How is a caesarean section performed: indications, stages of the operation, video, recovery. Unplanned caesarean: when is the urgent need for surgery? Operation technique in the lower segment of the cross section

A caesarean section is an operation that is performed if there are sufficient indications for this and is a surgical resolution of childbirth. AT recent times this surgical intervention, in which the newborn appears through an incision in the anterior abdominal wall and uterine cavity, is extremely common and accounts for a quarter of total number childbirth. What are the grounds for performing a caesarean section, the course of the operation itself, its consequences and complications for the woman in labor and the child, and other issues should be considered more fully.

Indications for a caesarean section

Natural childbirth is considered a favorable form of childbirth. Sometimes, during pregnancy or directly during childbirth, a situation may arise that requires an immediate caesarean section.

Allocate absolute and relative indications for the production of caesarean section.

The absolute grounds for the operation include situations when a mortal threat is created to the woman in labor and the fetus. These include:

  • placenta previa;
  • absolutely narrow pelvis of the woman in labor;
  • malposition;
  • mechanical obstacles in the birth canal of the woman in labor;
  • severe gestosis;
  • concomitant severe diseases, etc.

But most operations of this kind occur according to relative indications, when there is a risk of serious complications for the mother and child during natural delivery. The most common relative indications for caesarean section are:

  • large size of the fetus;
  • relatively narrow pelvis of the woman in labor;
  • the age of the primipara is over 30 years;
  • prolonged infertility;
  • multiple pregnancy;
  • ECO, etc.

The decision to conduct a surgical delivery, having assessed all the risks for the mother and child, is made by the doctor, with the written consent of the woman in labor.

Preparing for a caesarean section

The question of the appointment of a planned caesarean section is decided by the doctor at about 34-35 weeks of pregnancy. 10 days before the expected date of the operation, the woman in labor is placed in a hospital for a preoperative examination. About the state of health of the pregnant woman and the fetus is going to full information. Other research is being done:

  • dopplerometry;
  • fetal cardiotocography;

If necessary, a pregnant woman undergoes a course during the specified period drug treatment. Immediately before the operation, a council of doctors gathers, to which the future woman in labor is invited to give written consent for surgery and anesthesia.

A few hours before the operation, the pregnant woman is given a cleansing enema, treatment and shaving of the perineum and abdomen. Immediately before the start of the operation, a catheter is inserted into the bladder in order to avoid injury to the filled specified organ during the surgical intervention.

Preparation for a caesarean section is associated with certain limitations, which make it possible to avoid severe postoperative consequences in the future.

The progress of the caesarean section

A typical cesarean section operation takes approximately 30-40 minutes. The child is born in 5-10 minutes. The entire course of the operation can be divided into several main stages:

  1. The use of anesthesia.
  2. Surgical tissue incision abdominal wall.
  3. Section of the uterine cavity.
  4. Extraction of the child.
  5. Examination of the uterus.
  6. Suturing of the uterine cavity and abdominal wall.

First of all, the woman in labor is anesthetized. Currently, regional or general anesthesia can be used for this operation.

Doctors give the greatest preference to regional anesthesia. With this anesthesia, the woman in labor remains conscious during the operation. Negative impact anesthesia for the baby with regional anesthesia of the mother is minimal, because the drug does not enter the blood.

In severe cases or emergency operation applied general anesthesia which favorably differs from other types of anesthesia in its instant action. Anesthesia is administered to the woman in labor intravenously, a tube is inserted into the trachea for artificial ventilation lungs.

After anesthesia, the doctor makes an incision in the tissues of the abdominal wall: either above the pubis in the transverse direction, or from the umbilical line down the midline of the lower abdomen. Then a transverse incision is made in the uterine cavity and the amniotic sac is opened. The doctor removes the child from the uterine cavity of the woman in labor by the head or pelvic end with his hands. After disconnecting the umbilical cord, the doctor transfers the newborn to the pediatrician for examination.

Then the placenta is removed from the uterine cavity of the woman in labor. If necessary, a manual examination is carried out. internal cavity organ for the presence of various neoplasms, damaged walls, etc.

After that, layer-by-layer suturing of the incisions on the uterine cavity and abdominal wall is performed. It should be noted that special self-absorbable threads are used for this. Recently, a cosmetic suture on the abdomen is often used, which is practically invisible.

After surgery, cold is placed on the woman's lower abdomen to quickly stop bleeding.

Possible Complications

Caesarean section is serious surgical intervention, during which an exception cannot be guaranteed severe complications for a woman in labor or for a fetus:

  • wound Bladder, intestines;
  • fetal injury;
  • uterine bleeding;
  • purulent-septic inflammatory reactions;
  • wound infection;
  • parameters, etc.

