Caesarean section: a modern approach. Method of operation, postoperative period. Indications for caesarean section, rehabilitation

Terms, duration and course of the operation

All pregnant women experience fear of childbirth. And even worse, if the birth will take place not in a natural way, but by caesarean section. But to make it not so scary, let's figure out why a caesarean section is done, how long the operation is usually performed, how long it takes and consider the entire course of the operation.

During pregnancy monitoring, the doctor makes a recommendation on how the birth should go. If a woman's pregnancy is proceeding normally, then most likely, childbirth will take place naturally. If there are any abnormalities during the course of pregnancy or during the birth itself, then doctors may decide to carry out the birth using a caesarean section.

Distinguish between emergency and planned caesarean section:

• given during pregnancy. In this case, the woman in labor prepares for the operation in advance, undergoes all the necessary examinations and, at a predetermined period of pregnancy, goes to the pathology department. The most common indications for a planned caesarean section are:
• premature detachment of the placenta;
• hemolytic disease of the fetus;
• multiple pregnancy;
• severe form of preeclampsia;
• absolutely narrow pelvis;
• transverse position of the fetus, etc.
• emergency caesarean section is carried out with unforeseen complications directly during childbirth that threaten the health of the mother or child. The health of both the child and the mother may depend on the timeliness of the decision to perform the operation. In such situations, the qualifications of the doctor and the determination of the woman in labor are very important (after all, the operation cannot be performed without her consent).

Optimal timing

A planned caesarean section is usually done at 40 weeks pregnant. This is the optimal time for the operation - with a sufficient mass, the fetus is already considered full-term, and the child's lungs are sufficiently developed so that he can breathe on his own.

With a second cesarean section, the timing of the operation is shifted down - it is done a couple of weeks earlier than the planned delivery date, usually this is the 38th week of pregnancy.

This approach avoids the onset of contractions, which reduces the risk of various complications during the operation. Remember that only a doctor can correctly determine how long to do a caesarean section in each case.

Preparing for the operation

A woman in labor who is scheduled for a planned caesarean is usually referred to the hospital about a week before the operation. If a woman wants to stay at home, then she can come to the hospital on the day when the operation will take place. But this is permissible only in the absence of severe complications and with good health of the mother and child.

Postoperative period

After the operation, painkillers are usually prescribed, as a woman experiences severe pain after a caesarean section. Also, depending on the condition of the woman, the doctor may prescribe various medications, such as antibiotics, or supplements that improve the functioning of the gastrointestinal tract.

You can get up after the operation no earlier than six hours later. It is also recommended to buy a postoperative bandage, which will greatly facilitate the condition when walking.

Nutrition after the operation should be special - on the first day after a cesarean section, you can drink only plain water.

On the second day, a woman can try soups, cereals and other liquid foods.

On the third day, with proper recovery, you can eat any food that is allowed during lactation.

If you are still scheduled for a planned caesarean section, then do not be afraid. Most often, the fear of a caesarean is due to a lack of awareness about the progress of the operation. Knowing what exactly she has to go through, it is much easier for a woman to psychologically prepare herself for the upcoming events.

The Greek word "Caesar" and the Latin "Caesar" have the same meaning. They mean "monarch" or "ruler". According to legend, the name of the caesarean section is directly related to Julius Caesar. The fact is that his mother died during labor pains. The only thing that the frightened obstetricians could think of was to cut open the mother's stomach and extract the child. The caesarean section was surprisingly successful. Since then, this kind of operation is called "caesarean section".

What is a caesarean section?

A caesarean section is a surgical intervention in which the baby is removed using an incision in the woman's abdomen. The risk is twelve times higher than with natural childbirth. The operation of caesarean section is planned and urgent or emergency, which is carried out in case of urgent need in the process of natural childbirth.

According to statistics, 25% of all children are born as a result of a caesarean section. In countries such as Brazil and the Dominican Republic, 57% of all deliveries are by caesarean section. The next in the list of leaders are Egypt - 52%, Turkey - 48%, Italy - 38%. In China, every fourth birth is by caesarean section. But, at the same time, the third part of them is carried out simply at the request of the patient, without serious medical indicators.

