Are stitches removed after a caesarean section? How long does it take to be on guard? When to See a Doctor

A seam on the abdomen after a caesarean section is a subject of discussion for many women who have given birth. How long will the healing last, is it possible to make it so that after that it becomes invisible and it is not embarrassing to put on a swimsuit, what should I do if there are pains or signs of inflammation in the area of ​​​​the incision on the uterus? And one more important question - if the seam broke after a cesarean section, what should I do?

Surgical delivery has been practiced for hundreds of years. And even in the last century, all doctors agreed that one delivery in this way is an absolute indication for the same delivery if a woman wants to have more children. Now, in some cases, doctors recommend natural childbirth. Now, even a cosmetic suture is possible after a caesarean section, thanks to which the incision on the abdomen becomes invisible a year after the operation. And you don’t need to lubricate it with anything so that a noticeable scar does not form on the skin, especially since it is useless. The healing and aesthetics of the result will depend not on how many sutures after cesarean, that is, on the number of stitches, but on the quality of the suture material (whether there was inflammation after the operation), the type of suture (horizontal or vertical), as well as the individual characteristics of the skin (there are whether the tendency to form keloid scars). The size of the seam on the abdomen after cesarean is about 10-15 cm.

How the doctor made the incision in the uterus is important. Previously, it was always a vertical incision (corporal) - from the navel. Now they almost always do a horizontal, transverse, right above the pubis. Types of sutures after caesarean section determine the prognosis for a future pregnancy. The second is preferable, as it practically guarantees its favorable course. Very low failure rate. If the suture becomes inflamed and hurts after a cesarean, then there is a high probability that it will heal poorly. It is quite possible that it will be insolvent, in which it is impossible to plan a new pregnancy at all. About how to process a seam after a cesarean section at home is usually told in the maternity hospital. Usually it's just green. A woman is recommended to treat the wound with alcohol for a month after bathing, and then with brilliant green or a concentrated solution of manganese. Also, women recommend regularly smearing a caesarean suture with Contractubex. This is said to help prevent the formation of an unsightly scar on the skin. However, many modern doctors do not approve of this recommendation, since this remedy has no proven effectiveness.

If everything heals well, then doctors may advise not to process the outer seam on the abdomen at all. Is that not to wet within 7-10 days after the operation. Hot showers and baths (sauna) are also contraindicated for 1.5 months. For more information, contact the doctor who performed the operation.

On average, the time it takes for a cesarean suture to heal is 1 month. In the case of cosmetic smaller. Throughout this period, you must carefully observe the cleanliness in the area of ​​\u200b\u200bthe seam. Just don't wash it with a washcloth. If all is well, after a year there will be an inconspicuous scar. It is not yet possible to completely remove the suture after a caesarean section. Theoretically, this can be done by excising a skin area with a scar, but after this operation, a scar will also remain ... Therefore, you should not rely on the possibilities of plastic surgery and cosmetologists for the time being, it is better to properly monitor the condition of the seam yourself.

When should you take action, perhaps consult a surgeon? Occasionally, poor or improper care of sutures after cesarean provokes an inflammatory process. Infectious pathogens enter the wound. In overweight women, inflammation can be caused by poor drainage of the wound. Also, some types of material with which a suture is formed on the uterus after cesarean have a negative effect. The reason for an urgent visit to the doctor is usually the reddening of the seam, its suppuration, swelling, soreness, there is a discrepancy. Especially if this is all accompanied by an increase in body temperature.

If the seam after cesarean is hard, this can also indicate inflammation. Or be a sign of the formation of a rough keloid scar. But the second is more often not relevant for the postpartum period. Keloid scars usually form a few months after surgery. By the way, in this case, the sealing of the seam after childbirth, as well as the inflammatory process, which is not present in this case, is accompanied by soreness, itching, burning, increased sensitivity of the skin in its area, slight redness and other unpleasant symptoms. But does not require treatment.