In a newborn born during a caesarean section, the natural process of launching adaptive mechanisms is disrupted. It is established that such a child has a body temperature below the average value, respiratory system imperfect, reduced physiological reflexes and muscle tone, the immune system often fails, the umbilical wound heals for a long time.

Achievements of modern medical science in the field of surgical delivery help the newborn to adapt to modern world. But such children demand heightened attention from doctors and mothers. All indicators physiological state the child, by the time he is discharged from the hospital, return to normal. And after a while, such children do not differ from children born naturally.

Recovery period after caesarean section

Recovery after a caesarean section is characterized by a particularly long and difficult period than after a natural birth.

Immediately after the operation, the woman in labor is placed in the intensive care unit. With good performance, she is transferred to the postpartum ward the next day. In the absence of complications, the newborn is transferred to the ward to the mother.

To avoid postoperative complications, a woman is recommended to get out of bed early, is carried out breathing exercises, massage. AT early period woman in labor is carried out drug therapy, leading to the active functioning of the uterus, pain relief. If necessary, antibiotics are prescribed, intravenously administered saline. The seam is processed every day. Healing internal seams and the functioning of the uterus are well determined by ultrasound.

Nutrition during the recovery of a woman plays an important role. To resume bowel function at first, it is necessary to follow a certain diet, which is prescribed by a doctor. With the normalization of the stool, you can switch to normal nutrition, observing some restrictions when breastfeeding the baby.

The discharge of the mother with the child, in the absence of complications, takes place on the 7-8th day under the supervision of a local doctor. Full recovery female sexual function after surgical delivery happens in 2-3 years.

Conclusion on the topic

The technique of performing a caesarean section at the present level has reached significant heights.

The operation is called a caesarean section., with which surgically the pregnant uterus is opened and the fetus with all its embryonic formations is removed from it. This operation has been known since ancient times. In the Roman Empire (late 7th century BC), it was forbidden to bury pregnant women without first extracting the child by caesarean section.

The first historically reliable fact of a caesarean section on a living woman was performed on April 21, 1610 by the surgeon Trautman from Wittenburg. In Russia, the first caesarean section with a favorable outcome for the mother and fetus was performed by G.F. Erasmus in 1756.

In 1780, Daniil Samoylovich defended his first dissertation on caesarean section.

The introduction of aseptic and antiseptic rules did not improve the consequences of the operation for the reason that mortality was due to bleeding or infectious complications associated with the fact that C-section ended without suturing the wound of the uterus.

In 1876, G.E. Rein and, independently of him, E. Porro, proposed a method for extracting a child with subsequent amputation of the uterus.

Since 1881, after F. Kehrer sewed up the uterine incision with a three-story suture, new stage formation of the caesarean section. It began to be performed not only according to absolute, but also according to relative indications. The search for a rational technique of the operation began, which led to the method of intraperitoneal retrovesical caesarean section, which is the main one at present.

Types of caesarean section

Distinguish between abdominal caesarean section (sectio caesarea abdominalis) and vaginal caesarean section (sectio caesarea vaginalis). Last in modern conditions almost never done. There is also a small caesarean section, which is performed at a gestational age of up to 28 weeks.

Abdominal caesarean section can be performed in two ways:

intraperitoneal and extraperitoneal.
Intra-abdominal caesarean section according to the type of incision on the uterus is divided into:

1. Cesarean section in the lower segment:
a) cross section;
b) longitudinal section (istmicocorporal caesarean section).

2. Classical caesarean section (corporal) with an incision in the body of the uterus.

3. Cesarean section followed by amputation of the uterus (Reynaud-Porro operation).

Indications for caesarean section

Indications for caesarean section are divided into absolute, relative, combined and those that are rare. Absolute readings those complications of pregnancy and childbirth are considered, in which the use of other methods of delivery poses a threat to the life of a woman. Cesarean section under such conditions is carried out without taking into account all necessary conditions and contraindications.

In a clinical situation where the possibility of childbirth through natural birth canal, but it is associated with a high risk of perinatal mortality, they speak of relative indications for surgery.

Merged readings combine a collection of several pathological conditions, each of which individually is not a reason for surgical intervention. Such indications, which are very rare, include a caesarean section on a dying woman. In addition, there are indications for caesarean section with documents of the mother and fetus.