There is also another extreme, when the number of such operations is extremely low, which is typical for countries such as Niger, Chad, Ethiopia. Caesarean section is performed in 2% of all cases. The reason for this low rate is an underdeveloped health care system.

The most optimal percentage of caesarean sections is owned by the Netherlands: there their number is 15%. This is due to the fact that home births are more often practiced in the country, which account for 65%, thus reducing the number of deliveries by caesarean section.

Why is a caesarean section done?

The operation of a caesarean section is done to avoid terrible consequences in the case of:

Advantages of a caesarean section

1. With a caesarean section, the option of death of the fetus or the woman in labor is practically excluded.
2. The genitals of a woman remain in the same form as before childbirth, which has a positive effect on her sexual life. The variant of the appearance of uterine ruptures, the occurrence of hemorrhoids, prolapse of the bladder is excluded.
3. Speed. Everything happens much faster than with natural childbirth. There is no need to suffer for hours in heavy contractions and endure unbearable pain until the birth canal opens.

Cons of a caesarean section

Possible risks for the child and for the expectant mother during caesarean section

Although a caesarean section is considered a harmless surgical intervention, it has some pretty serious risks that you should be aware of in advance.

Risks for the mother after a caesarean section:

1. Severe bleeding.
2. Damage to internal organs.
3. Wound infection.
4. Inability to walk for some time.
5. The occurrence of adhesions between tissues and internal organs.
6. Chronic pain in the lower abdomen.
7. Inability to give birth on their own in the future.

Risks for the baby after a caesarean section:

• cuts and abrasions on the body;
• disorders in the work of the pulmonary and cardiovascular systems;
• difficult adaptation.

Postoperative recovery period after caesarean section

The first day after the caesarean section, the mother stays in the operating unit. An anesthesiologist and an obstetrician-gynecologist closely monitor the woman's health.

A day later, the woman is transferred to the postpartum ward. To recover from a caesarean section, it is recommended that mom drink non-carbonated water with the addition of lemon. There is no need to eat on this day, as a woman is given droppers with vitamins and microelements.

On the second day, sweet tea, boiled meat, broth are allowed. On the third day, you can eat everything except foods that are prohibited during.

During the first two to three days after a caesarean section, a woman takes painkillers. Then the need for these medicines disappears. In addition, drugs are prescribed that reduce the uterus and normalize the work of the gastrointestinal tract.

The suture after caesarean section is bandaged daily. Over time, it will become completely invisible. It is not recommended to wet the abdomen for 7 days after the caesarean section.

In the postpartum period after a caesarean section, one should not lift weights, allow overwork and psycho-emotional stress.

Everything about caesarean section from preparation to surgery:

Video: Why a caesarean section?

Video: Natural childbirth after caesarean section

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, obstetrics entered a new stage of 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 beauty 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?

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

How the scar is formed is determined by the postoperative period. If after the first caesarean section the woman had some 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 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.

Pelvic deformity or narrow pelvis

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 malformations of the pelvic bones.

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.

Degrees of a narrow pelvis

Anomalies in the position of the fetus

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

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 in such childbirth is the weakness of labor. 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

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.

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

Premature placental abruption

Threat of uterine rupture

Clinically narrow pelvis

"For" and "against" caesarean section

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

Natural childbirth is not possible in the following cases:

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

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. With this surgical manipulation, a dissection of the posterior wall of the vagina is performed 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), pelvic muscle strains, and involuntary urination associated with sprains.

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. The baby is most at risk when various third-party methods are used in natural childbirth to remove 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

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.

The risk of development is especially high in emergency, unscheduled operations. Due to the direct contact of the uterus with a non-sterile environment, pathogenic microorganisms 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 the uterus, its 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, any physical activity is 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

Another significant disadvantage is the poor adaptation of the baby to the external environment after the operation. During natural childbirth, the fetus, passing through the birth canal of the mother, gradually adapts to changes in the 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 it is absorbed by the lung tissue, but in debilitated children, this fluid can cause the development of 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

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) indicates an inflammatory process in the body of a pregnant woman, which is a relative contraindication to 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. Elevated glucose levels ( 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. Therefore, if the doctor detects a high glucose level, 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
An ultrasound examination 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
A coagulogram is a laboratory test that 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 day of the operation

Description of the caesarean section

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

Pfannenstiel access

Access by Joel-Kohen

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

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

Transverse incision technique in the lower part of the uterus

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).

