Cesarean section: planned or emergency - what are the differences. Pros and cons of caesarean section. Childbirth and emergency caesarean section: what happens

Even with the strongest attitude of a pregnant woman to give birth on her own, sometimes circumstances develop in such a way that only an emergency can help delivery C-section.

Indications for surgical intervention often occur when childbirth has begun, even if the pregnancy proceeded safely and complications were not expected.

What is a caesarean section

Although the concept of caesarean section seems to be known to everyone, not all women are faced with this method of childbirth, and they do not know what an emergency caesarean section is.

- is the most used abdominal operation among women, helping to give birth to a baby in violation of normal process associated with diseases and pathological features of the mother and child.

An emergency cesarean is distinguished by the spontaneity of the operation, which is carried out according to vital indications.

Reasons for the growth in the number of transactions

A caesarean section avoids not just health problems, its main task is to save the life of the woman in labor and the fetus.

AT recent times there has been an increase in such transactions. In Europe, one third of births are by caesarean section.

Obstetricians attribute this growth to quite objective reasons:

Age of primiparas - women who give birth for the first time age rapidly. Increasingly, first births occur over the age of 30. Such women in labor acquire many gynecological and somatic diseases. This complicates the course of pregnancy and childbirth. Pregnancies are often interrupted, accompanied by the development of the child, his hypoxia. In childbirth, the fetal membrane occurs, observed in the natural course of childbirth, weak generic activity, immaturity, other pathologies.
The frequency of diseases such as heart disease, obesity, pathology, increases every year. chronic diseases do not contribute healthy childbirth, the course of pregnancy, impair the development of the fetus.
Physiological causes - women in labor, abnormal presentation of the fetus and prolapse of the umbilical cord before the birth of the baby.
Assignment to absolute indications of those that were previously classified as relative.

Types of caesarean section

Types of surgical delivery are classified according to the incision site, technique and urgency.

According to the technique of execution, the types of cesarean are distinguished:

Abdominal - used more often than others. The operation is performed under anesthesia, its duration is 10-15 minutes. The incision is made transverse above the pubis or longitudinal from the navel to the pubis. After that, the uterus is dissected in the lower segment. The fetal bladder is torn, the child and placenta are removed, the incision is sutured.
The vaginal view is used for abortion in the second trimester of pregnancy. It is performed extremely rarely - with scarring on the cervix, serious illnesses pregnant. Carried out in two ways. The first, more gentle, is to cut the uterus along the anterior wall. In this case, the cervix and internal organs are not affected. happening in short terms. In the second method, the incision is made along the walls of the vagina and uterus. The operation is very traumatic, the recovery period is long and is accompanied by postoperative complications.

In relation to the peritoneum, there are the following types of caesarean section:

corporal - the incision is made along the midline with a dissection of the body of the uterus;
isthmic-corporal - dissect the abdominal cavity from the navel to the pubis, while the uterus is dissected along the midline in the lower segment and along the body;
the incision is made in the lower segment of the uterus with or without bladder detachment.

By timing:

planned according to indications;
emergency, which is carried out to save the life of a woman in labor and a baby.

Indications for a planned operation

Caesarean by relative and absolute indications. There is no exact division, it all depends on the woman, her state of health.

The list of indications for elective surgery that are identified during pregnancy:

birth canal that prevent their child from passing - a narrow pelvis, fractures or congenital pathologies pelvic bones, tumor neoplasms internal organs located in the pelvis;
kidney transplant;
complete placenta previa;
scars on the uterus, cervix, cicatricial narrowing;
pelvic presentation of the fetus;
plastic surgery performed on the genitals, ruptures of the perineum;
the death of a child in a previous birth or a birth injury that led to disability;
multiple pregnancy with breech presentation of the first fetus;
preeclampsia and eclampsia in severe form;
fetal growth retardation.

Indications for emergency surgery

Surgical intervention is carried out in case of complications of childbirth or pregnancy that arose at the last moment.