I. Indications from the mother:

- Anatomically narrow pelvis III and IV degree of sonority (p. vera<7см) и формы узкого таза, редко встречаются (косозмищенний, поперечнозвужений, воронкообразный, спондилолистичний, остеомалятичний, сужен екзостазамы и костными опухолями и др..)
- Clinically narrow pelvis;
- Central placenta previa;
- Partial placenta previa with severe bleeding and lack of conditions for urgent delivery per vias naturalis;
- Premature detachment of a normally located placenta and the absence of conditions for urgent delivery per vias naturalis;
- Rupture of the uterus, which is fraught or has begun;
- Two or more scars on the uterus;
- Failure of the scar on the uterus;
- Scar on the uterus after a corporal caesarean section;
- Cicatricial changes in the cervix and vagina;
- Anomalies of labor activity that are not amenable to medical correction
- Severe varicose veins of the cervix, vagina and vulva;
- Malformations of the uterus and vagina;
- Condition after rupture of the perineum III degree and plastic surgery on the perineum;
- Conditions after surgical treatment of genitourinary and intestinal fistulas;
- Tumors of the pelvic organs that interfere with the birth of a child;
- Cervical cancer;
- Lack of effect from the treatment of severe forms of preeclampsia and the impossibility of urgent delivery;
- Traumatic injuries of the pelvis and spine;
– Extragenital pathology if there is a record corresponding to the specialist about the need to exclude the second stage of labor in accordance with the guidelines;

II. Fetal indications:

— Fetal hypoxia is confirmed by objective research methods in the absence of conditions for
urgent delivery per vias naturalis;
- Breech presentation of the fetus with a body weight of more than 3700 g in combination with other obstetric pathology and a high degree of perinatal risk;
- Prolapse of pulsating loops of the umbilical cord
- Incorrect position of the fetus after the outflow of amniotic fluid;
- High straight standing swept seam;
– Extensor insertion of the fetal head (frontal, anterior facial)
– Treated infertility with a high risk of perinatal pathology;
– Fertilization “in vitro”;
- The state of agony or clinical death of the mother with a live fetus;
- Multiple pregnancy with breech presentation and fetus.

Contraindications for delivery by caesarean section:

- Extragenital and genital infections;
- Duration of labor more than 12 hours;
- The duration of the anhydrous period is more than 6 hours;
– Vaginal examinations (more than 3);
- Intrauterine fetal death.

Conditions for the operation:

- Live fruit;
- Absence of infection;
- Consent of the mother to the operation.

Preparation for the operation depends on whether it is carried out in a planned manner before the onset of labor, or during childbirth. It should be noted that during childbirth, the lower segment of the uterus is well expressed, which facilitates the operation.

If the operation is carried out in a planned manner, then you should first prepare everything necessary for a blood transfusion to a woman and for resuscitation of a child that can be born in. On the eve of the operation, they give a light lunch (liquid soup, broth with white bread, porridge), in the evening sweet tea. A cleansing enema is done in the evening and in the morning on the day of the operation (2 hours before the operation). Amniotomy is performed 1.5-2 hours before surgery. On the eve of the operation, sleeping pills are given at night (luminal, phenobarbital (0.65), pipolfen or diphenhydramine 0.03-0.05 g each).

In the case of an emergency caesarean section, before the operation with a full stomach, it is emptied through a tube and an enema is given (in the absence of contraindications: bleeding, eclampsia, rupture of the uterine body, etc.). stomach contents into the respiratory tract (Mendelssohn's syndrome). Urine is removed by a catheter on the operating table.

An expedient method of anesthesia is endotrachial anesthesia with nitrous oxide in combination with neuroleptic and analgesic agents.

In modern obstetrics, a caesarean section is often used with a transverse incision in the lower segment of the uterus, since this method gives the least number of complications. When performing a caesarean section using this method, there is less blood loss, it is easier to insert the edges of the wound and sew them together. But this is not always justified, especially in the presence of a large fetus, when it is difficult to remove it and it becomes the transition of the edges of the incision to the ribs of the uterus and injury to the uterine arteries.

Operation technique in the lower segment of the cross section.

The incision of the anterior abdominal wall can be performed by lower median or upper median laparotomy or by Pfannenstiel. The first two autopsies are recommended in urgent cases. When carrying out a planned caesarean section, Pfannenstiel access is possible.

The pregnant uterus is taken out into the surgical wound. Several sterile napkins are introduced into the abdominal cavity, the outer end of which is attached with outer linen clips. The uterovesical fold is dissected 2 cm above the bottom of the bladder and bluntly separated up and down. On the front wall of the uterus with a scalpel, a longitudinal incision is made 1-2 cm long, and then stupidly or with the help of scissors they continue it up to 12 cm. The amniotic membranes are torn through the wound, and the fetus is removed with a hand held over the lower pole of the head. The umbilical cord is cut between two clamps. The child is handed over to the midwife. If the placenta has not separated on its own, manual separation and removal of the placenta is performed. After that, a control audit of the uterine cavity is carried out with a curette and sutures are applied, starting from the edges of the wound in layers:

1) muscular-muscular sutures in the amount of 10-12 at a distance of 0.5-0.6 cm from each other;
2) muscular-serous with immersion of the seams of the first row in them;
3) catgut transverse serous-serous suture connecting both edges of the peritoneum.