Corporal methodology

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.

Isthmicocorporal technique

Stages of a caesarean section

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

First stage

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

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 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

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.

Fourth stage

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

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);
• the presence in the obstetric department of appropriate devices 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).

General anesthesia

The stages of anesthesia are:

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

Complete muscle relaxation is achieved by intravenous administration of muscle relaxants ( drugs that relax muscles). The main muscle relaxant used in obstetric practice is succinylcholine. Muscle relaxants relax all the muscles of the body, including the uterine.
Due to the complete relaxation of the 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

• 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

Two types of regional anesthesia are used:

• spinal anesthesia.

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 to 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

Complications during the operation

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.

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

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 of the 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. A characteristic symptom of endometritis is 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 can also affect the 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

The danger of a blood clot lies in the fact that it can clog a blood vessel and stop blood from reaching the organ that is supplied with blood 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 cesarean section consists in the appointment of special drugs that thin the blood and prevent the formation of blood clots.

Adhesion formation

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 a caesarean section, the 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, painful constipation.

Severe pain syndrome

Postoperative scar

Complications associated with 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 effect of anesthesia

Influence on the emotional sphere

Effect on the gastrointestinal tract

Recovery of a woman rehabilitation) after caesarean section

Diet

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 vegetable) - 80 - 90 grams;
• carbohydrates ( 30 percent easily digestible) - 200 - 250 grams;
• energy value - 2000 - 2000 kilocalories.

• 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.

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 clean 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.

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.

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).

• 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.

How to relieve pain after caesarean section?

Factors that provoke pain after a caesarean section are:

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

Reducing the pain caused by the stitch

• 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.

Another factor that makes the suture hurt is a cough that occurs due to the accumulation of mucus in the lungs after anesthesia. In order to get rid of mucus faster and at the same time reduce pain, it is recommended that a woman after a cesarean section take a deep breath, and then, drawing in her stomach, exhale sharply. 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?

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?

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 the 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 legs, sliding the heel along the bed.

Why is there discharge after a caesarean section?

What does a suture look like after a caesarean section?

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?

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 Stress 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 go through the natural birth canal, which can adversely affect his 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?

Initial loads

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.

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 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.

How to make a scar on the skin invisible?

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

Laser resurfacing

Aluminum oxide grinding ( microdermabrasion)

Chemical peel

Scar tattoo

Ointments to reduce the seam after caesarean section

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 the appearance of the 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

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

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

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).

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), can 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.

After the birth of a child, the load on the mother's nervous system increases. To ensure the timely formation of the menstrual function, a woman should devote sufficient time to good rest and avoid increased 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?

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

After a caesarean section, re-pregnancy can be complicated. So, every third woman has threats of termination of pregnancy. The most common 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 scar failure, a common symptom of 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 placenta 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

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

- this is an operative intervention through the abdominal wall, as a result of which a newborn is born. This operation was performed in ancient Rome and ancient Greece, but in those days it was done only for the dead.

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

Only in the 19th century did doctors learn to save the life of the mother, and in the middle of the 20th century, with the advent of the era of antibiotics, caesarean section became a standard procedure that carries minimal risks for a woman.

Indications for caesarean section (list)

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

Absolute readings:

• Complete placenta previa - suggests that the baby's place was implanted so close to the entrance to the cervix that, as it enlarged, it began to block the child's exit through the natural birth canal.
• An anatomically narrow pelvis is an absolute contraindication to conventional childbirth. Such a diagnosis is made if the woman's pelvic bones have grown together in such a way that they do not allow the child to go out.
• Transverse presentation of the fetus - if before the onset of childbirth the child could not stand in the head or at least in the breech presentation, then he will not be able to be born on his own.
• The presence of more than two caesarean sections in history. It is believed that natural childbirth in this case creates a threat of uterine rupture and intra-abdominal bleeding, which can be fatal for the expectant mother.