Indications for an emergency caesarean section:

placenta previa;
open bleeding;
premature detachment of the placenta with its normal location;
uterine rupture along the scar, its threat;
acute oxygen starvation of the fetus;
near-death state or death of a woman in labor;
not gynecological diseases, leading to sudden deterioration health of the pregnant woman;
weakness of labor activity;
foot presentation of the baby;
uterine rupture;
prolapse of the umbilical cord during childbirth.

Stages of caesarean section

The operation is performed in several stages:

opening of the peritoneum;
dissection of the uterus;
birth of a child;
the birth of the placenta;
suturing the uterus;
check and toilet;
suturing the incision abdominal cavity;
treatment with antiseptics, applying an antiseptic sticker to the seams.

Amniotic fluid during cesarean section is sucked off by the surgeon before removing the baby, or they leave on their own.

Complications with caesarean section

Women who persist in their desire to give birth on their own do not know why an emergency caesarean section is dangerous.

The danger lies in the very urgency of the operation. When planning caesarean doctors and the woman has time to prepare - the gynecologist examines the pregnant woman and the fetus for possible complications.

The consequences of an emergency caesarean section are more severe than with a planned operation - the choice of anesthesia is more difficult, the postoperative period is more difficult, intestinal paresis is more often diagnosed, and the risk of adhesions increases.

Intraoperative

Complications arising during the operation:

sudden bleeding;
complications from anesthesia - a sudden allergic reaction;
difficulty in removing the child;
injury to internal organs.

Postoperative

defeat spinal cord when incorrectly carried out;
, provoked by blood loss;
development of purulent-septic complications;
soreness of the seams;
development of adhesive processes;
difficulties associated with breastfeeding, violation of milk production;
subsequent pregnancies should be planned, you can not become pregnant within two years after cesarean;
high probability that next birth will be carried out by caesarean section;
ban on active physical activity for 6 months.

Video: emergency caesarean section indications

Many pregnant women often argue about which is better to choose, a caesarean section or a natural birth. Every year the number of women in labor who want to give birth by cesarean increases. This can be explained as follows, medicine does not stand still, the seam is made small and inconspicuous, and you do not feel pain from contractions. It is worth remembering that a cesarean section is an operation that is performed in the abdomen and pelvis, and if there are no indications, then it is better to choose natural way delivery.

Without medical grounds doctors do not prescribe a caesarean section, for this there must be indications in which a woman cannot give birth naturally. This operation carried out only with the consent of the mother. Caesarean section is divided into two types: planned and emergency. A planned caesarean section is prescribed during pregnancy and the woman knows the date of hospitalization for childbirth. The decision on an emergency caesarean section is made on the spot by doctors when there is a threat to the life of the baby or mother.

Indications for a planned caesarean section:

low presentation, when the cervix is blocked by the placenta;
with pronounced varicose veins veins in the vaginal area, as this can cause severe bleeding;
cervical fibroids;
with the active stage of genital herpes;
with malformations of the uterus or vagina;
oncological diseases, tumors of the ovaries, cervix and other organs small pelvis;
with infertility in the past, along with the influence of other factors;
narrow pelvis, impossible passage of the child through the birth canal;
breech presentation of the fetus with the influence of other factors;
with the transverse position of the fetus;
complicated preeclampsia in the second half of pregnancy;
if there is a risk of uterine rupture during childbirth, if there is a scar or suture;
the age of the woman in labor exceeding 30 years with the influence of other aggravating factors;
a large fetus and a mismatch in the size of the mother's pelvis;
after two or more caesarean sections;
pregnancy after IVF;
with individual diseases of a woman: kidney disease, cardio - vascular system, retinal disinsertion, poor eyesight, high pressure, diseases nervous system, hard stage diabetes, Rhesus - conflict between mother and child and much more;
with complications during multiple pregnancy.