What to do if the suture after cesarean does not heal and oozes, any surgeon will answer. Most likely, the wound will be cleaned and then drained. In addition, antibiotics will be prescribed. May be compatible with breastfeeding (be sure to tell your doctor if you are breastfeeding). With a slight divergence of the seam, as a rule, it is not sewn up again. Only treated with antiseptic agents.

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They resort to a caesarean section in case of a threat to the life of the mother or child. For this, tissues are dissected, which, after removing the fetus, must be sutured. The seam after a caesarean section will become barely visible over time and will not be an obstacle to natural childbirth during a second pregnancy.

Types of seams

After the operation, the tissues of the uterus, subcutaneous fat layer and skin are sutured.

According to the depth of imposition, the seams are divided into:

• internal (suturing the uterus and subcutaneous fat);
• external - applied to the skin.

The direction of the cut, and, consequently, the outer seam, is:

• longitudinal from the navel to the bosom;
• transverse along the skin pubic fold;
• transverse below the middle of the distance from the navel to the womb by 3 cm.

The doctor chooses the type of incision depending on the urgency of the operation and the characteristics of the course of childbirth.

Planned operative delivery ends with the imposition of a transverse cosmetic suture along the pubic fold of the skin. After it, a minor cosmetic defect remains, which is easily hidden by underwear and a swimsuit, over time it will become almost invisible.

A longitudinal incision is used in emergency conditions, for example, in acute fetal hypoxia (a prolonged lack of oxygen can lead to the destruction of brain cells) or massive bleeding in a woman. In such cases, wide and fast access is required. The trace after a longitudinal dissection is prone to thickening and increasing.

Postoperative period

In the postoperative period of caesarean section, the suture needs care and observation. In the operating room, it is treated with an antiseptic and sealed with a sterile dressing or temporary sticker. Every day for 5-7 days, the edges of the wound are processed and examined by a doctor or nurse. If the seam becomes wet after a caesarean section, the bandage is changed as necessary.

Follow-up after surgery is required to provide timely assistance with:

• pain syndrome;
• rise in temperature;
• occurrence of complications.

Medicines are used only approved for use during breastfeeding, in safe dosages for the baby.

The seam and the stomach after a cesarean section hurt quite a lot. For pain relief, drugs are prescribed - analgesics (narcotic and non-narcotic). In order to prevent infection of the wound and internal organs, antibiotic and antimicrobial drugs are prescribed. They are administered intravenously or intramuscularly.

To prevent the formation of adhesions, it is recommended to get up on the second day. You need to climb carefully and with the help of the clinic staff or relatives. A sudden rise can lead to dizziness and a sudden drop in blood pressure.

Postpartum bandage allows to reduce pain and load on the abdominal wall. It must be put on before getting out of bed.

Complications after surgery

From the internal organs:

• inflammation of the periuterine tissue;
• adnexitis - inflammation of the fallopian tubes and ligaments, ovaries;
• endometritis - inflammation of the endometrium (inner layer of the uterus).

These processes can lead to miscarriage, infertility, menstrual irregularities.

On the part of the postoperative wound, complications are divided according to the time of occurrence:

• early - hematomas, inflammation, suppuration, divergence of the seam;
• late - ligature fistulas resulting from rejection of the suture material.

If suddenly after a caesarean section, the suture oozes and a rich red, brown liquid separates, immediately inform the physicians. This may be bleeding or hematoma formation.

Inflammation

The introduction of infection into the postoperative wound will cause inflammation, which is extremely dangerous, as it entails suppuration and divergence of the edges. Another reason for the inflammation of the seam after cesarean section is the reaction of the tissues to the suture material. The rejection of alien silk threads occurs due to the individual characteristics of the human body.

Lack of treatment will lead to the fact that the seam after a caesarean section will begin to fester. You cannot self-medicate. It is necessary to contact a surgeon who will examine the wound surface, create the possibility of outflow of pus and prescribe antibiotics, local treatment with hypertonic solutions and ointments.