Relative readings:

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

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

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

Choice of anesthesia

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

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

Tissue dissection

Surgical manipulations are performed in several stages:

• 1. A catheter is inserted into the bladder for timely drainage of urine, the pubic area is shaved - this is an additional guarantee of the hygiene of the upcoming intervention.
• 2. A screen is placed between the upper and lower parts of the body, thus delimiting the operable zone.
• 3. The incision site is pre-marked, and then the edges of the marked area are manually pulled together to make sure that the skin is sufficiently stretched so that the edges of the wound can subsequently be sewn together.
• 4. If there is an old scar from a previous caesarean, then it is first excised with a scalpel.
• 5. The surgeon makes a transverse or longitudinal incision of the abdominal wall with smooth translational movements. He has to carry out a scalpel along the marked lines several times, slightly deepening the instrument into the thickness of the skin and fat layer.
• 6. When dissecting the muscles, the doctor makes an effort to manually push them apart and get to the uterus.
• 7. The edges of the wound are fixed by an assistant and parted to provide the surgeon with more complete access to the body of the uterus.
• 8. The same transverse incision is made on the uterus in several stages as on the abdominal cavity.

Until the moment of dissection of the genital organ, the operation is almost bloodless and the help of an assistant in terms of stopping bleeding is minimal.

Fruit extraction

As little time as possible should elapse from the moment the uterus is incised to its suturing. Therefore, the child is removed quickly, if there are loops of the umbilical cord on his neck, then they are removed, and the umbilical cord itself is cut off.

For several minutes, doctors wait for the placenta to separate from the walls of the uterus on its own. Then it is removed and the accumulated blood and clots are removed.

Tissue suturing

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

The uterus itself is located outside the abdominal cavity, it is set after the suture is applied. Then the skin, together with the fat layer, is pulled apart and fixed, and the surgeon at this time sutures the abdominal muscles. Unlike the uterus and skin, they are cut vertically.

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

After a caesarean section

If the delivery was made by surgical intervention, this does not mean that the woman will not have bleeding from the uterus.

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

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

Many are concerned about the question of how many days after a cesarean section can I be discharged from the hospital? Typically, such patients are under observation for a little longer than those who had a natural birth. But on the 7th - 10th day, as a rule, most women are ready for discharge.

At first, you should pay increased attention to the condition of the seam. If it is found that it has become edematous, inflamed, festered, or its soreness does not decrease, but rather intensifies, it is necessary to urgently consult a doctor to avoid the development of an infection.

To prevent muscle strain after a caesarean section, a bandage should be worn. The fact is that in the first few weeks it is necessary to eliminate the load on the press, so the sagging stomach needs to be supported.

Pregnancy and childbirth after caesarean section

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

The earliest term that will be relatively safe for a woman in labor is a caesarean section performed one year after the first caesarean section. And even in this case, a woman exposes her body to a serious risk - for a long time, the suture on the uterus may begin to diverge, so the doctor should regularly monitor its condition and thickness according to the results of ultrasound.

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

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

There are cases when the seam after the operation has grown together extremely unsuccessfully, and it is very dangerous for a woman to bear the next pregnancy.

In Soviet times, there was nothing to think about natural delivery, with a history of caesarean section. Such experiments have not been practiced. Now the situation has changed, and in recent years, many mothers, when planning a second child, are thinking about how he would appear not on the operating room, but on the birth table.

In large clinics in Russia, such a difficult task is taken up, there was even a case of spontaneous birth after two obstetric operations in history (which is a reckless risk from the point of view of doctors).

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

When can I have sex after a caesarean section?

As with natural delivery, you should have sex only 2 months after the baby is born. Even though the vagina itself was not torn as a result of the passage of the baby through the birth canal, there is a possibility of infection, which will cause the suture on the uterus to become inflamed.

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

Approximately 20% of babies are born in a non-standard way - through a surgical incision in the anterior wall of the abdomen and uterus. Such an operation is called a caesarean section and has been practiced for more than a dozen years. According to what indications and for how long a caesarean is performed, how the procedure is carried out, under what kind of anesthesia - these and many other questions prevent expectant mothers from sleeping peacefully. We will try to present all the most interesting and important information here.