With a planned caesarean section, the time of the operation is scheduled close to the preliminary date of delivery, and sometimes when contractions appear. Most often, a woman is hospitalized in advance in order to once again examine and check the condition of the mother and child. For everyone, this happens individually, they can prescribe a caesarean after 37 weeks, if there are indications for this. With a planned caesarean section, women in labor often choose epidural anesthesia and see the baby immediately after being removed from the womb. The incision is always performed in a transverse way and the baby does not experience cerebral hypoxia.

An emergency caesarean section is indicated if:

weakness of tribal forces;
fetal hypoxia;
prolapse of the umbilical cord from the vagina during the outflow of amniotic fluid;
bleeding and premature detachment of the placenta;
obstruction of the fetus through the birth canal;
individual testimony of the mother.

Indications for an emergency caesarean section are any complications of delivery when there is a risk to the health of the child or mother. An urgent caesarean section is prescribed directly during a woman's labor, while doctors often use anesthesia and the mother does not see the child right away, the incision can be made vertically, with this option, the child is removed faster, and this is very important when oxygen starvation fetus.

The process of performing a caesarean section

The woman is admitted to the hospital in advance for examination. Before a caesarean section, a woman is prescribed special diet. On the appointed date put cleansing enema. AT bladder a catheter is inserted, which is removed a few hours after the operation. There are two types of anesthesia: epidural or general anesthesia. The abdomen is processed antiseptic. A partition is installed between the woman and the stomach so that she does not see the progress of the operation. When the painkiller takes effect, cut abdominal wall and make an incision in the uterus. The fetal bladder is opened and the doctor removes the baby. The umbilical cord is cut, the placenta is also separated by surgery. The uterus is sutured with special threads that absorb after 3-4 months. Sutures or staples are applied to the skin, which are removed on the 5th - 6th day. A sterile dressing is applied. The caesarean section operation lasts approximately 40 minutes. After completion, ice is applied to the abdomen for 2 hours for better contraction of the uterus. It is allowed to get up after 6 hours (sit or stand a little). For the first two days, a woman cannot lift a child and he is in children's department, it is brought for feeding.

If the caesarean section went without complications, you may feel well in just a few days. Every woman's body is different and different. the immune system therefore, it affects the recovery process after surgery. The postoperative period is more difficult for women with overweight and in the presence of diseases. It should be noted that the qualifications of the team and the doctor who performed the operation play an important role.

Consequences of a caesarean section:

sloppy seam;
pain in the suture area;
it is difficult to choose a position for feeding, when sitting, the baby presses on the seam;
psychological discomfort associated with the inability to give birth itself;
some have a weak bond with the child;
difficulties in caring for a child in the early stages;
antibiotic therapy;
infection of the incision site, urinary tract;
infection of the internal tissues of the uterus;
sexual life not earlier than the passage of 7 - 8 weeks;
complications and long recovery menstrual cycle;
it is undesirable to become pregnant for 2-3 years;
you can not have abortions;
only light is allowed exercise stress, you can not lift weights;
more difficult to establish breastfeeding;
the occurrence of blood clots;
side effects of anesthesia: headache, nausea, back pain, nerve damage, etc;
the occurrence of scars;
urgent removal of the uterus.

The consequences of caesarean for the child:

in rare cases baby trauma;
there is an opinion that children born by the CS method are slower to adapt to the environment;
amniotic fluid may remain in the baby's lungs;
respiratory failure if the operation was done before the start of contractions;
anesthesia can get into the blood of the child;
the immune system works worse;
lower glucose and hormone levels.

Do not panic ahead of time and set yourself up for bad thoughts. Children differ in development the first month, in the future they develop in the same way as babies born naturally.

Cesarean section has its positive aspects:

Do you know exactly when your baby was born?
absence pain during fights;
reducing the risk of uterine prolapse;
reduction of delivery time 20 - 40 minutes;
no perineal and cervix ruptures.

After being discharged home, do not forget about self-care, follow the rules of personal hygiene, perform simple physical exercises, diet, do not neglect wearing postpartum bandage and then you quickly come in former form. In subsequent pregnancies, the opportunity to give birth naturally remains. This will depend on how you feel and how your pregnancy progresses.

