performed gives the doctor the opportunity to act at his own discretion and at the request of the woman herself.

The fashion for caesarean section was provoked not only by the ability to “quickly” solve the problem, but also by the financial side of the issue. More and more clinics offer women in labor operative delivery in order to avoid pain and give birth quickly. The Berlin Charité clinic has gone even further in this matter. She offers the service of the so-called "imperial birth". According to the doctors of this clinic, an imperial birth makes it possible to experience the charm of natural childbirth without painful contractions. The difference between this operation is that local anesthesia allows parents to see the moment the baby is born. At the moment the child is taken out of the mother's womb, the cloth protecting the mother and surgeons is lowered and thus given to the mother and father ( if he's around) the opportunity to observe the birth of a baby. The father is allowed to cut the umbilical cord, after which the baby is placed on the mother's chest. After this touching procedure, the canvas is lifted, and the doctors complete the operation.

When is a caesarean section necessary?

There are two options for caesarean section - planned and emergency. Planned is the one when initially, even during pregnancy, indications for it are determined.

It should be noted that these indications may change during pregnancy. So, a low-lying placenta can migrate to the upper sections of the uterus and then the need for surgery disappears. A similar situation occurs with the fetus. It is known that the fetus changes its position during pregnancy. So, from a transverse position, it can move into a longitudinal one. Sometimes such changes can occur just a couple of days before delivery. Therefore, it is necessary to constantly monitor carry out continuous monitoring) the condition of the fetus and mother, and before the scheduled operation, once again undergo an ultrasound examination.

Caesarean section is necessary if the following pathologies are present:

• caesarean section in history and failure of the scar after it;
• anomalies of placental attachment total or partial placenta previa);
• deformity of the pelvic bones or an anatomically narrow pelvis;
• fetal position anomalies breech presentation, transverse position);
• large fruit ( over 4 kg) or giant fruit ( over 5 kg), or multiple pregnancy;
• severe pathologies on the part of the mother, associated and not associated with pregnancy.

Previous caesarean section and inconsistency of the scar after it

As a rule, a single caesarean section excludes repeated physiological births. This is due to the presence of a scar on the uterus after the first operative delivery. It is nothing more than a connective tissue that is not able to contract and stretch ( in contrast to the muscle tissue of the uterus). The danger lies in the fact that in the next birth, the place of the scar may become a place of uterine rupture.

How the scar is formed is determined by the postoperative period. If, after the first caesarean section, the woman had any inflammatory complications (which are not uncommon), then the scar may not heal well. The consistency of the scar before the next birth is determined using ultrasound ( ultrasound). If on ultrasound the thickness of the scar is less than 3 centimeters, its edges are uneven, and connective tissue is visible in its structure, then the scar is considered insolvent and the doctor decides in favor of a second caesarean section. This decision is also influenced by many other factors. For example, a large fetus, the presence of multiple pregnancy ( twins or triplets) or pathologies in the mother will also be in favor of caesarean section. Sometimes a doctor, even without contraindications, but in order to exclude possible complications, resorts to a caesarean section.

Sometimes, already in the birth itself, signs of inferiority of the scar may appear, and there is a threat of uterine rupture. Then an emergency caesarean section is performed.

Anomalies of attachment of the placenta

The unconditional indication for caesarean section is total placenta previa. In this case, the placenta, which is normally attached to upper departments uterus ( fundus or body of the uterus), located in its lower segments. With total or full presentation placenta completely covers internal os, with partial - by more than one third. The internal os is the lower opening in the cervix, which connects the uterine cavity and the vagina. Through this opening, the head of the fetus passes from the uterus into the internal genital tract, and from there out.

The prevalence of complete placenta previa is less than 1 percent of total births. Natural childbirth becomes impossible, since the internal os, through which the fetus must pass, is blocked by the placenta. Also, with uterine contractions ( which occur most intensively in the lower sections) the placenta will exfoliate, which will lead to bleeding. Therefore, with complete placenta previa, delivery by caesarean section is mandatory.

With partial placenta previa, the choice of delivery is determined by the presence of complications. So, if pregnancy is accompanied by an incorrect position of the fetus or there is a scar on the uterus, then childbirth is resolved by surgery.

With incomplete presentation, a caesarean section is carried out in the presence of the following complications:

• transverse position of the fetus;
• an inconsistent scar on the uterus;
• polyhydramnios and oligohydramnios ( polyhydramnios or oligohydramnios);
• discrepancy between the size of the pelvis and the size of the fetus;
• multiple pregnancy;
• the woman is over 30 years of age.

Anomalies of attachment can serve as an indication not only for a planned caesarean section, but also for an emergency one. So, the main symptom of placenta previa is periodic bleeding. This bleeding occurs without pain, but is distinguished by its abundance. It becomes the main cause of oxygen starvation of the fetus and feeling unwell mother. Therefore, frequent, heavy bleeding is an indication for emergency delivery by caesarean section.

Pelvic deformity or narrow pelvis

Anomalies in the development of the pelvic bones are one of the causes of prolonged labor. The pelvis can be deformed for a variety of reasons that arose both in childhood and in adult life.

The most common causes of pelvic deformity are:

• rickets or poliomyelitis suffered in childhood;
• poor nutrition in childhood;
• spinal deformity, including the coccyx;
• damage to the pelvic bones and their joints as a result of injuries;
• damage to the pelvic bones and their joints due to neoplasms or diseases such as tuberculosis;
• congenital anomalies pelvic bone development.

The deformed pelvis serves as a barrier to the passage of the child through the birth canal. At the same time, initially the fetus can enter the small pelvis, but then, due to any local narrowing, its progress is difficult.

In the presence of a narrow pelvis, the child's head initially cannot enter the small pelvis. There are two variants of this pathology - anatomically and clinically narrow pelvis.

An anatomically narrow pelvis is a pelvis that is more than 1.5 to 2 centimeters smaller than a normal pelvis. Moreover, even a deviation from the norm of at least one of the dimensions of the pelvis leads to complications.

The dimensions of a normal pelvis are:

• external conjugate- the distance between the supra-sacral fossa and the upper border of the pubic joint is at least 20 - 21 centimeters;
• true conjugate- 9 centimeters are subtracted from the outer length, which, respectively, will be equal to 11 - 12 centimeters.
• interosseous size- the distance between the upper iliac spines should be 25 - 26 centimeters;
• length between the furthest points of the iliac crests should be at least 28 - 29 centimeters.

Based on how much smaller the size of the pelvis, there are several degrees of narrowness of the pelvis. The third and fourth degree of the pelvis is an unconditional indication for caesarean section. At the first and second, the size of the fetus is estimated, and if the fetus is not large, and there are no complications, then natural childbirth is performed. As a rule, the degree of narrowness of the pelvis is determined by the size of the true conjugate.

Degrees of a narrow pelvis

True conjugate size	Degrees of narrowness of the pelvis	Childbirth option
9 - 11 centimeters	I degree of narrow pelvis	Natural childbirth is possible.
7.5 - 9 centimeters	II degree narrow pelvis	If the fetus is less than 3.5 kg, then natural childbirth is possible. If more than 3.5 kg, then the decision will be made in favor of a caesarean section. The likelihood of complications is high.
6.5 - 7.5 centimeters	III degree of narrow pelvis	Natural childbirth is not possible.
Less than 6.5 centimeters	IV degree narrow pelvis	Exclusive caesarean section.

A narrow pelvis complicates the course of not only the birth itself, but also pregnancy. In the later stages, when the baby's head does not descend into the small pelvis ( because it is larger than the pelvis), the uterus is forced to rise up. The growing and rising uterus puts pressure on the chest and, accordingly, on the lungs. Because of this, a pregnant woman develops severe shortness of breath.

Anomalies in the position of the fetus

When the fetus is located in the uterus of a pregnant woman, two criteria are evaluated - the presentation of the fetus and its position. The position of the fetus is the ratio of the vertical axis of the child to the axis of the uterus. With the longitudinal position of the fetus, the axis of the child coincides with the axis of the mother. In this case, if there are no other contraindications, then childbirth is resolved naturally. In the transverse position, the axis of the child forms a right angle with the axis of the mother. In this case, the fetus cannot enter the small pelvis to pass further through the woman's birth canal. Therefore, this position, if it does not change by the end of the third semester, is an absolute indication for caesarean section.

The presentation of the fetus characterizes which end, head or pelvic, is located at the entrance to the small pelvis. In 95 - 97 percent of cases, there is a head presentation of the fetus, in which the head of the fetus is located at the entrance to the woman's small pelvis. With such a presentation, at the birth of a child, his head initially appears, and then the rest of the body. In breech presentation, birth occurs in reverse ( legs first, then head), since the pelvic end of the child is located at the entrance to the small pelvis. Breech presentation is not an unconditional indication for caesarean section. If the pregnant woman has no other pathologies, her age is less than 30 years, and the size of the pelvis corresponds to the expected size of the fetus, then natural childbirth is possible. Most often, with a breech presentation, the decision in favor of a caesarean section is made by the doctor on an individual basis.