Healing

A scar on the skin is formed a week after the operation. The silk sutures are removed at the same time. Absorbable sutures are used for cosmetic intradermal sutures. They dissolve in the period from 65 to 80 days from the moment of application and do not require removal. The treatment of sutures after cesarean section in this case is performed in the same way as when using silk suture material.

For quick rehabilitation, it is advised to do feasible exercises while lying on the bed. Contraction of the pelvic floor muscles increases blood circulation in the pelvis, speeds up recovery.

Aesthetic correction

Operating gynecologists strive to make the incision small and neat, but sufficient to pass the fetal head, which contributes to rapid healing and minimal formation of connective tissue at the incision site. Depending on the individual characteristics of the body, the scar after a caesarean section may be less or more noticeable. When forming a scar, you need to use special creams and ointments that promote rapid tissue regeneration and prevent the formation of keloid scars.

Correction methods:

• laser resurfacing;
• mechanical and chemical peeling.

Peels, unlike laser resurfacing, have a rough effect on the scar and adjacent tissues. The opposite result is possible, when the defect becomes more noticeable. Laser resurfacing is performed after the complete formation of the scar. Getting rid of the defect occurs after several procedures.

Before you decide on laser correction, you need to consult a doctor. The procedure is painless and the visible effect will not keep you waiting. The layer-by-layer effect of the laser beam makes the seam soft and allows it to merge with healthy tissues.

After discharge from the hospital

Pain after caesarean section may occur after the healing of the external tissues and discharge from the hospital.

It is provoked by a sharp increase in pressure in the abdominal cavity, which occurs when:

• coughing, sneezing;
• lifting weight.

Caesarean section upsets only because it leaves a mark. But the jubilation at the appearance of a new life eliminates this small drawback. There is also a positive side to the appearance of a scar. You can safely answer the question of the crumbs “where did I come from” - from the tummy, without going into details, and provide proof - a scar.

The doctor talks about how the suture will look like

A caesarean section is an obstetric operation that is performed by making an incision in the uterus to remove the baby. This is a common operation that is performed for a number of pathologies, and has been practiced for a long time. Expectant mothers who need to go through such an intervention, as well as women who have recently resolved from childbirth in this way, are interested in many questions regarding this procedure. What will the seam look like after a caesarean section, will it look ugly? How to take care of him, and what symptoms should be alarmed? We will give answers to these and many other questions in this article.

Types of stitches after caesarean section

The appearance of the seam and a number of other points depends on what type of incision was made by the surgeon in the process. In general, seams can be horizontal, vertical and internal. A corporal incision is made in case of acute fetal hypoxia or significant bleeding during childbirth, after which a vertical-type suture remains. This is not the most beautiful seam that will be visible in the future, however, emergency measures force us to use just such an approach. The scars of the seam after the section will have a nodular appearance, the lower abdomen will not look too beautiful. However, such an incision is rarely practiced, its scope is only in emergency cases, when there is no particular choice.

Information If a planned cesarean section is made, the incision is made horizontally, above the pubis, in the natural crease of the body, and therefore it will be almost invisible, especially if the suture is made neatly and without tears, intradermal.

Internal sutures are used directly on the uterus, they can be of various types, and here the doctor makes his choice based on the risks present, creating conditions for speedy healing. In this case, self-absorbable synthetic materials are used.

Care

For the first time, a suture after a caesarean section is processed in a hospital, and doctors take care of the sutures for the period the patient is in it. In the future, it is necessary to continue care at home. As a rule, the means and the frequency of their use are prescribed by doctors at discharge or before it, you can get individual prescriptions and recommendations from the doctor, depending on which stitch was applied after a cesarean section, how the healing process is going, and so on. But a number of recommendations remain general for any case.