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

Who should perform the operation?

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

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

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

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

Types of caesarean section

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

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

Planned caesarean section

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

emergency caesarean section

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

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

Types of incisions for caesarean section

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

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

Concerning reoperation, then the seam from the previous one is simply excised.
As a result, only one seam remains visible on the woman's body.

How is the operation going?

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

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

After that, doctors must remove the placenta, while processing everything qualitatively. necessary vessels to prevent bleeding. The surgeon then sews up the cut tissue. A woman is put on a dropper, giving a solution of oxytocin, which accelerates the process of uterine contraction. This phase of the operation is the longest. From the moment the baby is born to the end of the operation, it takes about 30 minutes. In time, this operation, a caesarean section, takes about 40 minutes.

What happens after childbirth?

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

After a caesarean section, the mother is given antibiotics to avoid inflammatory process as well as painkillers to relieve discomfort.

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

Consequences of surgery

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

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

For a woman, the state of the suture that is made on the uterus is much more important. After all, it depends on him how it goes next pregnancy and how the woman will give birth. The suture on the abdomen can be corrected, but the suture on the uterus cannot be corrected.

Menstruation and sexual life

If there were no complications during the operation, then menstrual cycle begins and goes exactly the same as after childbirth naturally. If a complication nevertheless arose, then the inflammatory can proceed for several months. In some cases, menstruation can be painful and heavy.

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

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

lactation after surgery

Many young mothers who have undergone surgery worry that it is difficult to establish feeding after a caesarean. breast milk. But this is absolutely not true.

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

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

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

On the part of the mother, indications for surgery are cases when, due to a particular disease, childbirth poses a threat to her health, and with indications on the part of the fetus, cases when the birth act is a burden for him, which can lead to birth trauma, birth in asphyxia (a state of acute oxygen deficiency).

This happens in the following situations:

Clinically narrow pelvis. In this case, when normal sizes pelvis, which were identified during pregnancy, at the time of childbirth it turns out that inner dimensions pelvis do not correspond to the size of the fetal head. This is found out when the contractions are already in full swing, the cervix has dilated, but the head, despite good labor activity and attempts that have already begun, does not move along the birth canal. This is possible in cases where the size of the fetal head is large relative to the size of the bone pelvis:

there is anatomical narrowing or abnormal forms of the oblique pelvic ring,
with large fetuses,
when the head does not configure, that is, the bones of the skull are not able to overlap each other, as is normal (the reason for this is a post-term pregnancy),
when the fetal head is inserted into the pelvis not in the smallest size, but unbends on the way to the pelvic bones, for example, so that it is not the nape of the fetus, as is the case in most cases, but the face.

If a clinically narrow pelvis is suspected, the woman is observed for an hour: if the head does not advance, a caesarean section is performed.

Premature rupture of amniotic fluid and lack of effect from labor induction. Normally, amniotic fluid is poured out at the end of the first stage of labor, i.e., when the cervix is already open. In the case when the waters poured out before the onset of contractions, they speak of premature rupture of amniotic fluid. Further events can develop according to different scenarios. Along with the outpouring of water, regular labor activity can begin, but it also happens that contractions do not begin. Then apply the methods of artificial labor induction, for this intravenous injection PROSTAGLANDINS AND OXYTOCIN - drugs that promote the onset of labor. This is necessary because after opening amniotic sac the fetus is no longer protected from the penetration of infection by the membranes and cannot be in the uterine cavity for more than 24 hours after the outflow of amniotic fluid, as this is fraught with the development of infectious and inflammatory complications in both the mother and the fetus. If under the influence medicines labor activity does not begin, then a caesarean section is performed.