All instruments, napkins are taken from the abdominal cavity, after which the wall is sutured in layers
belly.

The main stages of the operation:
1. Opening of the anterior abdominal wall and peritoneum.
2. Opening the lower segment of the uterus 2 cm below the vesicouterine fold.
3. Removal of the fetus from the uterine cavity.
4. Removal of litter by hand and revision of the uterine cavity with a curette.
5. Suturing the uterus.
6. Peritonization due to the vesicouterine fold.
7. Revision of the abdominal cavity.
8. Stitching of the anterior abdominal wall.

Technique of classical (corporal) caesarean section.

In case of preterm pregnancy, in order to carefully remove the premature fetus, an isthmic-corporal cesarean section is recommended, in which, after transverse dissection, vidseparation and retraction with the help of mirrors of the vesicouterine fold, the uterus expands in the lower segment with a longitudinal incision, which then continues up to 10-12 cm. Further actions of the surgeon and the method of suturing the wound of the uterus are similar to the previously given operation.

The corporal caesarean section is less frequently used in modern obstetrics. It is performed in the absence of access to the lower segment, or when the lower segment is not yet formed, with severe varicose veins in the lower segment, with presentation, low attachment or complete detachment of a normally located placenta, as well as in the presence of a scar on the uterus after earlier performed corporal caesarean section.

The anterior abdominal wall is dissected along the white line of the abdomen in layers. The incision starts above the pubis and leads to the navel. The front surface of the uterus is fenced off from the abdominal cavity with napkins so that amniotic fluid does not get into it. On the front wall of the uterus, a longitudinal incision about 12 cm long is made and the fetus is removed through it by the leg or head, which are grasped by hand.

The umbilical cord is cut between two clamps. The child is handed over to the midwife. After that, the litter is removed, the uterine cavity is checked with a hand or a curette, the uterine wall is sutured in layers (muscular-muscular, serous-muscular and serous-serous sutures). All instruments and napkins are removed and the abdominal wall is sutured in layers.

With the outflow of amniotic fluid (more than 10-12 hours), after numerous vaginal examinations and with the threat of infection or its manifestations, it is advisable to perform an extraperitoneal cesarean section according to the Morozov method or a cesarean section with a temporary restriction of the abdominal cavity according to Smith.

Smith's technique.

The opening of the anterior abdominal wall is carried out according to Pfannenstiel (transverse incision) or a lower median laparotomy is performed. The peritoneum extends 2 cm above the bottom of the bladder. The vesicouterine fold is dissected 1-2 cm above the bladder, its leaves are separated down and up, which was fired the lower segment of the uterus (at a height of 5-6 cm). The edges of the vesicouterine fold are sutured to the parietal peritoneum from above and below, and the bladder, together with the fixed peritoneal fold, is pulled down. A semilunar incision is made to open the uterine cavity. The operation is then performed like a normal caesarean section.
Technique of posterior caesarean section.

Laparotomy according to the Pfannstiel method with a 14-15 cm incision. Next, the rectus abdominis muscles are stratified, and the pyramidal muscles are dissected with scissors. Muscles (especially led) push the side apart and separate from the peritoneal tissue, expose the triangle: outside - the right side of the uterus, from the inside - the lateral vesicular fold, from above - the fold of the parietal peritoneum. Next, the fiber is peeled off in the region of the triangle, the bladder is separated and moved to the right until the lower segment of the uterus is exposed. In the lower segment, a transverse incision 3-4 cm long is made, bluntly expanding to the size of the head. The fetus is removed by the head or by the legs in breech presentation. The litter is isolated, the integrity of the bladder and ureters is checked, the walls of the uterus are sutured, the wound of the anterior abdominal wall is sutured in layers.

Reyno-Porro surgery is a caesarean section with supravaginal amputation of the uterus. In 1876, G.E. Rein experimentally substantiated, and E. Porro performed a caesarean section in combination with the removal of the uterus (the operation had to prevent the development of a postpartum infectious disease). At present, this operation is performed very rarely.

The indications for its implementation are:

- Infection of the uterine cavity;
- Complete atresia of the genital apparatus (the impossibility of draining lochia)
- Cases of uterine cancer;
- Atonic bleeding that cannot be stopped by conventional methods;
- True increment of the placenta;
- Uterine fibroids.