For any complications, the seam after a cesarean section is treated with antiseptics - iodine, brilliant green. Usually, in the absence of complications, the suture is processed for another week after discharge, this is enough. Mechanical damage - rubbing of the seam, and others, should be excluded, it is also necessary to wear a special bandage to support the abdominal wall. It is worth noting the following list of the most important recommendations:

• Do not lift more than the weight of an infant;
• You should not lie down a lot, you need to walk more, but at the same time avoid excessive loads;
• A month after the operation, you can start using products that will make the seam less noticeable - you should ask your doctor for recommendations on this.

Treatment

The first suture treatments after a caesarean section are carried out in the hospital, once a day, as part of routine patient care and dressings. In the future, it will be necessary to continue this at home - the doctor will give detailed recommendations before discharge. As a rule, care is performed once a day, by treating the suture with antiseptic agents and changing the bandage. If the doctor gave these and other recommendations for certain periods of treatment and healing, you should definitely follow them.

How long does a suture heal after a caesarean section?

Every woman in labor who has to go through a caesarean section is worried about how much pain she will have to endure, how to take care of the suture, and how long it will take to heal. It will be easier to present this information in the form of a table:

Additionally The healing of the suture after cesarean section is a long process, even if no complications and pathologies are observed. And if there are any difficulties, the healing process can be much longer. In general, the timing indicators turn out to be quite approximate, since each organism is individual, each has its own regeneration rate, inclinations. And therefore, if there are some deviations from generally accepted indicators, and there are no problems or pathologies, this is also normal.

Possible complications

Having touched on the topic of complications associated with stitches after caesarean section, it is worth considering in more detail. In what cases should a woman sound the alarm and urgently consult a doctor, and what manifestations are considered the norm? It is worth knowing about it in all its nuances.

The seam can bring problems not only during the recovery period, but also much later, years later. At first, bleeding of the suture or hematoma should attract attention - they can signal medical errors, problems with suturing blood vessels, with inaccurate or early removal of sutures.

Important Inflammation of the suture is another problem that may be relevant in the early stages. In this case, there is usually a fever, purulent or bloody discharge from the suture, redness or swelling. In this case, you should consult a doctor immediately, this is a dangerous condition in which antibiotics and special ointments are prescribed. If you start such a problem, in the future it will be possible to solve it only by surgery.

Among the late complications, it is necessary to note ligature fistulas that occur due to rejection of the suture material after a cesarean section or infection - a hot, painful red induration should be removed by the doctor, the problem cannot be solved on its own. Keloid scars are not considered a complication as such, this is a cosmetic defect that is easily eliminated today.

How to remove the seam after a caesarean section?

Despite all the efforts of doctors, the appearance of a suture after a cesarean section may not please a woman, especially when it comes to its vertical type. Are there ways to remove it today, is it possible to do this, and how is it done? These questions concern many women. There are options, and they are worth using.

Laser scar removal gives good results, and in addition, liquid nitrogen and ultrasound are widely used. Various kinds of ointments and creams are actively used, which can be purchased at a pharmacy or in a cosmetic store. Hormonal agents, chemical peeling, and also a surgical approach in the form of excision of this scar are also applicable. If desired, you can get rid of the scar - or make it as invisible as possible. It is also worth noting that some women who have decided not to give birth in the future simply make a beautiful tattoo in place of the scar.

Joint pain after caesarean section

There is nothing surprising in the fact that the seam after the operation hurts, no - because under it there is a wound up to the uterus. The first days he can get sick very badly, and in this case, doctors offer analgesics - they can relieve pain. Pain can last a week, this is the norm.

Analgesics are prescribed immediately after, these are morphine and its derivatives, which will allow you not to suffer the first days. Next, analgin and other non-steroidal anti-inflammatory drugs are used. You can not take arbitrary painkillers - they must be prescribed by a doctor, taking into account lactation and other relevant, individual aspects. The suture will hurt for about 2 months with a longitudinal dissection, and about 1.5 for a transverse one, if proper care is provided and there are no complications. If complications occur, the suture after a cesarean section may hurt for longer. And minor pulling pains can occur periodically for another year.