Anomalies in the development of labor activity that are not amenable to drug therapy. These most often include the weakness of labor activity. At the same time, the strength of the contractions is insufficient, the contractions are not long. The main reasons leading to the weakness of labor activity are as follows:

excessive neuropsychic stress (excitement, negative emotions),
dysfunction of the glands internal secretion,
pathological changes uterus (endomyometritis (inflammation of the uterus) in the past, defective scar on the uterus, malformations of the uterus, uterine fibroids),
overstretching of the uterus due to polyhydramnios, multiple pregnancy, large fruit,
with congenital reduced excitability of the muscle cells of the uterus,
other reasons.

For the treatment of weakness of labor, drugs are used that are administered intravenously with a dropper. When using these drugs, the doctor examines the woman in labor at certain intervals, observes the speed at which the cervix opens. If the uterus does not respond to the administered drugs, then they say that rhodostimulation is ineffective. In this case, one also has to resort to operative delivery.

Acute fetal hypoxia. During childbirth, the condition of the fetus is monitored as carefully as the health of the mother. How the baby feels can be judged by several indicators. The first is the fetal heart rate. Normally, the baby's heart beats at a frequency of 140-160 beats per minute, during a contraction, the heartbeat increases to 180 beats per minute. The heartbeat of the fetus during childbirth is recorded using a special device - a heart monitor and recorded on tape. The doctor can also determine the fetal heart rate with a stethoscope. A deviation in the fetal heartbeat may indicate that the baby does not have enough oxygen. Another indicator of the baby's condition is the nature of the amniotic fluid. Normally the water is clear. When the color of the water changes during childbirth from light green to dark brown, one can also talk about the occurrence of acute oxygen deficiency. The change in the nature of the amniotic fluid is due to the appearance of the original feces - meconium.

In case of acute fetal hypoxia, when the condition of the baby deteriorates sharply during childbirth, the immediate completion of labor is required, since under conditions oxygen deficiency the fetus will die inside the uterus.

Placental abruption. Violation of the connection between the placenta and the uterine wall is accompanied by bleeding, which adversely affects both the condition of the woman and the condition of the fetus. root cause premature detachment placenta is not always possible to establish. This can lead to how mechanical injury upon impact and fall, as well as diseases of various organs and systems (hypertension, kidney disease, etc.), abnormalities in the development of the uterus, polyhydramnios, multiple pregnancy, short umbilical cord. Other reasons are also possible.

Placental abruption causes bleeding. Depending on how the placenta exfoliates - from the edge or in the center, blood may leak out or accumulate between the placenta and the wall of the uterus. In any case, due to blood loss, the condition of both the mother and the baby quickly and progressively worsens. To avoid negative consequences, it is necessary to immediately end the birth in an operative way.

Threatening or incipient uterine rupture. Uterine ruptures are an injury that is extremely rare. This condition can be caused by a discrepancy between the size of the fetus and the mother's pelvis (clinically narrow pelvis), as well as previous operations (caesarean section, operations to remove myomatous nodes). The contractions become frequent, very painful, the pain in the lower abdomen becomes permanent, the uterus does not relax between contractions. With the completed rupture in the mother and fetus, signs of acute blood loss are determined.

Presentation and prolapse of the umbilical cord. There are cases when the loops of the umbilical cord are presented in front of the head or the pelvic end of the fetus, that is, they will be born first, or the loops of the umbilical cord fall out even before the birth of the head. This can occur with polyhydramnios. This leads to the fact that the loops of the umbilical cord are pressed against the walls of the pelvis by the head of the fetus, blood circulation between the placenta and the fetus stops. This situation also requires immediate surgical intervention.

Heavypreeclampsia. Preeclampsia is a pathology of the second half of pregnancy, which is characterized by an increase blood pressure, a violation of the kidneys, which is expressed in the appearance of protein in the urine, as well as the presence of edema. The operation is performed with a persistent increase in blood pressure during childbirth to high numbers, which is not regulated by medication, as well as with the progression of the disease, which is expressed by the appearance of seizures. In this case, there is a spasm of the vessels of the pregnant woman, including the vessels that feed the placenta.