Large fetus or multiple pregnancy

A large fruit is one that weighs more than 4 kilograms. By itself, a large fetus does not mean that natural childbirth is impossible. However, in combination with other circumstances ( narrow pelvis of the first degree, the first birth after 30) it becomes an indication for a caesarean section.

Approaches to childbirth in the presence of a fetus of more than 4 kilograms in different countries are not the same. In European countries, such a fetus, even in the absence of other complications and successfully resolved previous births, is an indication for caesarean section.

Similarly, experts approach the management of childbirth in multiple pregnancies. By itself, such a pregnancy often occurs with various anomalies in the presentation and position of the fetus. Very often, twins end up in a breech presentation. Sometimes one fetus is located in the cranial presentation, and the other in the pelvic. The absolute indication for caesarean section is the transverse position of the entire twin.

At the same time, it is worth noting that both in the case of a large fetus and in the case of multiple pregnancy, natural delivery is often complicated by vaginal ruptures and premature discharge of water. One of the most serious complications with such childbirth is the weakness of labor activity. It can occur both at the beginning of childbirth, and in the process. If the weakness of labor activity is detected before childbirth, then the doctor may proceed to an emergency caesarean section. Also, the birth of a large fetus is more often complicated than in other cases by traumatism of the mother and child. Therefore, as is often the case, the question of the method of childbirth is determined by the doctor on an individual basis.

An unscheduled caesarean section in the case of a large fetus is resorted to if:

• weakness of labor activity is revealed;
• fetal oxygen starvation is diagnosed;
• the size of the pelvis does not correspond to the size of the fetus.

Severe pathologies on the part of the mother, associated and not associated with pregnancy

Indications for surgery are also maternal pathologies associated with pregnancy or not. The first are gestosis varying degrees severity and eclampsia. Preeclampsia is the condition of a pregnant woman, which is manifested by edema, high blood pressure and protein in the urine. Eclampsia is a critical condition that is manifested by a sharp increase in blood pressure, loss of consciousness and convulsions. These two conditions pose a threat to the life of the mother and child. Natural childbirth with these pathologies is difficult, because suddenly rising pressure can cause pulmonary edema, acute heart failure. With a sharply developed eclampsia, which is accompanied by seizures and a serious condition of a woman, they proceed to an emergency caesarean section.

The health of a woman can be threatened not only by pathologies caused by pregnancy, but also by diseases not associated with it.

The following diseases require a caesarean section:

• severe heart failure;
• exacerbation of renal failure;
• retinal detachment in this or a previous pregnancy;
• exacerbation of urinary infections;
• cervical fibroids and other tumors.

These diseases during natural childbirth can threaten the health of the mother or interfere with the progress of the child through the birth canal. For example, cervical fibroids will create a mechanical obstacle to the passage of the fetus. With an active sexual infection, there is also an increased risk of infection of the child at the moment when he passes through the birth canal.

Dystrophic changes in the retina are also a frequent indication for caesarean section. The reason for this is the fluctuations in blood pressure that occur in natural childbirth. Because of this, there is a risk of retinal detachment in women with myopia. It should be noted that the risk of detachment is observed in cases of severe myopia ( myopia from minus 3 diopters).

An emergency caesarean section is performed unscheduled due to complications that arose during the birth itself.

Pathologies, upon detection of which an unscheduled caesarean section is performed, are:

• weak generic activity;
• premature detachment of the placenta;
• the threat of uterine rupture;
• clinically narrow pelvis.

Weak labor activity

This pathology, which occurs during childbirth and is characterized by weak, short contractions or their complete absence. It can be primary and secondary. In the primary, the dynamics of labor is initially absent, in the secondary, the contractions are initially good, but then weaken. As a result, childbirth is delayed. Sluggish labor activity is the cause of oxygen starvation ( hypoxia) of the fetus and its traumatization. When this pathology is detected in urgent order perform operative delivery.

Premature placental abruption

Premature abruption of the placenta is complicated by the occurrence of deadly bleeding. This bleeding is very painful, and most importantly - profuse. Massive blood loss can cause death of the mother and fetus. There are several degrees of severity of this pathology. Sometimes, if the detachment is insignificant, then it is advisable to use expectant tactics. This requires constant monitoring of the condition of the fetus. If placental abruption progresses, it is urgent to carry out delivery by caesarean section.

Threat of uterine rupture

Rupture of the uterus is the most dangerous complication in childbirth. Fortunately, its frequency does not exceed 0.5 percent. In the event of a threat of rupture, the uterus changes its shape, becomes sharply painful, and the fetus stops moving. At the same time, the woman in labor becomes excited, her blood pressure drops sharply. The main symptom is a sharp pain in the abdomen. Rupture of the uterus ends in death for the fetus. At the first signs of a rupture, the woman in labor is prescribed medications that relax the uterus and eliminate its contractions. In parallel, the woman in labor is urgently transferred to the operating room and the operation is deployed.

Clinically narrow pelvis

A clinically narrow pelvis is one that is detected in the birth itself in the presence of a large fetus. The dimensions of the clinically narrow pelvis correspond to normal, but do not correspond to the size of the fetus. Such a pelvis causes prolonged labor and therefore may serve as an indication for an emergency caesarean section. The cause of the clinical pelvis is an incorrect calculation of the size of the fetus. So, the size and weight of the fetus can be approximately calculated from the circumference of the abdomen of a pregnant woman or according to ultrasound. If this procedure has not been done in advance, then the risk of detecting a clinically narrow pelvis increases. A complication of this is rupture of the perineum, and in rare cases, the uterus.

"For" and "against" caesarean section

Despite the high percentage of children born by caesarean section, this operation cannot be equated with physiological childbirth. This opinion is shared by a number of experts who believe that such a "demand" for cesarean section is not quite normal. The problem of the growing number of women who prefer childbirth under anesthesia is not so harmless. After all, by relieving themselves from suffering, they complicate the future life not only for themselves, but also for their child.

In order to evaluate all the pros and cons of a caesarean section, it must be remembered that in 15-20 percent of cases this type of surgical intervention is still performed for health reasons. According to WHO, 15 percent are those pathologies that prevent natural childbirth.

Advantages of a caesarean section

Elective or emergency caesarean section helps to safely remove the fetus when this is not possible naturally. The main advantage of caesarean section is saving the life of the mother and child in cases where they are threatened death. After all, many pathologies and conditions during pregnancy can end fatally during natural childbirth.

Natural childbirth is not possible in the following cases:

• total placenta previa;
• transverse position of the fetus;
• narrow pelvis 3 and 4 degrees;
• heavy, life threatening pathology of the mother tumors in the small pelvis, severe preeclampsia).

In these cases, the operation saves the life of both the mother and the child. Another advantage of cesarean is the possibility of its emergency in cases where the need suddenly arose. For example, with weak labor activity, when the uterus is unable to contract normally and the child is threatened with death.

The advantage of caesarean section is also the ability to prevent such complications of natural childbirth as perineal and uterine ruptures.

A significant plus for a woman's sexual life is the preservation of the genital tract. After all, pushing the fetus through itself, the woman's vagina is stretched. The situation is worse if an episiotomy is performed during childbirth. During this surgical procedure, an incision is made rear wall vagina, in order to avoid ruptures and make it easier to push the fetus out. After an episiotomy, further sexual life is significantly complicated. This is due to both the stretching of the vagina and the long non-healing sutures on it. Caesarean section will minimize the risk of prolapse and prolapse of the internal genital organs ( uterus and vagina), sprains of the pelvic muscles and involuntary urination associated with stretching.

An important plus for many women is that the birth itself is quick and painless, and you can program them for any time. The absence of pain is one of the most stimulating factors, because almost all women have a fear of painful natural childbirth. A caesarean section also protects the child being born from possible injuries that he can easily get during complicated and protracted births. Biggest risk the baby is exposed when various third-party methods are used in natural childbirth to retrieve the baby. It can be forceps or vacuum extraction of the fetus. In these cases, the child often receives craniocerebral injuries, which subsequently affect his health.

Cons of a caesarean section for a woman in labor

Despite all the seeming ease and speed of the operation ( lasts 40 minutes) caesarean section remains a complex abdominal operation. The disadvantages of this surgical intervention affect both the child and the mother.

The disadvantages of the operation for a woman are reduced to all sorts of postoperative complications, as well as to complications that may arise during the operation itself.

The disadvantages of a caesarean section for the mother are:

• postoperative complications;
• long recovery period;
• postpartum depression;
• difficulty initiating breastfeeding after surgery.

A high percentage of postoperative complications
Since caesarean section is an operation, it bears all the disadvantages that are associated with postoperative complications. These are primarily infections, the risk of which is much higher with caesarean section than with natural childbirth.

The risk of development is especially high in emergency, unscheduled operations. Due to direct contact of the uterus with non-sterile environment pathogens enter it. These microorganisms are subsequently the source of infection, most often endometritis.

In 100 percent of cases, a cesarean section, like other operations, loses a fairly large amount of blood. The amount of blood that a woman loses in this case is two or even three times the volume that a woman loses in natural childbirth. This causes weakness and malaise in the postoperative period. If a woman was anemic before childbirth ( low hemoglobin content), which worsens her condition even more. In order to return this blood, transfusion is most often resorted to ( transfusion of donated blood into the body), which is also associated with the risk of side effects.
The most severe complications are associated with anesthesia and the effect of anesthetic on mother and baby.