Any surgical intervention, even the most insignificant, to a certain extent carries a potential danger to the health (and sometimes life) of the patient. That is why a pregnant woman cannot “order” a caesarean section to the attending physician just like that, for no apparent reason. And although in society one can find an opinion about the attractiveness of artificial childbirth due to their efficiency and painlessness, from a medical point of view, natural delivery will always be a priority.

There are absolute and relative reasons for the operation.

Absolute readings:

1. The first child was born by caesarean and independent childbirth can lead to complications.
2. The baby is located across the uterus or "sat down" on the ass.
3. The mother-to-be has been diagnosed with an illness or condition that could cause the baby to die during childbirth.
4. The baby's head is too big and won't fit through the pelvic bones.
5. Severe late toxicosis.
6. Multiple pregnancy.

Relative readings:

1. Anatomically non-standard development of the mother's skeleton (for example, a narrow pelvis, not intended for natural delivery).
2. Big baby with presentation.
3. Pregnancy beyond the expected due date.
4. Varicose veins of the genital tract in a pregnant woman.
5. Pathology of the development of the uterus.
6. Doubtful condition of scars from previous operations on the uterus.
7. Acute and chronic diseases of the mother, which can have a negative impact on the course of childbirth or harm the woman in labor (high degree of myopia, arterial hypertension).
8. late birth.
9. Artificial insemination, miscarriages or stillbirths in the past.
10. Severe swelling.

A planned caesarean section is usually prescribed in the following cases:

1. Severe infectious diseases in the expectant mother.
2. The pregnant woman is HIV-infected.
3. During prenatal diagnosis, symphysitis was detected (an excessive increase in cartilage in the area of ​​​​the pubic joint).
4. Shortly before birth, intrauterine fetal hypoxia was established.

Caesarean section: contraindications for surgery

Artificial childbirth is not carried out if:

• the child died in the womb;
• the baby was diagnosed with congenital malformations incompatible with life;
• infection of the skin and genital organs of the mother occurred.

In all the situations listed above, under conditions of caesarean section, the risk of developing sepsis and peritonitis sharply increases due to the penetration of infection into the blood.

How many weeks is a caesarean section

A planned caesarean section is prescribed during pregnancy, and only the doctor can decide on the final date of the operation. The optimal time to start the procedure is the first contractions. In order not to miss a crucial moment, the expectant mother goes to the hospital 1 - 2 weeks before the due date.

A planned caesarean section is prescribed no earlier than 37 weeks of pregnancy. Which week a caesarean is done depends on the decision of the specialists. When choosing a day for surgical intervention, the doctor always focuses on the expected date of the baby's birth. To prevent the development of intrauterine hypoxia, a caesarean section is performed at a period of 38-39 weeks.

If the first pregnancy ended in operative delivery, the second child will also be born by caesarean section. A second operation, as in the first birth, is prescribed for a period of 38 to 39 weeks, however, if the doctor is embarrassed by the condition of the suture from the first cesarean, the woman in labor will be operated on before the PDR period.

How to do a caesarean: preparatory stage

The doctor will inform the woman in labor about the necessary preparations for the operation. 12 hours before the procedure, you need to refrain from eating and 5 hours from drinking. An enema is given just before a caesarean section. There is little pleasant, but the risk of infection during childbirth is practically absent, and the rehabilitation process will go faster.

During the operation, the integrity of the abdominal muscles is broken by a large incision. The first time after artificial birth, even the slightest tension in the abdomen will cause tangible discomfort, despite medical anesthesia. And the enema given before the operation will save the young mother from the pain when trying to go to the toilet “in a big way” in the first days after the cesarean, since the intestines will be relatively emptied.

If it matters, the expectant mother will be warned about the need to epilate the pubis.

How is a caesarean section done: the sequence of the procedure

The operation is carried out in several stages and is certainly accompanied by anesthesia. The woman in labor will be offered three options for anesthesia in the form of epidural, spinal anesthesia or general anesthesia. We'll talk more about them a little later.

When the painkillers take effect, the doctor will make an incision in the pregnant woman's abdomen. Most often, this manipulation is carried out according to the Pfannestiel method - the incision runs along the pubic hair growth line. In emergency cases, when every second counts, a lower median incision is performed - from the navel along the midline down to the pubis. During a planned operation, the uterus is cut, like the abdomen, horizontally. A vertical incision is performed with multiple pregnancies or pathological attachment of the placenta.