Emergency surgery involves the necessary minimum preparation. First, hygienic treatment is performed. If the pregnant woman took food a few hours before the operation, then the stomach is washed and the probe is left in the stomach to avoid bronchospasm from getting vomit into Airways. The patient is administered sedative drugs intravenously, which has a positive effect on her psychological state, and also accelerates and deepens the action of the anesthetic that will be administered during anesthesia. Empty the bladder.

To perform a caesarean section, the consent of the mother to the operation is required, which is reflected in the history of childbirth even in emergency situations.

Pain management during an emergency caesarean section

Since the current situation requires an early resolution, methods of anesthesia are used that can be implemented as much as possible. short time.

That is why for pain relief during emergency caesarean section operations, more often than during planned operations, the so-called GENERAL ANESTHESIA. In this case, the woman is in an unconscious state, an apparatus for artificial respiration is used.

Since at epidural anesthesia the analgesic effect occurs after 15-30 minutes, then in emergency operations this method of anesthesia is used only when the catheter has been inserted into the space above the solid meninges, even during childbirth. In this case, the woman remains conscious.

Can be used during emergency surgery SPINAL ANESTHESIA. With this method, as well as with epidural anesthesia, an injection is made in the back in lumbar region, the anesthetic is injected into the spinal space. Anesthesia begins to work within the first 5 minutes, which allows you to quickly start the operation. As with epidural anesthesia, it is only anesthetized Bottom part body, the woman remains conscious.

Features of the operation

If during a planned operation a transverse incision is often made in the lower abdomen, then during an emergency operation a longitudinal incision from the navel to the pubis is possible. Such an incision provides wider access to the organs of the abdominal cavity and small pelvis, which is important in a difficult situation.

With emergency surgery, there is always a higher chance infectious complications, that's why antibacterial drugs(antibiotics) are prescribed both during the operation and in postoperative period within 5-7-10 days.

Because some emergency situations, leading to operative delivery, are associated with large blood loss, in case of an emergency operation, there may be a need for blood and blood substitutes.

After the operation, a woman, depending on the cause that led to the caesarean section, spends in the intensive care unit from one to several days. After the mother is transferred to the postpartum ward, normal condition the baby is brought to his mother on the same day. Milk after an emergency operation comes on 3-10 days, as well as after a normal birth. However, since the causes that lead to emergency surgery often lead to fetal suffering, the baby may need treatment and observation in the intensive care unit after surgery.

Speaking of emergency caesarean section, one cannot fail to mention psychological state future mother. Indeed, unlike a planned operation, when a woman knew in advance about the upcoming method of delivery, during an emergency operation, the decision is often made overnight, because the indications for an emergency operation are such that they leave no choice to doctors and expectant mother. In this situation, expectant mothers may experience a state of inferiority, discomfort from unrealized opportunities, anxiety that everything is going wrong. You should not focus on this. Understanding that in this situation the operation is the only way to save your health, and maybe the life of you and your baby, will help you overcome negative emotions.

If immediately before the birth, doctors diagnose that the child cannot be born naturally, an emergency caesarean section is prescribed, the purpose of which is to eliminate complications, health threatening and the life of the mother and fetus. It is resorted to extremely rarely, when, already in the process of the birth of a baby, facts are discovered that were previously hidden from the eyes of physicians.

No one can predict how everything will happen, so everyone should be ready for such a turn of events: both the medical staff and the woman. Emergency surgery is performed only if there are certain medical indications.

Doctors, by virtue of their professional competence, know in which cases an emergency caesarean section is performed: medical indications for this operation are clearly defined.

If there is a serious threat to the life, health of the mother and baby during which the body of the woman in labor cannot cope on her own, a decision is made on surgical intervention. it last resort which doctors go to in the name of saving lives.

What are the most common reasons for an emergency caesarean section in medical practice?