Long recovery period
After surgery on her uterus contractility decreases. This, as well as impaired blood supply ( due to damage to blood vessels during surgery) causes prolonged healing. The long recovery period is also aggravated by the postoperative suture, which can very often diverge. Muscle recovery cannot be started immediately after the operation, because within a month or two after it all sorts of physical exercise prohibited.

All this limits the necessary contact between mother and child. A woman does not immediately start breastfeeding, and caring for a baby can be difficult.
The recovery period is delayed if a woman develops complications. Most often, intestinal motility is disturbed, which is the cause of prolonged constipation.

Women after caesarean section have a 3 times higher risk of rehospitalization in the first 30 days than women who gave birth vaginally. It is also associated with the development of frequent complications.

The prolonged recovery period is also due to the action of anesthesia. So, in the first days after anesthesia, a woman is worried about severe headaches, nausea, and sometimes vomiting. Pain at the injection site of epidural anesthesia restricts the mother's movements and negatively affects her general well-being.

postpartum depression
In addition to the consequences that can harm the mother's bodily health, there is psychological discomfort and a high risk of developing postpartum depression. Many women may suffer from the fact that they did not give birth to a child on their own. Experts believe that the interrupted contact with the child and the lack of close proximity during childbirth are to blame.

It is known that postpartum depression ( the frequency of which has been increasing in recent years) no one is safe. However, the risk of its development is higher, according to many experts, in women who have undergone surgery. Depression is associated both with a long recovery period and with the feeling that the connection with the baby has been lost. Both psychoemotional and endocrine factors are involved in its development.
With caesarean section, a high percentage of early postpartum depression was recorded, which manifests itself in the first weeks after childbirth.

Difficulties in starting breastfeeding after surgery
After surgery, there are difficulties with feeding. This is due to two reasons. The first is that the first milk ( colostrum) becomes unsuitable for feeding the child due to the penetration of drugs for anesthesia into it. Therefore, on the first day after the operation, the child should not be breastfed. If a woman has undergone general anesthesia, then the feeding of the child is postponed for several weeks, since the anesthetics used for general anesthesia are stronger and, therefore, take longer to be removed. The second reason is the development of postoperative complications that prevent the full care and feeding of the child.

Cons of a caesarean section for a baby

The main disadvantage for the child during the operation itself is negative impact anesthetic. General anesthesia has recently become less common, but, nevertheless, the medicines used in it have a negative effect on the respiratory and nervous system of the child. Local anesthesia is not so harmful for the baby, but there is still a risk of oppression of vital organs and systems. Very often, children after cesarean section are very lethargic in the first days, which is associated with the action of anesthetics and muscle relaxants on them ( medicines that relax the muscles).

Another significant disadvantage is the poor adaptation of the baby to the external environment after the operation. In natural childbirth, the fetus, passing through the birth canal of the mother, gradually adapts to changes external environment. It adapts to the new pressure, light, temperature. After all, for 9 months he is in the same climate. With a caesarean section, when the baby is abruptly removed from the mother's uterus, there is no such adaptation. In this case, the child experiences a sharp drop in atmospheric pressure, which, of course, negatively affects his nervous system. Some believe that such a drop is a further cause of problems with vascular tone in children ( for example, the cause of banal vascular dystonia).

Another complication for the baby is fetal fluid retention syndrome. It is known that the child, while in the womb, receives the necessary oxygen through the umbilical cord. His lungs are not filled with air, but with amniotic fluid. When passing through the birth canal, this fluid is pushed out and only a small amount of it is removed using an aspirator. In a baby born by caesarean section, this fluid often remains in the lungs. Sometimes she sucks lung tissue, but in debilitated children, this fluid can cause pneumonia.

As with natural childbirth, with a caesarean section there is a risk of injuring the child if it is difficult to extract it. However, the risk of injury in this case is much lower.

There are many scientific publications on the topic that children born as a result of caesarean section are more likely to suffer from autism, attention deficit hyperactivity disorder, and are less stress resistant. Much of this is disputed by experts, because although childbirth is important, many believe, it is still only an episode in the life of a child. After childbirth, a whole complex of care and upbringing follows, which determines both the mental and physical health of the child.

Despite the abundance of minuses, sometimes a caesarean section is the only possible way to extract the fetus. It helps reduce the risk of maternal and perinatal mortality ( fetal death during pregnancy and within the first week after delivery). Also, the operation avoids many herbs, which are not uncommon in protracted natural childbirth. At the same time, it should be carried out according to strict indications, only when all the pros and cons are weighed. After all, any childbirth - both natural and by caesarean section - carry possible risks.

Preparing a pregnant woman for a caesarean section

Preparation of a pregnant woman for a caesarean section begins after the indications for its implementation have been determined. The doctor must explain to the expectant mother all the risks and possible complications of the operation. Next, select the date when the operation will be performed. Before the operation, the woman undergoes periodic ultrasound examination, passes the necessary tests ( blood and urine), attends preparatory courses for expectant mothers.

It is necessary to go to the hospital a day or two before the operation. If a woman has a repeated caesarean section, then it is necessary to be hospitalized 2 weeks before the proposed operation. During this time, the woman is examined by a doctor, takes tests. Blood of the required group is also prepared, which will compensate for blood losses during the operation.

Before carrying out the operation, it is necessary to carry out:
General blood analysis
A blood test is done primarily in order to assess the level of hemoglobin and red blood cells in the blood of a woman in labor. Normally, the hemoglobin level should not be less than 120 grams per liter of blood, while the content of red blood cells should be in the range of 3.7 - 4.7 million per milliliter of blood. If at least one of the indicators is lower, then this means that the pregnant woman is suffering from anemia. Women with anemia tolerate surgery worse and, as a result, lose a lot of blood. The doctor, knowing about anemia, must ensure that there is a sufficient volume of blood of the required type in the operating room for emergency cases.

Attention is also paid to leukocytes, the number of which should not exceed 9x10 9

An increase in leukocytes ( leukocytosis) speaks of an inflammatory process in the body of a pregnant woman, which is relative contraindication to a caesarean section. If there is an inflammatory process in a woman's body, then this increases the risk of developing septic complications tenfold.

Blood chemistry
The main indicator that the doctor is most interested in before surgery is blood glucose. Enhanced level glucose ( popularly sugar) in the blood indicates that the woman may have diabetes. This disease is the second cause of complications in the postoperative period after anemia. Women with diabetes mellitus are more likely to develop infectious complications ( endometritis, wound suppuration), complications during the operation. So if the doctor discovers high level glucose, he will prescribe treatment to stabilize its level.

Risk of major ( over 4 kg) and giant ( over 5 kg) of the fetus in such women is ten times higher than in women who do not suffer from this pathology. As you know, a large fetus is more prone to injury.

General urine analysis
A general urine test is also carried out in order to exclude infectious processes in the woman's body. So, inflammation of the appendages, cervicitis and vaginitis are often accompanied by an increased content of leukocytes in the urine, a change in its composition. Diseases of the genital area are the main contraindication to caesarean section. Therefore, if signs of these diseases are detected in the urine or in the blood, the doctor may postpone the operation due to an increased risk of purulent complications.

ultrasound
Ultrasonography It is also a mandatory examination before a caesarean section. Its purpose is to determine the position of the fetus. It is very important to exclude anomalies incompatible with life in the fetus, which are an absolute contraindication to caesarean section. In women with a history of caesarean section, ultrasound is performed to assess the consistency of the scar on the uterus.

Coagulogram
Coagulogram is a method laboratory research which studies blood clotting. Coagulation pathologies are also a contraindication to caesarean section, because bleeding develops due to the fact that the blood does not clot well. The coagulogram includes such indicators as thrombin and prothrombin time, fibrinogen concentration.
The blood group and its Rh factor are also re-determined.

On the eve of the operation

On the eve of the operation, lunch and dinner for a pregnant woman should be as light as possible. Lunch may include broth or porridge, for dinner it will be enough to drink sweet tea and eat a sandwich with butter. During the day, the anesthesiologist examines the woman in labor and asks her questions, mainly related to her allergic history. He will find out if the woman in labor has allergies and to what. He also asks her about chronic diseases, pathologies of the heart and lungs.
In the evening, the woman in labor takes a shower, toilets the external genitalia. At night she is given a mild sedative and some kind of antihistamine ( e.g. suprastin tablet). It is important that all indications for surgery are re-evaluated and all risks are weighed. Also, before the operation, the expectant mother signs a written agreement for the operation, which indicates that she is aware of all possible risks.

On the day of the operation

On the day of the operation, the woman excludes any food and drink. Before the operation, the pregnant woman must get rid of makeup, remove nail polish. By the color of the skin and nails, the anesthesiologist will determine the condition of the pregnant woman under anesthesia. You must also remove all jewelry. A cleansing enema is given two hours before the operation. Immediately before the operation, the doctor listens to the fetal heartbeat, determines its position. A catheter is inserted into the woman's bladder.

Description of the caesarean section

A caesarean section is a complex surgical intervention during childbirth with the extraction of the fetus from the uterine cavity through the incision made. In terms of duration, the usual caesarean section takes no more than 30-40 minutes.