Management of the postoperative period:

At the end of the operation, immediately apply cold and weight on the lower abdomen for 2 hours;

In order to prevent hypotonic bleeding in the early postoperative period, intravenous administration of 1 ml (5 units) of oxytocin or 0.02% - 1 ml of methylergometrine per 400 ml of 5% glucose solution is indicated for 30-40 minutes;

in the postoperative period, the function of the bladder and intestines is carefully monitored (catheterization every 6 hours, normalization of potassium levels, prozerin)

in order to prevent thromboembolic complications, bandaging of the lower extremities and the use of anticoagulants according to indications are indicated;

the patient is allowed to rise at the end of the first day, to walk on the second day; breastfeeding in the absence of contraindications after a few hours; discharge from the maternity ward is carried out on the 11-12th day after the operation;

after discharge from the hospital, all women with a scar on the uterus should be registered in the dispensary at the antenatal clinic;

during the first year after the operation, contraception is mandatory: with an uncomplicated course of the operation and the postoperative period, and under conditions of a normal menstrual cycle, the use of intrauterine contraceptives is indicated, in other cases, preference should be given to synthetic progestins;

the time of subsequent pregnancy is decided taking into account the assessment of the postoperative uterine scar, but not earlier than 2 years from the date of surgery;

Ultrasound in the normal course of a subsequent pregnancy must be carried out at least 3 times (when registering, in the period of 24-28 weeks of pregnancy and in the period of 34-37 weeks);

planned hospitalization to prepare for delivery is indicated at 36-37 weeks; delivery of women with an operated uterus should be performed at 38-39 weeks of pregnancy;

According to the World Health Organization, 13% of children in Russia are born by caesarean section, and this figure is growing every year. Now, childbirth with surgical intervention is carried out not only for medical reasons - some women themselves choose this method of delivery. What happens to the body during a caesarean section? Will it hurt? What are the indications for surgery? How to prepare for a caesarean section? What is the advantage of this method of delivery over natural childbirth? What are the disadvantages of a caesarean section? How long does the rehabilitation after such childbirth take?

In what cases is an operation required?

Cesarean section is carried out as planned or urgently. A planned caesarean section is prescribed according to the indications or at the request of the pregnant woman. However, without medical indications, perinatal centers and maternity hospitals refuse to perform cesarean deliveries, which is why many Russian women leave to have surgery in Belarus.

The decision to conduct an urgent CS is made already during childbirth, if the woman cannot give birth on her own or complications arise that require surgical intervention (fetal hypoxia, placental abruption). Preparation for a caesarean section, if it is an emergency, is not carried out.

The grounds for the operation are absolute and relative. Absolute experts include:

  • Narrow pelvis of the woman in labor. If the pelvic bones are not wide enough, the baby's head will not be able to pass through the birth canal.
  • Pathologies in the structure of the pelvic bones.
  • Tumor of the ovaries.
  • Myoma of the uterus.
  • Acute gestosis.
  • Weak labor activity.
  • Early detachment of the placenta.
  • Scars and stitches on the uterus. During childbirth, wounds that have not yet healed may disperse, which will lead to rupture of the tissues of the muscular organ.

In the presence of relative indications, a woman in labor has the opportunity to give birth on her own, however, natural childbirth can harm her health. In this case, doctors need to foresee all the risks before prescribing a planned caesarean. Relative indications for caesarean section are as follows:

  • Vision problems in pregnant women. When a woman pushes, the load on the eyes increases. For the same reason, it is not recommended to give birth on your own if the woman in labor underwent eye surgery less than a year before the date of birth.
  • Diseases of the kidneys.
  • Dysfunctions of the nervous system.
  • Oncology.
  • Diseases of the cardiovascular system.
  • Sexually transmitted infections in the mother.
  • Repeated births, provided that the first ones were with complications.

Are there any contraindications?

There are no contraindications under which a caesarean section cannot be performed under any circumstances. If a woman's life is in danger, a caesarean section is prescribed anyway. All contraindications are mainly associated with the risk of the onset of a purulent-septic process after childbirth. A caesarean section may be refused if the patient has had inflammatory diseases of the pelvic organs and the lower genital organs and there is a high probability of infection of the fetus.

Factors that may be the cause of the development of complications associated with the inflammatory process include:

  • childbirth lasting more than a day;
  • acute form of chronic diseases - SARS, influenza, pyelonephritis, etc.;
  • a long period from the outflow of amniotic fluid to the birth of a child (more than 12 hours);
  • more than 5 vaginal examinations per childbirth;
  • delivery before the 33rd week of pregnancy;
  • death of the fetus inside the womb.

Technique

During childbirth with surgery, the surgeon cuts the anterior abdominal wall above the pubis, then the wall of the uterus. Where and how the incision is made depends on the qualifications of the doctor and the type of operation. There are three techniques: classical, isthmicocorporal and Pfannenstiel.

Technique of corporal (classic) caesarean section

Corporal caesarean section is prescribed only in the presence of the following indications:

  • adhesive disease;
  • varicose veins;
  • removal of the uterus after childbirth;
  • thinned or modified scars on the uterus;
  • prematurity of the fetus (up to 33 weeks);
  • Siamese twins;
  • there is a threat to the life of a woman if it is possible to save the fetus;
  • the location of the fetus at an angle of 90 degrees relative to the vertical axis of the body.