Absolute readings

Clinically narrow pelvis: a discrepancy between the size of the pelvis of the woman in labor and the parameters of the fetus, when the baby's head does not squeeze into the birth canal without injury - in this case, an emergency cesarean is performed with full disclosure cervix;
premature rupture of amniotic fluid, in which drug stimulation of labor is ineffective: the fetus cannot be left in the uterus defenseless from infections;
another indication for an emergency cesarean is a violation of the connection between the uterine wall and the placenta: detachment of the latter causes severe bleeding, due to which the mother or child may die;
detection of anomalies during labor: it can be very unresponsive to external stimulation; especially often this happens when there is an excessive nervous tension mother or malformation of the uterus;
incorrect presentation of the baby in the womb: oblique or transverse, when it lies diagonally or across - natural childbirth will end in the death of the fetus;
uterine rupture;
prolapse or presentation of umbilical cord loops.

These are typical indications for an emergency caesarean, when minutes count and you can’t hesitate to save either the child, or the mother, or both at once.

If during pregnancy during medical examinations the woman was found serious problems with health, she is advised to agree to in order to avoid complications. However, she has the right to refuse. In 50% of such cases, surgeons have to perform an emergency cesarean, which allows you to save the mother and child.

Non-absolute readings

preeclampsia: impaired kidney function in the second half of pregnancy, a sharp jump in blood pressure, convulsions, increased content protein in the urine;
diabetes;
preeclampsia;
diseases (most often chronic) of the heart and kidneys;
myopia, if there is a risk of retinal detachment;
any genital infections;
high pressure;
sometimes when breech presentation a woman expresses a desire to give birth herself, but in most cases complications arise during childbirth and an emergency caesarean section is performed;
the same situation occurs when multiple pregnancy: doctors may recommend elective surgery for a woman, but this is not absolute reading, many refuse surgical intervention, and during labor, an emergency cesarean is performed.

Despite the fact that an emergency caesarean section is always unforeseen and very dangerous situation for doctors and stress for a woman in labor and a child, sometimes this the only possibility save their lives. AT this case you need to completely trust the doctors and follow exactly all their recommendations.

For reference. The main indication for an emergency caesarean is often preeclampsia, which is diagnosed during pregnancy. The disease is characterized severe edema, high blood pressure, loss of protein (it comes out with urine), convulsions. It is one of the most common causes of maternal death during childbirth. Sometimes only urgent operation can fix the situation.

Features 37 weeks

Often, an emergency caesarean is performed for up to 37 weeks, as it is considered one of the most critical. It is during this period that the unexpected development of such complications as fetal hypoxia, premature birth in multiple pregnancies.

Do not worry about the fact that the child was not full-term until the desired date. At 37 weeks, already fully formed, full-fledged babies are born. Many of them end up in the intensive care unit, where they undergo rehabilitation. At this time, the young mother herself is recovering from the stress she experienced and the operation so unexpected for her.

Despite the fact that the decision to conduct an emergency caesarean section at 37 weeks and earlier is made spontaneously, already in the course of labor, both doctors and the woman must anticipate such a development in advance. Usually, pathologies are detected even during pregnancy and suggest two paths for the development of events: agree to a planned operation or wait for natural childbirth. In any case, the woman in labor should be warned about the possibility of an emergency cesarean if something goes wrong at the time the baby is born.

According to statistics. At 37 weeks emergency section carried out in 20% of cases.

Training

If during delivery the situation gets out of control, preparation for an emergency caesarean section is carried out as soon as possible. Since every minute counts, an additional team of doctors is urgently involved: a surgeon and an anesthesiologist. In some cases, when labor activity, albeit weak, has already begun, and the cervix has opened, the actions of the medical staff must be clear and quick, otherwise the child may receive injuries that are incompatible with life. A little easier if doctors have at least some margin of time.