The operation can be performed according to various methods, depending on the necessary access to the uterus and to the fetus. There are three main options for surgical access ( abdominal wall incision) to the pregnant uterus.

Surgical access to the uterus are:

• access along the midline of the abdomen ( classic cut);
• low transverse Pfannenstiel approach;
• suprapubic transverse approach according to Joel-Cohen.

Classic Access

Access along the midline of the abdomen is a classic surgical approach for caesarean section. It is performed along the midline of the abdomen from the level of the pubis to a point about 4 to 5 centimeters above the navel. Such an incision is quite large and often leads to postoperative complications. IN modern surgery a low classic cut is used. It is made along the midline of the abdomen from the pubis to the navel.

Pfannenstiel access

In such operations, the Pfannenstiel incision is most often the surgical access. The anterior abdominal wall is cut across the midline of the abdomen along the suprapubic fold. The incision is an arc 15 - 16 centimeters long. Such a surgical approach is the most beneficial in cosmetic terms. Also, with this access, the development of postoperative hernias is rare, in contrast to the classical approach.

Access by Joel-Kohen

The Joel-Kochen approach is also a transverse incision, as is the Pfannenstiel approach. However, the dissection of the tissues of the abdominal wall is made slightly above the pubic fold. The incision is straight and has a length of about 10 - 12 centimeters. This access is used when the bladder is lowered into the pelvic cavity and there is no need to open the vesicouterine fold.

During caesarean section, there are several options for accessing the fetus through the wall of the uterus.

Options for incision of the uterine wall are:

• transverse incision in the lower part of the uterus;
• median incision of the body of the uterus;
• median section of the body and lower part of the uterus.

Techniques for caesarean section

In accordance with the options for uterine incisions, several methods of operation are distinguished:

• transverse incision technique in the lower part of the uterus;
• corporal technique;
• isthmicocorporal technique.

Transverse incision technique in the lower part of the uterus

The technique of transverse incision in the lower part of the uterus for caesarean section is the technique of choice.
Surgical access is performed according to the Pfannenstiel or Joel-Kohen technique, less often - a small classic access along the midline of the abdomen. Depending on the surgical approach, the transverse incision technique in the lower part of the uterus has two options.

Variants of the transverse incision technique in the lower part of the uterus are:

• with dissection of the vesicouterine fold ( Pfannenstiel access or small classical incision);
• without incision of the vesicouterine fold ( access by Joel-Kohen).

In the first variant, the vesicouterine fold is opened and the bladder is moved away from the uterus. In the second option, the incision on the uterus is made without opening the fold and manipulation of the bladder.
In both cases, the uterus is dissected in its lower segment, where the fetal head is exposed. A transverse incision is made along the muscle fibers of the uterine wall. On average, its length is 10 - 12 centimeters, which is enough for the passage of the fetal head.
With the method of transverse incision of the uterus, the least damage is done to the myometrium ( muscular layer of the uterus), which favors the rapid healing and scarring of the postoperative wound.

Corporal methodology

The corporal caesarean section method consists in extracting the fetus through a longitudinal incision on the body of the uterus. Hence the name of the method - from the Latin "corporis" - the body. Surgical access with this method of operation is usually classical - along the midline of the abdomen. Also, the body of the uterus is cut along the midline from the vesicouterine fold towards the bottom. The length of the incision is 12 - 14 centimeters. Initially, 3-4 centimeters are cut with a scalpel, then the incision is enlarged with scissors. These manipulations cause profuse bleeding, which forces you to work very quickly. The fetal bladder is cut with a scalpel or fingers. The fetus is removed and the afterbirth is removed. If necessary, the uterus is also removed.
A corporal caesarean section often results in the formation of many adhesions, the wound heals for a long time, and there is a high risk of scar dehiscence during subsequent pregnancy. This method is used extremely rarely in modern obstetrics and only for special indications.

The main indications for corporal caesarean section are:

• the need for a hysterectomy removal of the uterus) after delivery - with benign and malignant formations in the wall of the uterus;
• profuse bleeding;
• the fetus is in a transverse position;
• live fetus in a dead woman in labor;
• lack of experience with the surgeon in performing caesarean section by other methods.

The main advantage of the corporal technique is fast opening uterus and fetal extraction. Therefore, this method is mainly used for emergency caesarean section.

Isthmicocorporal technique

In the isthmicocorporal caesarean section, a longitudinal incision is made not only in the body of the uterus, but also in its lower segment. Surgical access is performed according to Pfannenstiel, which allows opening the vesicouterine fold and moving the bladder downwards. The incision of the uterus begins in its lower segment one centimeter above the bladder and ends on the body of the uterus. The longitudinal section averages 11 - 12 centimeters. This technique is rarely used in modern surgery.

Stages of a caesarean section

The caesarean section operation consists of four stages. Each surgical technique has similarities and differences at different stages of the surgical intervention.

Similarities and differences in the stages of caesarean section with different methods

Stages	Method of transverse incision of the uterus	Corporal methodology	Isthmicocorporal technique
First stage: surgical access.	according to Pfannenstiel; according to Joel-Kohen; low classic cut.	classic access; according to Pfannenstiel.	classic access; according to Pfannenstiel.
Second phase: opening of the uterus; opening of the fetal bladder.	Cross section of the lower part of the uterus.	Median section of the body of the uterus.	Median section of the body and lower part of the uterus.
Third stage: extraction of the fetus; removal of the placenta.		The fetus and afterbirth are removed by hand. If necessary, the uterus is removed.	The fetus and afterbirth are removed by hand.
Fourth stage: suturing of the uterus; suturing of the abdominal wall.	The uterus is sutured with a suture in one row.	The abdominal wall is sutured in layers.	The uterus is sutured with two rows of sutures. The abdominal wall is sutured in layers.

First stage

At the first stage of the operation, a transverse incision is made with a scalpel in the skin and subcutaneous tissue of the anterior abdominal wall. Usually resort to transverse incisions of the abdominal wall ( Pfannenstiel and Joel-Kohen access), less often to median incisions ( classic and low classic).

Then the aponeurosis is cut transversely with a scalpel ( tendon) rectus and oblique abdominal muscles. Using scissors, the aponeurosis is separated from the muscles and white ( middle) lines of the abdomen. Its upper and lower edges are captured with special clamps and stratified to the navel and pubic bones, respectively. The exposed muscles of the abdominal wall are pushed apart with the fingers along the course of the muscle fibers. Next, a longitudinal incision is made in the peritoneum ( membrane covering internal organs) from the level of the navel to the top of the bladder and the uterus is visualized.

Second phase

At the second stage, access to the fetus is created through the uterus and fetal membrane. With the help of sterile napkins, the abdominal cavity is delimited. If the bladder is located quite high and interferes with the course of the operation, then the vesicouterine fold is opened. To do this, a small incision is made on the fold with a scalpel, through which most of the fold is cut longitudinally with scissors. This exposes the bladder, which can be easily separated from the uterus.

This is followed by dissection of the uterus itself. Using the transverse incision technique, the surgeon determines the location of the fetal head and makes a small transverse incision with a scalpel in this area. With the help of the index fingers, the incision is expanded in the longitudinal direction up to 10 - 12 centimeters, which corresponds to the diameter of the fetal head.

Then the fetal bladder is opened with a scalpel and the fetal membranes are separated with fingers.

Third stage

The third stage is the extraction of the fetus. The surgeon inserts a hand into the uterine cavity and grasps the fetal head. With a slow movement, the head is bent and turned with the back of the head to the incision. The shoulders are gradually extended one by one. The surgeon then inserts fingers into the armpits of the fetus and pulls it completely out of the uterus. With unusual diligence ( locations) the fetus can be removed by the legs. If the head does not pass, then the incision on the uterus expands by a couple of centimeters. After removing the baby, two clamps are applied to the umbilical cord and cut between them.

To reduce blood loss and make it easier to remove the placenta, medications are injected into the uterus with a syringe, which lead to a contraction of the muscle layer.

Drugs that promote uterine contraction include:

• oxytocin;
• ergotamine;
• methylergometrine.

Then the surgeon gently pulls on the umbilical cord, removing the placenta with the afterbirth. If the placenta itself does not separate, then it is removed with a hand inserted into the uterine cavity.

Fourth stage

At the fourth stage of the operation, a revision of the uterus is performed. The surgeon inserts his hands into the uterine cavity and checks it for the presence of remnants of the placenta and placenta. The uterus is then sutured in one row. The seam can be continuous or discontinuous with a distance of no more than one centimeter. Currently, threads made of synthetic materials are used, which dissolve over time - vicryl, polysorb, dexon.

Wipes are removed from the abdominal cavity and the peritoneum is sutured with a continuous suture from top to bottom. Next, the muscles, aponeurosis and subcutaneous tissue are sutured in layers with continuous sutures. A cosmetic suture is applied to the skin with thin threads ( silk, nylon, catgut) or medical brackets.

Methods of anesthesia for caesarean section

A caesarean section, like any other surgical procedure, requires appropriate anesthesia ( anesthesia).