The scar oozes and fester

The allocation of a small amount of transparent ichor for the first week after the operation is a completely normal phenomenon, which should not be emphasized. However, the release of blood, and even more so, pus from the stitches after a cesarean section, should cause concern - this is a reason to see a doctor. Bloody discharge may indicate problems with vascular closure, and other, even more serious problems with the body. Purulent discharge, discharge with a smell, especially accompanied by fever and other symptoms, is a direct reason to consult a doctor immediately. Also, do not be silent if the discharge looks normal, but does not stop for too long. Itching is another reason for attention.

Additionally If the seam itches after about a week, this is a normal moment in the healing process. However, you can't scratch it. But if it burns, other unpleasant sensations arise, then it is worth telling the doctor about them, and as soon as possible.

When can I wet the caesarean suture?

Taking a shower for the first time after a caesarean section is usually allowed after two days - if the seam is normal for this period. Short-term exposure to water will not be dangerous already during this period, and after taking a shower, it is recommended to treat the wound surface. After discharge from the hospital, you can take a shower in any case. However, it should be understood that it is impossible to rub the seam with a washcloth, and you should not touch it once again. In a month - one and a half it will be possible to take a bath, but without too much enthusiasm.

Important Swimming in open water, bathing procedures in the first months after healing should be approached with caution, in this regard there are increased risks.

Seal over the scar

Sealing in the area of ​​the seam after caesarean section, and in particular, above it, can be of a different nature, and if it occurs, you should consult a doctor for a final diagnosis. If purulent phenomena are excluded, seals may occur due to the accumulation of lymph over the scar. This is a seroma, and it usually heals on its own. If it does not go away for a long time, you should consult a doctor.

The complex healing process associated with infection can also create lumps that need to be treated after an accurate diagnosis by a doctor. Colloidal scars, growths of cartilaginous tissue - all this sometimes leads to seals. If you have doubts about the nature of the compaction, and even more so if it causes you anxiety, pain, discomfort, a consultation with a doctor will definitely not be superfluous. Contact a specialist who, if necessary, will conduct an ultrasound of the seam, investigate the causes of the appearance of seals, which may even have autoimmune nature due to the rejection by the body of the materials with which the wound is sutured, or to be formed due to their poor quality, expiration.

Broken seam after caesarean

As a rule, the divergence of the seam after caesarean section becomes a complication that is relevant for 6-11 days, when the threads are removed. The reason for this may be lifting weights of more than 4 kg, which is unacceptable. Also, problems of this kind can arise due to an infection that prevents normal overgrowth. Inaccuracy when changing dressings or improper care can also lead to such a consequence - the suture spreading after cesarean in different directions. In any case, regardless of what could cause the discrepancy, you need to urgently consult a doctor, such a complication does not tolerate delay or attempts to solve the problem on your own.

Seam after the second caesarean section

It is known that a caesarean section operation does not prevent new pregnancies in the future, when the sutures heal and the body recovers. However, what will the scar look like after the second cesarean, what will be the features of caring for it? This is worth knowing in advance.

In general, the seam after the second caesarean section will not be different, and the specifics of the operation remain the same, only the manipulations will take a little longer. During the second caesarean, the old suture is excised, as the incision is made along it. The healing process after the second caesarean will take a little longer, and also the duration of the period accompanied by pain may be longer, and the pain for the initial period is more intense, however, appropriate medications and competent care can minimize these negative manifestations.

Information The suture after a repeated caesarean section will take longer to form, and care for it should be carried out with particular care. In addition, it must be remembered that the risk of adhesions and other negative aspects, complications, increases during a second operation.

Removal of stitches

As a rule, the stitches are removed before discharge, approximately on the sixth day after the operation, depending on the speed of healing, the presence of complications may vary. Suture removal is a fairly quick procedure in which the last knot is removed and then the thread is carefully removed from the skin. Often the question arises how painful it is to remove the stitches after such an operation. Depending on the pain threshold, people judge differently, and therefore it is impossible to accurately convey the sensations, but no matter how it was, many women say that these sensations coincide in intensity with the feeling of plucking the eyebrows. It is impossible to talk about the extreme pain of such procedures.