According to the classical method, access to the child is obtained using a lower median laparotomy. An incision is made along the uterus, exactly in the middle. The uterine cavity is cut very quickly - if cut slowly, the woman in labor can lose a lot of blood. The fetal bladder is opened with a scalpel or manually, then the fetus is removed from it and the umbilical cord is clamped. To speed up the process, a woman is given oxytocin intravenously or intramuscularly. To prevent purulent-inflammatory processes, antibiotics are injected.

Bottom caesarean section is a kind of corporal. With this type of caesarean section, access to the fetus is provided through the bottom of the uterus.

Sutures are applied, retreating from the edge of the incision 1 cm. Each layer of the uterus is sutured separately. Immediately after suturing, the abdominal organs are re-examined and the abdomen is sutured.

A variety of KKS - isthmicocorporal section

Isthmicocorporal caesarean section differs from the classical one in that the obstetrician cuts the fold of the peritoneum and pushes the bladder down. After isthmicocorporal cesarean, a 12 cm long scar remains on the skin just above the bladder. Otherwise, the procedure is completely similar to corporal cesarean.

Operation Pfannenstiel

According to the Pfannenstiel method, the abdominal wall is cut along the suprapubic line 3 cm above the pubic symphysis (connection of the pelvic bones above the entrance to the vagina). This method is used more often than the classical method, since after it there are fewer complications and a shorter recovery period. The seam with this approach is less noticeable than with the classic one.

Preparing a woman in labor at the hospital

Before a caesarean section, if it was planned, the woman undergoes a complete examination in the maternity hospital. Women in labor are examined by a therapist and an otolaryngologist. Pregnant women also require an electrocardiogram and ultrasound. Diseases that have become indications for CS should, if possible, be cured. This includes conditions associated with indications, such as anemia. Iron deficiency during pregnancy is often accompanied by a lack of protein, so anemia is treated with drugs containing protein compounds. Be sure to check blood clotting.

On the eve of the day of birth, the anesthesiologist examines the pregnant woman and selects the safest method of pain relief for her. Due to advance preparation, the risks of elective CS are much lower than those of emergency CS.

Types of anesthesia

The considered method of childbirth involves surgical intervention, so delivery cannot take place without anesthesia. The types of anesthesia used for cesarean section differ in the mechanism of action and injection site - the analgesic can be injected into a vein (general anesthesia) or into the spinal cord (epidural and spinal anesthesia).

Epidural anesthesia

Before a cesarean, a catheter is placed in the lumbar spine, where the spinal nerves are located. As a result, pain in the pelvic area is dulled, although the woman in labor remains conscious, which means she can follow the progress of the operation. This method of pain relief is suitable for women with bronchial asthma and heart problems. Epidural anesthesia is contraindicated in violation of blood clotting, allergies to anesthetic and curvature of the spine.

spinal anesthesia

Spinal anesthesia is a type of epidural anesthesia in which the drug is injected into the spinal membrane. A needle, thinner than for epidural anesthesia, is inserted between the 2nd and 3rd or 3rd and 4th vertebrae so as not to damage the bone marrow. Spinal anesthesia requires less anesthetic, moreover, the likelihood of complications is low due to the precise insertion of the needle, and the effect occurs quickly. However, anesthesia does not last long - no more than two hours from the moment of administration.

General anesthesia

General anesthesia for caesarean section is now rarely used due to possible consequences in the form of CNS pathologies in the newborn and the risk of hypoxia. An anesthetic is administered intravenously to a woman, after which she falls asleep, an oxygen tube is inserted into her trachea. General anesthesia is indicated for obesity, fetal presentation, emergency CS, or if the mother has had spinal surgery.

Sequence

The operation is carried out in stages. The procedure is as follows:

  1. The patient is cut the wall of the peritoneum. This procedure is called a laparotomy. Different types of caesarean section suggest different approaches to laparotomy. With a lower median laparotomy, the incision is made 4 cm below the navel along the white line of the abdomen and ends slightly above the pubis. The Pfannenstiel incision is made along the suprapubic skin fold, its length is about 15 cm. How is laparotomy done according to the Joel-Kohen method? First, a superficial transverse incision is made 2.5-3 cm below the highest point of the pelvic bones. Then the incision is deepened to the subcutaneous fat, the white line of the abdomen is dissected and the abdominal muscles are bred to the sides. The latter method is faster, blood loss is less than with Pfannenstiel laparotomy, but the incision scar looks less aesthetically pleasing.
  2. The woman's uterus is cut open to allow access to the fetus. According to the classical technique, an incision is made along the midline of the anterior wall of the uterus, from one uterine angle to another, or at the bottom of the uterus (bottom CS). Sometimes the bottom of the uterus is cut - the place where the body of the reproductive organ passes into the cervix.
  3. The fruit is taken out. If the child lies head up, he is pulled out by the leg or by the inguinal fold; if across - for the lower leg. Then the umbilical cord is clamped, and the placenta is removed manually.
  4. Surgeons stitch up the uterus. One (muscular-muscular) or two (muscular-muscular and muco-muscular) rows of sutures are applied to the incision.
  5. Finally, the abdominal wall is sutured in two stages. The aponeurosis is sutured with a continuous suture. The skin is sutured with a cosmetic suture or metal plates.