The choice of method of anesthesia depends on a number of factors:

• pregnancy history ( information about previous births, obstetric and gynecological pathologies );
• general condition of the body of a pregnant woman ( age, comorbidities, especially of the cardiovascular system);
• state of the fetal body abnormal position of the fetus, acute placental insufficiency or fetal hypoxia);
• type of transaction ( emergency or planned);
• availability in obstetric department appropriate apparatus and equipment for anesthesia;
• experience of an anesthesiologist;
• wish of the mother be conscious and see a newborn baby or sleep peacefully during surgical procedures).

Currently, there are two options for anesthesia for surgical delivery - general anesthesia and regional ( local) anesthesia.

General anesthesia

General anesthesia is also called general anesthesia or endotracheal anesthesia. This type of anesthesia consists of several stages.

The stages of anesthesia are:

• induction anesthesia;
• muscle relaxation;
• aeration of the lungs with the help of a ventilator;
• main ( supporting) anesthesia.

Induction anesthesia acts as a preparation for general anesthesia. With its help, the patient calms down and is put to sleep. Induction anesthesia is performed using intravenous administration general anesthetics ( ketamine) and inhalation of gaseous anesthetics ( nitrous oxide, desflurane, sevoflurane).

Complete muscle relaxation is achieved by intravenous administration of muscle relaxants ( drugs that relax muscle tissue ). The main muscle relaxant used in obstetric practice is succinylcholine. Muscle relaxants relax all the muscles of the body, including the uterine.
Due total relaxation respiratory muscles, the patient needs artificial aeration of the lungs ( breathing is supported artificially). To do this, a tracheal tube connected to a ventilator is inserted into the trachea. The machine delivers a mixture of oxygen and anesthetic to the lungs.

Basic anesthesia is maintained by the administration of gaseous anesthetics ( nitrous oxide, desflurane, sevoflurane) and intravenous antipsychotics ( fentanyl, droperidol).
General anesthesia has a number of negative effects on the mother and fetus.

Negative effects of general anesthesia

General anesthesia is used under the following conditions:

• regional anesthesia is contraindicated for pregnant women ( especially in pathologies of the heart and nervous system);
• the life of the pregnant woman and/or the fetus is at risk, and the caesarean section is urgent ( emergency);
• the pregnant woman categorically refuses other types of anesthesia.

Regional anesthesia

During cesarean section operations, the regional method of anesthesia is most often used, since it is the safest for the woman in labor and the fetus. However this method requires high professionalism and accuracy from the anesthesiologist.

Two types of regional anesthesia are used:

• spinal anesthesia.

Epidural anesthesia method
The epidural method of anesthesia consists in "paralysis" spinal nerves responsible for sensitivity in the lower body. At the same time, the woman in labor remains fully conscious, but does not feel pain.

Before the start of the operation, the pregnant woman is punctured ( puncture) at the level of the lower back with a special needle. The needle is deepened to the epidural space, where all the nerves exit the spinal canal. A catheter is inserted through the needle thin flexible tube) and remove the needle itself. Pain medications are injected through the catheter lidocaine, marcaine), which suppress pain and tactile sensitivity from the lower back to the tips of the toes. Thanks to the indwelling catheter, anesthetic can be added during the operation as needed. After the surgery is completed, the catheter remains for a couple of days for the administration of pain medications in the postoperative period.

Spinal anesthesia method
The spinal method of anesthesia, like the epidural, leads to a loss of sensation in the lower body. Unlike epidural anesthesia, with spinal anesthesia, the needle is inserted directly into the spinal canal, where the anesthetic enters. In more than 97 - 98 percent of cases, a complete loss of all sensitivity and relaxation of the muscles of the lower body, including the uterus, is achieved. The main advantage of this type of anesthesia is the need for small doses of anesthetics to achieve the result, which provides less impact on the body of the mother and fetus.

There are a number of conditions under which regional anesthesia is contraindicated.

The main contraindications include:

• inflammatory and infectious processes in the area of ​​lumbar puncture;
• blood diseases with impaired coagulation;
• acute infectious process in the body;
• allergic reactions for painkillers;
• the absence of an anesthesiologist who has the technique of regional anesthesia, or the lack of equipment for it;
• severe pathology of the spine with its deformation;
• categorical refusal of a pregnant woman.

Complications of caesarean section

The greatest danger is the complications that arose during the operation itself. Most often they are associated with anesthesia, but can also be the result of a large loss of blood.

Complications during the operation

The main complications during the operation itself are associated with blood loss. Blood loss, both in natural childbirth and in caesarean section, is inevitable. In the first case, the woman in labor loses from 200 to 400 milliliters of blood ( Of course, if there are no complications). During an operative delivery, a woman in labor loses about a liter of blood. This massive loss is due to damage to the blood vessels that occurs when incisions are made at the time of surgery. The loss of more than a liter of blood during caesarean section creates the need for a transfusion. Massive blood loss that occurred at the time of the operation, in 8 cases out of 1000 ends with the removal of the uterus. In 9 cases out of 1000 it is necessary to carry out resuscitation measures.

The following complications may also occur during the operation:

• circulatory disorders;
• violations of ventilation of the lungs;
• violations of thermoregulation;
• damage to large vessels and nearby organs.

These complications are the most dangerous. Most often, there are violations of blood circulation and ventilation of the lungs. With hemodynamic disorders, both arterial hypotension and hypertension can occur. In the first case, the pressure drops, the organs cease to receive sufficient blood supply. Hypotension can be caused by both blood loss and an overdose of the anesthetic. Hypertension during surgery is not as dangerous as hypotension. However, it negatively affects the work of the heart. The most severe and dangerous complication associated with the cardiovascular system is cardiac arrest.
Respiratory disorders can be caused by both the action of anesthesia and pathologies on the part of the mother.

Disorders of thermoregulation are manifested by hyperthermia and hypothermia. Malignant hyperthermia is characterized by an increase in body temperature by 2 degrees Celsius within two hours. In hypothermia, body temperature drops below 36 degrees Celsius. Hypothermia is more common than hyperthermia. Thermoregulation disorders can be provoked by anesthetics ( e.g. isoflurane) and muscle relaxants.
During caesarean section, organs close to the uterus can also be accidentally damaged. The most common injury is the bladder.

Complications in the postoperative period are:

• complications of an infectious nature;
• the formation of adhesions;
• severe pain syndrome;
• postoperative scar.

Complications of an infectious nature

These complications are the most common, ranging from 20 to 30 percent depending on the type of surgery ( emergency or planned). They most often occur in women with overweight or diabetes mellitus, as well as during an emergency caesarean section. This is due to the fact that during a planned operation, a woman in labor is pre-prescribed antibiotics, while during an emergency, no. The infection can affect both the postoperative wound ( incision in the abdomen), and the internal organs of a woman.

Infection of the postoperative wound, despite all attempts to reduce the risk of infections after surgery, occurs in one to two out of ten cases. At the same time, the woman has an increase in temperature, there is a sharp pain and redness in the wound area. Further, discharges appear from the incision site, and the edges of the incision themselves diverge. Discharges very quickly acquire an unpleasant purulent odor.

Inflammation of the internal organs extends to the uterus and organs urinary system. A common complication after caesarean section is inflammation of the tissues of the uterus or endometritis. The risk of developing endometritis during this operation is 10 times higher compared to natural childbirth. With endometritis, such common symptoms of infection as fever, chills, severe malaise also appear. characteristic symptom endometritis are bloody or purulent discharge from the vagina, as well as sharp pains in the lower abdomen. The cause of endometritis is infection in the uterine cavity.

The infection may also involve urinary tract. Usually after caesarean as after other operations) infection of the urethra occurs. This is related to the catheter thin tube) into the urethra during surgery. This is done to empty the bladder. The main symptom in this case is painful, difficult urination.

Blood clots

An increased risk of blood clots occurs with any operation. A thrombus is a blood clot in a blood vessel. There are many reasons for the formation of blood clots. During surgery, this reason is the entry into the bloodstream of a large amount of a substance that stimulates blood clotting ( thromboplastin). How longer operation, the more thromboplastin is released from the tissues into the blood. Accordingly, in complicated and protracted operations, the risk of thrombosis is maximum.

The danger of a thrombus is that it can clog blood vessel and stop the access of blood to the organ that is supplied by this vessel. The symptoms of thrombosis are determined by the organ where it occurred. So pulmonary thrombosis ( pulmonary thromboembolism) is manifested by cough, shortness of breath; thrombosis of the vessels of the lower extremities - sharp pain, pallor of the skin, numbness.

Prevention of thrombus formation during caesarean section consists in prescribing special preparations that thin the blood and prevent the formation of blood clots.

Adhesion formation

Spikes are called fibrous strands connective tissue, which can connect various organs or tissues and block the gaps of the viscera. The adhesive process is characteristic of all abdominal operations, including caesarean section.

The mechanism of adhesion formation is associated with the process of scarring after surgery. This process releases a substance called fibrin. This substance glues soft tissues together, thus restoring damaged integrity. However, gluing occurs not only where necessary, but also in those places where the integrity of the tissues was not violated. So fibrin affects the loops of the intestines, the organs of the small pelvis, soldering them together.