The stitches are removed by the doctor, before and after this procedure, antiseptic treatment is performed. Some women note a decrease in pain after removal, but in any case, we must remember that the treatment process is not over yet, and it will take many more months to fully form. The period of suture removal creates certain risks up to the divergence of the edges of the wound, and during this period it is necessary to follow medical recommendations with special attention. And in particular, you should not abandon the postpartum bandage, which is able to create good tissue support after surgery.

Important On the day of removal of sutures after caesarean section and in the following days, it is necessary to pay special attention to physical activity, reducing it to a minimum, it is absolutely impossible to lift anything heavy.

Effects

If it was about decent care for the suture after a cesarean section, compliance with medical recommendations and the absence of complications, the consequences will be minimal. So, the first 3 years after such a procedure, doctors recommend eliminating the risk of pregnancy - this is one of the main medical recommendations.

Information The seam can give rise to some discomfort - for example, in many girls it creates an insensitive zone, itches and tingles even years after the operation, and this is quite possible. Colloidal scars and other cosmetic defects are also quite a typical consequence of such an operation, however, if necessary, they can be prevented or reduced to nothing by using modern cosmetic preparations and procedures.

A seam can create a lot of problems during a subsequent pregnancy. It is noted that it is during this period that the maximum risk in his area falls. Many women report soreness and discomfort in late pregnancy. This is due to adhesions that always form during wound healing, and it is they that give rise to pain, because of which you should not worry too much if at least 2 years have passed after a cesarean. However, the gynecologist should find out about this, and he will check the condition of the sutures, if necessary, he will be able to prescribe ointments and creams that will help reduce pain and make the suture more elastic.

Competent and attentive care of the suture after a cesarean section in the postoperative period eliminates the bulk of the negative consequences, and if it has healed properly, then nothing will prevent a young mother from living a full life.

Suture correction after caesarean section

The first year after the operation, the suture is only being formed, and at this time it is important to provide it with proper care using those drugs that are relevant for a particular healing period according to the doctor's recommendations. With the right approach, correction after caesarean section may not be necessary in the future - especially if, from the second month, drugs are used in this area that promote healing and normal formation of the suture. If you don’t like something in it outwardly in the first months, you should not rush with cardinal correction methods, because in a year this area will look completely different. Moreover, most of the cardinal methods are not performed fresh, and therefore hardly anyone will agree to offer you the most effective procedures.

But once the suture heals and stops changing in appearance, after a year or two, you can use both the surgical method of repairing the suture with excision, as well as a host of cosmetic solutions in the form of a laser, liquid nitrogen, and many other suggestions.

Additionally Such a seam is corrected in the same way as any other scar. And for him, all the same methods that can be provided by any cosmetic clinic remain relevant. Just wait until the suture is completely healed - and you can go to one of them to find the best option for getting rid of such a cosmetic defect.

However, when choosing an approach, it is worth deciding in advance whether you want to have more children, or whether this birth was your last. In some cases, the method of suture correction after caesarean section excludes the possibility of touching this area in the future. Or makes this highly discouraged - in the future it can cause new complications if we are talking about a repeat cesarean.

Thus, a suture after a caesarean section will give you a minimum of trouble if it is provided with proper care and attention, and any alarming symptoms are promptly reported to the doctor. After such an operation, you can live your old life, have more children - subject to all medical recommendations, of course. A caesarean section and a seam after it is a pain, a cosmetic defect, but modern medicine and cosmetology reduces such manifestations to a minimum. In addition, as a reward for all this, you can enjoy motherhood even at the risk of difficult childbirth and in emergency cases.

A caesarean section is a major abdominal operation. With it, not only the skin, subcutaneous tissue and the muscle layer underlying them are dissected, but also a large muscular organ - the uterus. These incisions are quite large, because obstetricians need to comfortably remove the baby from the uterine cavity, and do it very quickly.