Below is a video of the operation.

Recovery period

The first 24 hours after the CS, the woman lies in the intensive care unit under droppers. On the second day, the woman in labor is transferred to the ward. From that time on, she is allowed to get up, move around, cook and eat food on her own. On the 3rd day, a woman can sit down.

During the day after the operation, the woman in labor can drink only water. From the second day, foods that do not cause constipation can be introduced into the diet. You can ask your doctor for a list of such products.

The menstrual cycle in women recovers longer. If the mother does not breastfeed the baby, menstruation will return after about 3 months. Otherwise, it may take about six months to restore the cycle. The first 1.5-2 months, lochia can be released - a mixture of placental remains, ichor, parts of the mucous membrane and blood.

The seam must be treated with antiseptics and the bandage changed regularly. You need to wash so as not to wet the place of the scar on the skin. It is better to prepare for this in advance and practice at home. It is impossible to go to the pool and even more so to swim in the reservoirs - you can bring the infection. While the seam is tightened (it takes 3-4 weeks), the stomach may hurt.

Around the world, there is a clear trend towards gentle delivery, which allows you to save the health of both mother and child. A tool to help achieve this is the caesarean section (CS). A significant achievement has been the widespread use of modern methods of anesthesia.

The main disadvantage of this intervention is the increase in the frequency of postpartum infectious complications by 5-20 times. However, adequate antibiotic therapy significantly reduces the likelihood of their occurrence. However, there is still debate about when a caesarean section is performed and when physiological delivery is acceptable.

When is operative delivery indicated?

A caesarean section is a major surgical procedure that increases the risk of complications compared to normal natural childbirth. It is carried out only under strict indications. At the request of the patient, CS can be performed in a private clinic, but not all obstetrician-gynecologists will undertake such an operation without the need.

The operation is performed in the following situations:

1. Complete placenta previa - a condition in which the placenta is located in the lower part of the uterus and closes the internal pharynx, preventing the baby from being born. Incomplete presentation is an indication for surgery when bleeding occurs. The placenta is abundantly supplied with blood vessels, and even a slight damage to it can cause blood loss, lack of oxygen and fetal death.

2. Occurred ahead of time from the uterine wall - a condition that threatens the life of a woman and a child. The placenta detached from the uterus is a source of blood loss for the mother. The fetus ceases to receive oxygen and may die.

3. Previous surgical interventions on the uterus, namely:

  • at least two caesarean sections;
  • a combination of one CS operation and at least one of the relative indications;
  • removal of intermuscular or on a solid basis;
  • correction of the defect in the structure of the uterus.

4. Transverse and oblique positions of the child in the uterine cavity, breech presentation (“booty down”) in combination with the expected weight of the fetus over 3.6 kg or with any relative indication for operative delivery: a situation where the child is located at the internal os with a non-parietal region , and forehead (frontal) or face (facial presentation), and other features of the location that contribute to birth trauma in a child.

Pregnancy can occur even during the first weeks of the postpartum period. The calendar method of contraception in conditions of an irregular cycle is not applicable. The most commonly used condoms are mini-pills (progestin contraceptives that do not affect the baby while breastfeeding) or conventional (in the absence of lactation). Use must be excluded.

One of the most popular methods is . The installation of a spiral after a cesarean section can be performed in the first two days after it, but this increases the risk of infection, and is also quite painful. Most often, the spiral is installed after about a month and a half, immediately after the onset of menstruation or on any day convenient for a woman.

If a woman is over 35 years old and she has at least two children, if she wishes, the surgeon can perform surgical sterilization during the operation, in other words, tubal ligation. This is an irreversible method, after which conception almost never occurs.

Subsequent pregnancy

Natural childbirth after caesarean section is allowed if the formed connective tissue on the uterus is wealthy, that is, strong, even, able to withstand muscle tension during childbirth. This issue should be discussed with the supervising physician during the next pregnancy.

The likelihood of subsequent births in a normal way increases in the following cases:

  • a woman has given birth to at least one child through natural means;
  • if CS was performed due to malposition of the fetus.

On the other hand, if the patient is over 35 years old at the time of the next birth, she is overweight, comorbidities, mismatched fetal and pelvic sizes, it is likely that she will undergo surgery again.

How many times can a caesarean section be done?