After caesarean section adhesive process most often affects the intestines and the uterus itself. The danger lies in the fact that adhesions affecting the fallopian tubes and ovaries, in the future, can cause tubal obstruction and, as a result, infertility. The adhesions that form between the intestinal loops limit its mobility. The loops become, as it were, “soldered” together. This phenomenon can cause intestinal obstruction. Even if obstruction does not form, adhesions still disrupt the normal functioning of the intestine. The result is long-term, painful constipation.

Severe pain syndrome

Pain after caesarean section, as a rule, is much more intense than during natural childbirth. Pain in the area of ​​the incision and in the lower abdomen persists for several weeks after the operation. This is the time the body needs to recover. There may also be different adverse reactions for an anesthetic.
After local anesthesia, pain is present in the lumbar region ( at the injection site of the anesthetic). This pain can make it difficult for a woman to move for several days.

Postoperative scar

A postoperative scar on the front wall of the abdomen, although it does not pose a threat to a woman's health, is a serious cosmetic defect for many. Caring for him involves the release from lifting and carrying weights and proper hygiene in the postoperative period. At the same time, the scar on the uterus largely determines subsequent births. It is a risk for the development of complications in childbirth ( uterine rupture) and is often the cause of repeat caesarean section.

Complications associated with anesthesia

Despite the fact that local anesthesia has recently been performed for caesarean section, there are still risks of complications. The most frequent side effect after anesthesia is a severe headache. Much less often, nerves can be damaged during anesthesia.

The greatest danger is general anesthesia. It is known that more than 80 percent of all postoperative complications are associated with anesthesia. With this type of anesthesia, the risk of developing respiratory and cardiovascular complications is maximum. Most often, respiratory depression due to the action of an anesthetic is recorded. With prolonged operations, there is a risk of developing pneumonia associated with lung intubation.
With both general and local anesthesia, there is a risk of a drop in blood pressure.

How does a caesarean section affect the baby?

The consequences of a caesarean section are inevitable for both the mother and the child. The main effect that a caesarean section has on a child is associated with the effect of anesthesia on him and a sharp pressure drop.

The effect of anesthesia

The greatest danger to the newborn is general anesthesia. Some anesthetics depress the baby's central nervous system, causing them to initially appear calmer. The greatest danger is the development of encephalopathy ( brain damage), which, fortunately, is quite rare.
Substances for anesthesia affect not only the nervous system, but also the respiratory system. According to various studies, respiratory disorders in children born by caesarean section are very common. Despite the fact that the effect of the anesthetic on the fetus is very short ( from the moment of anesthesia to the extraction of the fetus takes 15-20 minutes), he manages to exert his inhibitory effect. This is confirmed by the fact that children removed from the womb by caesarean section do not react so intensely to birth. The reaction in this case is determined by the cry of the newborn, his breath or excitability ( grimace, movements). Often it is necessary to stimulate breathing or reflex excitability. It is believed that children born by caesarean section have Apgar scores ( newborn assessment scale), lower than those born naturally.

Influence on the emotional sphere

The effect of a caesarean section on a child is due to the fact that the child does not pass through the mother's birth canal. It is known that during natural childbirth, the fetus, before being born, gradually adapting, passes through the mother's birth canal. On average, the passage takes from 20 to 30 minutes. During this time, the baby gradually gets rid of amniotic fluid from the lungs and adapts to changes in the external environment. This makes his birth softer, unlike a caesarean section, where the baby is abruptly pulled out. There is an opinion that passing through the birth canal, the child experiences a kind of stress. As a result, he produces stress hormones - adrenaline and cortisol. This, some experts believe, subsequently regulates the child's resistance to stress and the ability to concentrate. The lowest concentration of these hormones, as well as thyroid hormones, is observed in children born under general anesthesia.

Effect on the gastrointestinal tract

Also, according to recent studies, children born by caesarean section are more likely than others to suffer from dysbacteriosis. This is due to the fact that at the time of the passage of the child through the birth canal, he acquires the mother's lactobacilli. These bacteria form the basis of the intestinal microflora. The gastrointestinal tract of a newborn is one of its most vulnerable places. The baby's intestines are practically sterile, as it lacks the necessary flora. It is also believed that caesarean section itself has an effect on the delay in the development of microflora. As a result of this, babies have disorders of the gastrointestinal tract, and because of its immaturity, it is most susceptible to infection.

Recovery of a woman rehabilitation) after caesarean section

Diet

After a caesarean section, a woman must follow a number of rules when eating food for a month. The diet of a patient who has undergone a caesarean section should help restore the body and increase its resistance to infections. The nutrition of the woman in labor should ensure the elimination of the protein deficiency that develops after the operation. A large amount of protein is found in meat broths, lean meats, and eggs.

The daily norms of the chemical composition and energy value of nutrition after cesarean section are:

• squirrels ( 60 percent animal origin) - 1.5 grams per 1 kilogram of weight;
• fats ( 30 percent plant origin ) - 80 - 90 grams;
• carbohydrates ( 30 percent easily digestible) - 200 - 250 grams;
• energy value - 2000 - 2000 kilocalories.

The rules for the use of products after cesarean section in the postpartum period (first 6 weeks) are:

• the first three days the consistency of the dishes should be liquid or mushy;
• the menu should include foods that are easily digestible;
• recommended heat treatment - boiling in water or steam;
• the daily norm of products must be divided into 5 - 6 servings;
• the temperature of the food consumed should not be too high or too low.

Patients after caesarean section should include in the diet foods rich in fiber, because it has a beneficial effect on the functioning of the gastrointestinal tract. Vegetables and fruits should be consumed steamed or boiled, because in fresh these foods can cause bloating. The first day after the caesarean section, the patient is advised to refuse to eat. A woman in labor should drink still mineral water with a small amount of lemon or other juice.
On the second day, the menu can include chicken or beef broth, boiled in third water. Such food is rich in protein, from which the body receives amino acids, with the help of which cells recover faster.

The stages of preparation and the rules for using the broth are:

• Place meat in water and bring to a boil. Then it is necessary to drain the broth, add pure cold water and drain again after boiling.
• Pour the third water over the meat, bring to a boil. Next, add vegetables and bring the broth to readiness.
• Divide the finished broth into portions of 100 milliliters.
• The recommended daily allowance is 200 to 300 milliliters of broth.

If the patient's well-being allows, the diet on the second day after cesarean section can be diversified fat-free cottage cheese, natural yogurt, mashed potatoes or low-fat boiled meat.
On the third day, steam cutlets, mashed vegetables, light soups, low-fat cottage cheese, baked apples can be added to the menu. It is necessary to use new products gradually, in small portions.

Drinking regimen after caesarean section
The diet of a nursing woman involves a reduction in the amount of fluid consumed. Immediately after the operation, doctors recommend that you stop drinking water and start drinking after 6 to 8 hours. The rate of liquid per day during the first week, starting from the second day after the operation, should not exceed 1 liter, not counting the broth. After day 7, the amount of water or drinks can be increased to 1.5 liters.

During the postpartum period, you can drink the following drinks:

• weakly brewed tea;
• rosehip decoction;
• dried fruits compote;
• fruit drink;
• apple juice diluted with water.

On the fourth day after the operation, you should gradually begin to introduce meals that are acceptable during breastfeeding.

Products that are allowed to be included in the menu when recovering from a caesarean section are:

• yogurt ( without fruit additives);
• cottage cheese of low fat content;
• kefir 1 percent fat;
• potato ( puree);
• beet;
• apples ( baked);
• bananas;
• eggs ( boiled or steamed omelettes);
• lean meat ( boiled);
• lean fish ( boiled);
• cereals ( except rice).

The following foods should be excluded from the diet during the recovery period:

• coffee;
• chocolate;
• spicy seasonings and spices;
• raw eggs;
• caviar ( red and black);
• citrus and Exotic fruits;
• fresh cabbage, radishes, raw onions and garlic, cucumbers, tomatoes;
• plums, cherries, pears, strawberries.

Do not eat fried, smoked and salty foods. It is also necessary to reduce the amount of sugar and sweets consumed.

How to relieve pain after caesarean section?

Pain after caesarean section disturbs patients during the first month after surgery. In some cases, pain may not disappear for more a long period sometimes for about a year. Measures that should be taken to reduce the feeling of discomfort depend on what caused it.

Factors that provoke pain after a caesarean section are:

• seam after surgery;
• bowel dysfunction;
• uterine contractions.

Reducing the pain caused by the stitch

To reduce the discomfort that causes postoperative suture, you should follow a number of rules for caring for him. The patient should get out of bed, turn from side to side and make other movements in such a way as not to put a load on the suture.

• During the first day, a special cool pillow can be applied to the seam area, which can be purchased at a pharmacy.
• It is worth reducing the frequency of touching the seam, as well as keeping it clean to prevent infection.
• Every day, the seam should be washed, and then dried dry with a clean towel.
• You should refrain from lifting weights and making sudden movements.
• So that the child does not put pressure on the seam during feeding, you should find a special position. A chair with low armrests for feeding, in a sitting position, pillows ( under the back) and roller ( between belly and bed) while feeding lying down.