How long does a cesarean section stitch heal, will it be noticeable, how to care for it, and what to do if the incision becomes inflamed or parted? All cut tissue heals differently. It depends not only on the individual characteristics of the body, but also on the state of health at the time after childbirth, on the age, on the physique of the woman, and on which incision was performed: longitudinal or transverse.

A longitudinal incision is more convenient for obstetricians in the sense that through it it is faster to get to the uterine cavity and get the baby. It is used in cases where there is a threat to the life of the mother or child: fetal hypoxia, bleeding in the mother, eclampsia in the mother. Doctors did it, got the baby out, handed it over to neonatologists or resuscitators, and then they stop the bleeding, remove the placenta, calmly and carefully sew up the cut tissues.

The seam after a longitudinal incision heals for about 2 months, but is felt and can periodically disturb during the year, sometimes longer. Such sutures tend to become thick and cosmetically unsightly.

A transverse incision in the lower abdomen is made in a larger percentage of cases, mainly after a planned caesarean section. The skin is often sutured using atraumatic suture material, and the thread passes intradermally, that is, there will be no traces of the needle on both sides - it will look like a neat thin line (in case you do not have an increased tendency to form keloid scars).

The seam after the transverse incision heals a little faster. As a rule, it is about 6 weeks. But it also tends to flare up for a year after a caesarean delivery. If the seam is inflamed after a cesarean section, do not tighten it.

Sutures on the skin are mainly superimposed with non-absorbable material - silk or nylon. These sutures are removed one week after the caesarean section. Of course, suturing with absorbable threads also takes place. Such threads dissolve themselves within a month or two (depending on the material).

After the operation, in the first three days, the seam hurts a lot. In the maternity hospital, a woman is given painkillers, so it is impossible to breastfeed during this period. If you want to establish then breastfeeding, then it is worth pumping to stimulate the production of milk in the mammary glands.

The seam is processed after a caesarean section with a 70% solution of ethyl alcohol with 0.05% chlorhexidine, 5% alcohol solution of iodine or brilliant green by the medical staff of the maternity hospital. A sterile bandage is applied to it. Before discharge, you should be told that upon returning home, you will need to carry out the same manipulations on your own: soak (while it still sticks to the skin) the old bandage, water it with peroxide, remove and treat with alcohol, and then brilliant green.

The treatment is usually carried out up to 7-10 days, then the seam can be smeared with sea buckthorn oil or Solcoseryl so that it heals faster and is less disturbed by pain pulling in it.

The suture on the uterus is completely scarred two years after the operation. It is after 2 years, not earlier, that a woman can plan her next pregnancy in order to be calm about the fact that the seam on the growing uterus will not open.

If you were discharged home, and the suture suddenly began to hurt more, if yellowish or bloody discharge appeared from it, if a seal appeared under the suture or the temperature rose - urgently contact the maternity hospital where you were delivered in this way - the obstetrician on duty will look at you at the emergency room and tells what happened and how to deal with it.

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 term "caesarean section" itself 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 birth. 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 ( that 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.

A narrow pelvis from an anatomical point of view is that pelvis, the size of which is more than 1.5 - 2 centimeters less than the size of 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 activity. It can occur both at the beginning of childbirth, and in the process. If the weakness of labor activity is detected before childbirth, then the doctor may proceed to an emergency caesarean section. Also, the birth of a large fetus is more often complicated than in other cases by traumatism of the mother and child. Therefore, as is often the case, the question of the method of childbirth is determined by the doctor on an individual basis.

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

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

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

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, in the detection of which an unscheduled caesarean section is performed, are:

• weak labor 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 sprains, 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 vascular damage 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 psycho-emotional 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 cesarean 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, should 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, suppuration of wounds), 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 moved apart with 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 anesthesia method 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 surgery is completed, the catheter remains for a couple of days for the administration of pain medication 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 the access of blood to 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 quickly get rid of mucus 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- during 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 to rotate 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;
• 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 triggered 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. Thus, every third woman has a threat 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