Through the incision, the doctor removes the baby from the uterus, separating the placenta. After the newborn is placed on the chest of a happy mother or handed over to the father. Then the baby is sent to the ward of the children's department.

After the baby is removed, oxytocin and methylergometrine are injected into the uterus, which help the hollow muscular organ contract faster. The operation is completed by suturing the cut tissues with a self-absorbable suture material. First, the uterus is sutured, then the peritoneum, muscles, ligaments and skin. The skin is fastened with a regular or intradermal (more accurate and aesthetic) suture.

How long does a caesarean section take? The operation takes approximately 30-40 minutes. After its completion, the newly-made mother is sent to the intensive care unit to recover from anesthesia, and then to the postpartum ward. To avoid the development of vein thrombosis, a woman is lifted out of bed immediately a few hours after the anesthesia has ceased to work. Walking is the best prevention of blockage of blood vessels. It is strictly forbidden to lift anything heavy.

Who does a caesarean in the maternity hospital depends on the policy of the medical institution and on the state of health of the woman in labor and her baby. Usually these are 2 obstetrician-gynecologists, 1 anesthesiologist, 1 midwife who takes the child and 1 neonatologist.

Anesthesia for caesarean section

Artificial childbirth is a serious abdominal operation and is performed only with preliminary anesthesia. There are several types of anesthesia that are used to make a woman feel comfortable during surgery.

Epidural anesthesia for caesarean section

To deprive a woman in labor of sensitivity by this method, an injection is made under the spine in the lumbar region - there are spinal nerves. A catheter is left at the puncture site, through which an anesthetic is periodically injected during the operation.

The main advantage of epidural anesthesia is that the woman in labor does not fall asleep and is well aware of everything that happens to her, but she does not feel the lower part of the body. The woman is immobilized from the waist down and will not be in much pain when doctors make incisions to remove the baby.

Among other "pluses" of this type of anesthesia, we note:

• ideal for women who suffer from bronchial asthma;
• does not distort the work of the cardiovascular system, since the anesthetic drug is dosed into the body;
• thanks to this injection, the administration of opioid anesthetics after surgery is allowed.

Despite the clear advantages of the procedure, epidural anesthesia for caesarean section has certain disadvantages and consequences.

This type of anesthesia is not suitable for:

• blood clotting disorders;
• infections;
• allergies to anesthetic;
• transverse presentation of the child;
• scar on the uterus;
• the presence of inflamed or purulent zones in the puncture area;
• curvature of the spine.

We also list the disadvantages of the method. There are women for whom they are crucial:

• the likelihood of the drug for anesthesia getting into the choroid or arachnoid membrane of the spinal cord, as a result of which the woman in labor develops convulsions, the pressure drops sharply;
• high degree of complexity of the procedure;
• anesthesia gains strength only 15-20 minutes after the injection;
• sometimes anesthesia works partially, so the woman in labor is forced to experience obvious discomfort during the operation;
• the likelihood of an anesthetic drug entering the placenta, which causes a violation of the heart rhythm and breathing of the baby.

If during caesarean section anesthesia is performed in the form of epidural anesthesia, the pregnant woman must be warned about the consequences of such a step: back pain and headaches, tremor of the lower extremities, problems with urination.

Spinal anesthesia for caesarean section

This type of anesthesia is in many ways similar to the previous technique. The injection is carried out in the back, but in this case a very thin needle is inserted even deeper, directly into the spinal membrane. The injection is made strictly in a certain place (between 2 and 3 or 3 or 4 vertebrae) so as not to damage the spinal cord. For spinal anesthesia with cesarean, a smaller volume of anesthetic is required than in the previous version.

Benefits of spinal anesthesia:

• complete loss of sensation;
• the rapid onset of the effect - a few minutes after the anesthetic enters the body;
• low likelihood of complications due to the exact injection site;
• absence of unforeseen reactions in case of improper injection.

Disadvantages of spinal anesthesia:

• short duration - the injection lasts no more than 2 hours;
• the likelihood of a decrease in blood pressure if the anesthetic is administered too quickly;
• the risk of developing a headache that persists on average up to 3 days after surgery.