The patient can relieve pain by learning how to move correctly. To turn from side to side while lying in bed, you need to fix your feet on the surface of the bed. Next, you should carefully raise your hips, turn them in the desired direction and lower them onto the bed. Following the hips, you can turn the torso. Special rules must also be observed when getting out of bed. Before taking a horizontal position, you should turn on your side and hang your legs on the floor. After that, the patient should raise the body and assume a sitting position. Then you need to move your legs for a while and get out of bed, trying to keep your back straight.

Another factor that makes the suture hurt is a cough that occurs due to the accumulation of mucus in the lungs after anesthesia. To get rid of mucus faster and at the same time reduce pain, a woman after a cesarean section is recommended to do deep breath, and then drawing in the stomach - a quick exhalation. The exercise should be repeated several times. First, a towel rolled up with a roller must be applied to the seam area.

How to reduce discomfort from poor bowel function?

Many patients after caesarean section suffer from constipation. To reduce pain, a woman in labor should exclude from the diet foods that contribute to the formation of gases in the intestines.

Foods that cause flatulence are:

• legumes ( beans, lentils, peas);
• cabbage ( white, Beijing, broccoli, colored);
• radish, turnip, radish;
• milk and dairy products;
• carbonated drinks.

The following exercise will help reduce the discomfort of bloating in the abdomen. The patient should sit in bed and make rocking movements back and forth. Breathing while swinging should be deep. A woman can also release gases by lying on the right or left side and massaging the surface of the abdomen. If there is no stool for a long time, you should ask the medical staff to give an enema.

How to reduce pain in the lower abdomen?

Discomfort in the uterine area can be reduced with non-narcotic pain relievers prescribed by a doctor. A special warm-up will help to alleviate the patient's condition, which can be carried out on the second day after the operation.

Exercises that will help to cope with pain in the lower abdomen are:

• Stroking the abdomen with the palm of your hand in a circular motion– iron in a clockwise direction, as well as up and down for 2 to 3 minutes.
• Massaging the chest- the right, left and upper surfaces of the chest should be stroked from the bottom up to the armpit.
• Stroking lumbar region - hands need to be brought behind the back and the back of the palms massage the lower back from top to bottom and to the sides.
• Rotational movements of the feet- pressing the heels to the bed, you need to alternately bend the feet away from you and towards you, describing the largest possible circle.
• Leg curl- alternately bend the left and right leg, sliding the heel on the bed.

A postpartum bandage that will support the spine will help reduce pain. It should be borne in mind that the bandage should be worn for no more than two weeks, since the muscles must independently cope with the load.

Why is there discharge after a caesarean section?

Discharge from the uterus that occurs during the recovery period after surgery is called lochia. This process is normal and is also typical for patients who have undergone a natural childbearing procedure. Through the genital tract, the remains of the placenta, dead particles of the uterine mucosa and blood from the wound, which is formed after the placenta has passed, are removed. The first 2 - 3 days of excretion have a bright red color, then darken, acquiring a brown tint. The amount and duration of the discharge period depends on the woman's body, the clinical picture of pregnancy, and the characteristics of the operation performed.

What does a suture look like after a caesarean section?

If a caesarean section is planned, the doctor makes a transverse incision along the crease above the pubis. Subsequently, such an incision becomes hardly noticeable, as it is located inside the natural fold and does not affect the abdominal cavity. When carrying out this type of caesarean section, the suture is applied by an intradermal cosmetic method.

In the presence of complications and the inability to perform a cross section, the doctor may decide on a corporal caesarean section. In this case, the incision is made along the anterior abdominal wall in a vertical direction from the navel to the pubic bone. After such an operation, there is a need for a strong connection of tissues, so the cosmetic suture is replaced with a nodal one. Such a seam looks more sloppy and may become more noticeable over time.
The appearance of the suture changes in the process of its healing, which can be conditionally divided into three stages.

The phases of scarring of the suture after caesarean section are:

• First stage ( 7 – 14 days) - the scar has a bright pink-red color, the edges of the seam are embossed with traces of threads.
• Second phase ( 3 – 4 weeks) - the seam begins to thicken, becomes less prominent, its color changes to red-violet.
• final step ( 1 – 12 months) - pain disappears, the seam is filled with connective tissue, as a result of which it becomes less noticeable. The color of the seam at the end of this period does not differ from the color of the surrounding skin.

Is it possible to breastfeed after a caesarean section?

Breastfeeding a child after a caesarean section is possible, but may be associated with a number of difficulties, the nature of which depends on the characteristics of the body of the woman in labor and the newborn. Also factors that complicate breastfeeding are complications during surgery.

The reasons that prevent the establishment of the process of breastfeeding are:

• Large blood loss during surgery- often after a caesarean section, the patient needs time to recover, as a result of which the first attachment to the breast is delayed, which subsequently causes difficulties with feeding.
• Medical preparations- in some cases, the doctor prescribes medicines to the woman that are incompatible with feeding.
• Stress associated with surgery – stressful condition can have a detrimental effect on milk production.
• Violation of the mechanism of adaptation in a child- at birth by caesarean section, the child does not pass the natural birth canal, which may adversely affect its sucking activity.
• Delayed milk production- with a caesarean section in the body of a woman in labor, the hormone prolactin, which is responsible for the production of colostrum, begins to be produced later than during natural childbirth. This fact can cause a delay in the arrival of milk by 3 to 7 days.
• Pain- the pain that accompanies recovery after surgery blocks the production of the hormone oxytocin, whose function is to release milk from the breast.

How to remove the stomach after a caesarean section?

During pregnancy, the skin subcutaneous tissue and the abdominal muscles are stretched, so the question of how to restore shape is relevant for many women in labor. Weight loss is facilitated by a balanced diet and breastfeeding. The complex will help to tighten the stomach and restore muscle elasticity. special exercises. The body of a woman who has undergone a cesarean section is weakened, therefore, such patients should start physical activity much later than ordinary women in labor. In order to prevent complications, you need to start with simple exercises gradually increasing their complexity and intensity.

Initial loads

For the first time after the operation, you should refrain from exercises that involve a load on the abdomen, as they can cause a divergence of the postoperative suture. Contribute to the restoration of the figure hiking in the fresh air and gymnastics, which should be started after consulting a doctor.

Exercises that can be done a few days after surgery are:

• It is necessary to take the initial position reclining or sitting on the couch. To increase comfort during exercise, a pillow placed under the back will help.
• Next, you need to proceed to flexion and extension of the feet. You need to perform exercises vigorously, without making jerky movements.
• The next exercise is the rotation of the feet to the right and left.
• Then you should begin to tension and relax the gluteal muscles.
• After a few minutes of rest, you need to start alternating flexion and extension of the legs.

Each exercise should be repeated 10 times. If discomfort and pain occur, gymnastics should be stopped.
If the patient's condition allows, starting from 3 weeks after caesarean section, you can start classes to strengthen the pelvis. Such exercises help to improve the tone of weakened muscles and at the same time do not put a load on the stitches.

The stages of performing gymnastics for the pelvic muscles are:

• It is necessary to strain and then relax the muscles of the anus, lingering for 1 - 2 seconds.
• Next, you need to tighten and relax the vaginal muscles.
• Repeat the alternation of tension and relaxation of the muscles of the anus and vagina several times, gradually increasing the duration.
• After a few workouts, you should try to perform the exercise separately for each muscle group, gradually increasing the strength of the tension.

Exercises for the abdominal muscles after a caesarean section

Exercises should be started after discomfort and pain in the suture area disappear ( not earlier than 8 weeks after surgery). Gymnastics should be given no more than 10 - 15 minutes a day, so as not to cause overwork.
For exercises on the press, you need to take a starting position, for which you should lie on your back, rest your feet on the floor and bend your knees. Place a small pillow under your head to relieve tension in your neck muscles.

Exercises that will help normalize the abdominal muscles after a cesarean section include:

• To perform the first exercise, you should spread your knees to the side, while clasping your stomach with your hands cross to cross. As you exhale, you need to raise your shoulders and head, and press your palms on your sides. After holding this position for a few seconds, you need to exhale and relax.
• Next, taking a starting position, you should take a deep breath, filling your stomach with air. As you exhale, you need to pull in your stomach, pressing your back to the floor.
• The next exercise should be started gradually. Place your palms on your stomach and raise your head while inhaling, without making sudden movements. On exhalation, take the starting position. The next day, the head should be raised a little higher. After a few more days, along with the head, you need to begin to raise your shoulders, and after a few weeks - to raise the entire body to a sitting position.
• The last exercise is to alternately bring the legs bent at the knees to the chest.

You should start gymnastics with 3 repetitions of each exercise, gradually increasing the number. 2 months after the caesarean section, focusing on the state of the body and the recommendations of the doctor, physical activity can be supplemented with sports such as swimming in the pool, cycling, yoga.

How to make a scar on the skin invisible?

You can reduce the scar on the skin after a cesarean section cosmetically using various medications. The results of this method are time-consuming and largely depend on the age and characteristics of the patient's body. More effective are methods that involve surgery.

Quick ways to reduce the visibility of the seam after a caesarean section include:

• plastic excision of the seam;
• laser resurfacing;
• grinding with aluminum oxide;
• chemical peeling;
• scar tattoo.