The number of such interventions is theoretically unlimited, however, to maintain health, it is recommended to do them no more than twice.

Usually, the tactics for re-pregnancy are as follows: a woman is regularly observed by an obstetrician-gynecologist, and at the end of the gestation period, a choice is made - surgery or natural childbirth. In normal childbirth, doctors are ready to perform an emergency operation at any time.

Pregnancy after caesarean section is best planned with an interval of three years or more. In this case, the risk of insolvency of the suture on the uterus decreases, pregnancy and childbirth proceed without complications.

How soon can I give birth after surgery?

It depends on the consistency of the scar, the age of the woman, concomitant diseases. Abortions after CS adversely affect reproductive health. Therefore, if a woman nevertheless became pregnant almost immediately after a CS, then with a normal course of pregnancy and constant medical supervision, she can bear a child, but delivery will most likely be operative.

The main danger of early pregnancy after CS is suture failure. It is manifested by increasing intense pain in the abdomen, the appearance of bloody discharge from the vagina, then signs of internal bleeding may appear: dizziness, pallor, drop in blood pressure, loss of consciousness. In this case, you must urgently call an ambulance.

What is important to know about the second caesarean section?

A planned operation is usually performed in the period of 37-39 weeks. The incision is made along the old scar, which somewhat lengthens the operation time and requires stronger anesthesia. Recovery from CS can also be slower because scar tissue and adhesions in the abdomen prevent good uterine contractions. However, with the positive attitude of the woman and her family, the help of relatives, these temporary difficulties are quite surmountable.

Possible ways to extract the fetus

A cesarean section is an operation that is performed in the abdominal cavity for the purpose of delivery. Of course, it is preferable to carry out natural childbirth, but there is a whole list of indications for a mandatory operation: both planned and emergency.

Abdominal caesarean section

This type is the most common. Held by incision in the anterior peritoneum(suprapubic or longitudinal from the navel to the womb) and subsequent transverse dissection of the uterus in the lower segment. Surgery is indicated in cases where a woman in labor has:

  • narrow pelvis;
  • placental abruption;
  • unprepared birth canal;
  • transverse or pelvic presentation of the fetus;
  • diseases of the uterus and other organs involved in the process of childbirth;
  • high risk of uterine rupture;
  • fetal hypoxia.

The operation is performed under anesthesia, from its introduction to the extraction of the child, a minimum of time should pass, no more than 10 minutes, so that a large amount of the drug does not enter the baby's body. The fetal bladder is torn, the child is removed from the uterus through an incision with the hands, immediately transferred to the midwife, then the gynecologist manually frees the uterus from the placenta.

Corporate mode of operation

Implies lower median incision of the abdominal wall, the uterus is cut lengthwise with a scalpel or with scissors exactly in the middle, this will ensure less blood loss. After the incision is made, the abdominal cavity is isolated so that amniotic fluid, particles of the placenta and other products of labor that can cause internal inflammatory diseases in a woman do not get there.

This type of operation is indicated for those who:

  • no access to the lower part of the uterus due to adhesions or diseases;
  • began premature birth.

When making an incision, the doctor should be careful and be aware of the possibility of damage to the bladder, as in pregnant women it shifts upward.

Extraperitoneal caesarean section

It is carried out without intervention in the abdominal cavity, the incision is made longitudinally slightly to the left of the middle of the abdomen, while only the muscles are dissected. Indications for this type of caesarean section:

  • obvious infectious processes in the abdominal cavity;
  • long anhydrous period in the fetus;
  • some acute illnesses of the pregnant woman.

Extraperitoneal caesarean section is contraindicated in those who have placental abruption, uterine rupture, scars from previous operations that may disperse, tumors on the uterus or on the ovaries.

Vaginal type of intervention

It is used quite rarely, since such an operation requires considerable surgical experience. It is prescribed as an abortion at a gestational age of 3-6 months, or when a woman giving birth has scarring on the cervix, a sharp deterioration in the health of the mother, the correctly lying placenta begins to exfoliate.

The technique of conducting the vaginal method is divided into 2 types:

  1. Only a small part of the anterior wall of the uterus is dissected. In this case, the cervix remains intact, the woman in labor receives fewer injuries than with a classical operation, and recovers faster.
  2. An incision is made in the vaginal wall, anterior uterine wall and lower segment.

Small caesarean section

It is a method of abortion in late pregnancy (from 13 to 22 weeks) if the mother or fetus has severe impairment of functioning. For children, these are genetic diseases, abnormalities in physical development or death, for the mother - diseases associated with the cardiovascular and nervous systems, acute renal failure, blood diseases, the need for sterilization.

The operation affects the anterior wall and cervix, the embryo and placenta are removed through the incision. Such an abortion is traumatic and is prescribed only in cases where artificial childbirth is not possible.