Doctors are forced to refuse to perform the operation under spinal anesthesia if the pregnant woman has contraindications to such anesthesia:

• rash or pustular formations at the site of the proposed injection;
• circulatory disorders and blood clotting;
• blood poisoning;
• diseases of a neurological nature;
• developmental pathology of the spine.

General anesthesia for caesarean section

Today, general anesthesia for artificial birth is used less and less, because of all types of anesthesia, it has the most negative impact on the mother and child. The procedure involves the intravenous administration of an anesthetic, in which the pregnant woman falls asleep within a few seconds. Then a tube for artificial oxygen supply is inserted into the woman's trachea.

General anesthesia for caesarean section is done in such cases:

• obesity, spinal surgery in the past, pathologies of blood clotting - other types of anesthesia for these diseases are not suitable;
• fetal presentation, prolapse of the umbilical cord;
• the need for an emergency caesarean section.

Benefits of general anesthesia:

• almost instantaneous loss of sensation.
• no interruptions in the work of the cardiovascular system;
• lack of difficulties in the implementation of anesthesia.

Disadvantages of general anesthesia:

• the likelihood of penetration of gastric juice into the lungs with the subsequent development of pneumonia;
• the likelihood of a detrimental effect of the anesthetic on the central nervous system of the newborn;
• the risk of developing hypoxia in the mother.

The best anesthesia for caesarean section is the one chosen by an experienced specialist. Only a doctor can take into account the advantages and disadvantages of each type of anesthesia and correlate them with the well-being and condition of a particular woman in labor. In this matter, you need to trust only professionals.

Possible complications after caesarean section

During the birth of a child, a woman experiences an enormous load and is subjected to severe stress, regardless of whether it is a natural or artificial birth. Surgery is not very long, but it can result in some complications for the woman in labor, including:

• bleeding;
• inflammation of the uterus;
• thromboembolism;
• adhesions;
• hernia in the area of ​​the scar;
• damage to certain organs during caesarean section (for example, the bladder).

Not only a woman, but also a newborn child can face unpleasant complications due to the operation:

• the risk of being born prematurely if a planned caesarean section is scheduled for an earlier date than the due date. In this regard, it will be difficult for the baby to adapt to the outside world. In addition, practice shows that "cesareans" get sick more often than babies born on their own;
• anesthesia, even the weakest, affects the baby as well. In the first hours of life, the newborn is sleepy and inactive. There is a risk of developing pneumonia due to anesthesia;
• after a caesarean section, mother and child are not together for some time. This may subsequently affect breastfeeding not in the best way.

Recovery period after caesarean section

It will take several months after the operation before the woman fully recovers and feels good. During this period, it is important to treat your health with great attention.

1. On the first day after cesarean, only drink is allowed. The choice is limited to non-carbonated water at room temperature. The next day, you can refresh yourself with yogurt, porridge, sweet tea and lean meat. A light diet should be followed for about a week after surgery.
2. After surgery, the seam hurts for some time, so the woman is prescribed painkillers. As you recover, the unpleasant sensations weaken every day.
3. For 2 to 3 weeks after a cesarean, a woman will have to intensively observe intimate hygiene, since at this time she will still be disturbed by spotting. Then they will completely disappear.
4. Approximately 2 weeks after the birth of the child, the seam on the abdomen should be regularly treated to prevent infection and decay. At the same time, the state of health is overshadowed by severe cutting pains in the incision area. The tissue at the site of stitching first turns red, and later, when the scarring process begins, it turns purple. In the future, the color of the scar will almost merge in color with the skin. The incision on the uterus will heal within six months.
5. 2 months after the operation, a woman is recommended to gradually join the sport. Intensive training is allowed only after 6 months. Sexual life is best resumed 1 month after childbirth.

Recently, more and more expectant mothers are thinking about the possibility of giving birth to a baby through a caesarean section. Perhaps women are afraid of the pain of natural delivery. However, the risk of complications is present in both spontaneous and operative childbirth. Before finally deciding how the little man will come into this world, you need to carefully listen to the arguments of your doctor about the "pluses" and "minuses" of a caesarean section.

How is a caesarean section done? Video