Suture excision from caesarean section

This method consists in repeating the incision at the suture site and removing coarse collagen and overgrown vessels. The operation is performed under local anesthesia and may be combined with the removal of excess skin to form a new contour of the abdomen. Of all the existing procedures to combat postoperative scars, this method is the fastest and most effective. The disadvantage of this solution is the high cost of the procedure.

Laser resurfacing

Laser suture removal involves 5 to 10 procedures, the exact number of which depends on how much time has passed since the cesarean section and how the scar looks. The scars on the patient's body are exposed laser radiation which removes damaged tissue. The process of laser resurfacing is painful, and after its completion, the woman is prescribed a course of drugs to eliminate inflammation at the site of the scar.

Aluminum oxide grinding ( microdermabrasion)

This method involves exposing the skin to small particles of aluminum oxide. With the help of special equipment, a stream of microparticles is directed to the surface of the scar at a certain angle. Thanks to this resurfacing, the surface and deep layers of the dermis are updated. For a tangible result, it is necessary to carry out from 7 to 8 procedures with a ten-day break between them. After completion of all sessions, the polished area should be treated with special creams that speed up the healing process.

Chemical peel

This procedure consists of two stages. First, the skin on the scar is processed fruit acids, which are selected depending on the nature of the seam and have an exfoliating effect. The next step is a deep cleansing of the skin using special chemicals. Under their influence, the skin on the scar becomes paler and smoother, as a result of which the seam is significantly reduced in size. Compared to grinding and plastic excision, peeling is less effective procedure, but more acceptable due to the affordable cost and the absence of painful sensations.

Scar tattoo

Applying a tattoo on the postoperative scar area provides an opportunity to hide even large scars and skin imperfections. The downside of this method is the high risk of infection and a wide range of complications that can cause the process of applying patterns to the skin.

Ointments to reduce the seam after caesarean section

Modern pharmacology offers special tools that help make the postoperative suture less noticeable. The components included in the ointments prevent further growth of scar tissue, increase collagen production and help reduce the size of the scar.

Drugs that are used to reduce the visibility of the suture after a caesarean section are:

• contractubex- slows down the growth of connective tissue;
• dermatix– improves appearance scar, smoothing and softening the skin;
• clearwin- brightens damaged skin by several tones;
• kelofibrase– evens out the surface of the scar;
• zeraderm ultra- promotes the growth of new cells;
• fermenkol- eliminates the feeling of constriction, reduces the scar in size;
• mederma- effective in the treatment of scars, the age of which does not exceed 1 year.

Recovery of menstruation after caesarean section

The restoration of the menstrual cycle in the patient does not depend on how the birth was carried out - naturally or by caesarean section. The timing of the appearance of menstruation is influenced by a number of factors related to the lifestyle and characteristics of the patient's body.

Circumstances on which the restoration of menstruation depends include:

• clinical picture of pregnancy;
• the patient's lifestyle, the quality of nutrition, the availability of timely rest;
• age and individual characteristics of the body of the woman in labor;
• the presence of lactation.

The effect of breastfeeding on the recovery of menstruation

During lactation, the hormone prolactin is synthesized in the body of a woman. This substance promotes the production of breast milk, but at the same time, it suppresses the activity of hormones in the follicles, as a result of which the eggs do not mature? and menstruation does not occur.

The timing of the appearance of menstruation are:

• With active breastfeeding- Menstruation can begin after a long period, which often exceeds 12 months.
• When feeding a mixed type- the menstrual cycle occurs on average 3 to 4 months after a caesarean section.
• With the introduction of complementary foods- very often, menstruation is restored within a fairly short time.
• In the absence of lactation- Menstruation can occur 5 to 8 weeks after the birth of the child. If menstruation does not occur within 2 to 3 months, the patient should consult a doctor.

Other factors affecting the restoration of the menstrual cycle

A delay in the onset of menstruation may be associated with complications that sometimes occur after a caesarean section. The presence of a suture on the uterus, combined with an infectious process, inhibits the recovery of the uterus and delays the onset of menstruation. The absence of menstruation may also be associated with individual features female body.

Patients who may have a missed period after a caesarean section include:

• women whose pregnancy or childbirth took place with complications;
• patients giving birth for the first time, whose age exceeds 30 years;
• women in labor whose health is weakened by chronic diseases ( especially the endocrine system).

For some women, the first menstruation may come on time, but the cycle is established for 4 to 6 months. If the regularity of menstruation has not stabilized within this period after the first postpartum period, the woman should consult a doctor. Also, a doctor should be contacted if menstrual function occurs with complications.

Problems in the restoration of menstruation after cesarean section and their causes are:

• Changed duration of menstruation- short ( 12 o'Clock in the noon) or too long periods ( exceeding 6 - 7 days) can occur due to diseases such as uterine fibroids ( benign neoplasm ) or endometriosis ( overgrowth of the endometrium).
• Non-standard volume of allocations- the number of discharges during menstruation, exceeding the norm ( 50 to 150 milliliters), may be the cause of a number of gynecological diseases.
• Smearing spotting of a prolonged nature at the beginning or end of menstruation- can be provoked by various inflammatory processes of the internal genital organs.

Breastfeeding causes a deficiency of vitamins and other nutrients that are necessary for normal functioning ovaries. Therefore, after a caesarean section, the patient is recommended to take micronutrient complexes and follow a balanced diet.

After the birth of a child, the load on the mother's nervous system increases. To ensure the timely formation of menstrual function, a woman should devote sufficient time good rest and avoid fatigue. Also in the postpartum period, it is necessary to correct the pathologies of the endocrine system, since the exacerbation of such diseases causes a delay in menstruation after a cesarean section.

How is the subsequent pregnancy after caesarean section?

A prerequisite for subsequent pregnancy is its careful planning. It should be planned no earlier than a year or two after the previous pregnancy. Some experts recommend a break of three years. At the same time, the timing of subsequent pregnancy is determined individually based on the presence or absence of complications.

During the first two months after the operation, a woman should exclude sexual intercourse. Then during the year she must take contraceptives. During this period, the woman should undergo periodic ultrasound examinations to assess the condition of the suture. The doctor evaluates the thickness and tissue of the suture. If the suture on the uterus consists of a large amount of connective tissue, then such a suture is called insolvent. Pregnancy with such a seam is dangerous for both the mother and the child. With contractions of the uterus, such a suture can disperse, which will lead to instant death of the fetus. The condition of the suture can be most accurately assessed not earlier than 10-12 months after the operation. A complete picture is given by such a study as hysteroscopy. It is carried out using an endoscope, which is inserted into the uterine cavity, while the doctor visually examines the seam. If the suture does not heal well due to poor uterine contractility, the doctor may recommend physiotherapy to improve its tone.

Only after the suture on the uterus has healed, the doctor can "give the go-ahead" for a second pregnancy. In this case, subsequent births can take place naturally. It is important that the pregnancy proceeds without difficulty. To do this, before planning a pregnancy, it is necessary to cure all chronic infections, raise immunity, and if there is anemia, then take treatment. During pregnancy, a woman should also periodically assess the condition of the suture, but only with the help of ultrasound.

Features of subsequent pregnancy

Pregnancy after caesarean section is characterized by increased control over the condition of the woman and constant monitoring of the viability of the suture.

After a caesarean section, re-pregnancy can be complicated. So, every third woman has threats of termination of pregnancy. Most frequent complication is placenta previa. This condition aggravates the course of subsequent births with periodic bleeding from the genital tract. Frequent bleeding can be the cause of preterm labor.

Another feature is the incorrect location of the fetus. It is noted that in women with a scar on the uterus, the transverse position of the fetus is more common.
The greatest danger during pregnancy is the failure of the scar, common symptom which is pain in the lower abdomen or back pain. Women very often do not attach importance to this symptom, assuming that the pain will pass.
25 percent of women experience fetal growth retardation, and children are often born with signs of immaturity.

Complications such as uterine rupture are less common. As a rule, they are noted when incisions were made not in the lower segment of the uterus, but in the area of ​​\u200b\u200bher body ( corporal caesarean section). In this case, uterine ruptures can reach 20 percent.

Pregnant women with a uterine scar should arrive at the hospital 2 to 3 weeks earlier than usual ( i.e. at 35-36 weeks). Immediately before childbirth, premature outflow of water is likely, and in the postpartum period - difficulties in the separation of the placenta.

After a caesarean section, the following pregnancy complications may occur:

• various anomalies of placental attachment ( low attachment or presentation);
• transverse position or breech presentation of the fetus;
• failure of the suture on the uterus;
• premature birth;
• rupture of the uterus.

Childbirth after caesarean section

The statement "once a caesarean - always a caesarean" is no longer relevant today. Natural childbirth after surgery in the absence of contraindications is possible. Naturally, if the first cesarean was carried out for indications not related to pregnancy ( for example, severe myopia in the mother), then subsequent births will be through a caesarean section. However, if the indications were related to the pregnancy itself ( for example, the transverse position of the fetus), then in their absence, natural childbirth is possible. At the same time, the doctor will be able to tell exactly how the birth will take place after 32-35 weeks of pregnancy. Today, every fourth woman after a caesarean section gives birth again naturally.