Preparation for an emergency operation involves the following steps:

Examinations, whether the woman in labor has allergies, reactions to anesthesia and others medications.
Specifies what time the last meal was.
The intestines and stomach are cleaned (if necessary) using a probe.
Since for short span time to clean the gastrointestinal tract completely is not always possible, a woman is given a solution of sodium citrate. This drug prevents the contents of the stomach from entering the respiratory tract.
Basic hygiene procedures are being followed.
The anesthesiologist makes a decision (together with the woman or her relatives present at the birth) about.
Premedication is carried out - preliminary before an emergency caesarean section, medical preparation of a woman in labor for general anesthesia and operations. Its goal is to reduce anxiety and secretion of the glands, while enhancing the effect of anesthetics. Includes the most narcotic analgesic, antihistamines and sedatives.

Preparation for the operation sometimes takes only a few minutes, a maximum of hours. This is how an emergency caesarean differs from a planned one: there is no time for additional tests and examinations, because of which some points may be missed by doctors. However, in such a situation, there is no choice when the life of a mother or a child is at stake and you need to act instantly.

When the surgical intervention is known in advance, doctors can calculate their every step as much as possible, and the woman in labor feels much calmer.

Useful information. If an emergency caesarean is performed immediately, no delay is expected, it is better for the woman to lie on her back with a slight slope to the left side. If you need to wait for surgery or anesthesia, it is better to lie completely on your left side. From a medical point of view, such positions are the most optimal for a woman in labor before a CS.

Effects

Since there is no time to prepare for an unexpected operation, the consequences of an emergency caesarean section are much more dangerous and pronounced than with a planned surgical intervention. Doctors cannot assess the whole situation objectively; some nuances are missed, as a result of which complications arise.

Consequences for the mother:

spinal cord injury and prolonged pain in the back during epidural and spinal anesthesia;
toxic reactions to drugs administered during anesthesia;
problems with lactation: milk may not appear;
lengthy , necessity bed rest within 2-3 weeks;
large blood loss, anemia - as a consequence;
, which forces a young mother to take medications that are undesirable during lactation;
you can’t play sports after an emergency cesarean for a long time, so you won’t be able to quickly restore your figure after childbirth;
the risk of developing adhesive processes;
the next pregnancy after an emergency caesarean section (more on this in) will be allowed only after 2 years and, most likely, it will end with the same operation.

Consequences for the child:

as a result of anesthesia during an emergency caesarean, the child's heart rate may decrease, breathing and motor skills may be disturbed, disorientation may be observed;
difficulty sucking;
violation of the production of proteins and hormones, which adversely affect the future adaptation of the child to environment and his mental activity;
decrease in immunity.

In case of emergency caesarean consequences for the child is largely due to the action of anesthesia. With a planned operation, complications are much less common. It's addictive rehabilitation period and requires more long recovery. If the young mother is this stage follow all the doctor's instructions, this will help her cope with all the consequences of the operation, both for own body as well as for the baby.

through the pages of history. Planned operations according to delivery - the trend of the last time. More recently, absolutely all caesarean sections were performed only on an emergency basis.

Recovery period

When a cesarean is performed spontaneously, without preparation, a woman in labor often becomes depressed, as she is not ready for such a turn of events. She wanted the child to be born naturally, like everyone else, and then the surgeons intervened. Such a state of mind of a young mother only delays the already long recovery period after operation. Therefore, her family and friends need to do everything to help her physically and psychologically.

Recovery in the hospital:

in the hospital after an emergency caesarean, you need to lie as long as the doctor says, there is no need to rush home;
pass the antibiotic therapy to avoid infections;
treat the seams with an antiseptic solution;
change bandages regularly.

Home recovery:

3 days without food solid food(more about nutrition after surgery);
the same amount of time - do not sit down;
do not wet the seam for a week;
2 weeks do not use a washcloth in the seam area;
2 months do not lift weights more than 3 kg;
for 2 months to refuse sexual activity;
six months not to engage in serious sports;
2-3 years do not give birth.

Psychological recovery:

you need to understand that if you refuse an emergency caesarean delivery could result in death;
a young mother needs to be given more rest: get enough sleep, walk, do your favorite things;
you can not be nervous, annoyed, worried, communicate with unwanted people;
it is strictly forbidden to go to work immediately after the end of bed rest;
contact a psychologist who works with young mothers in such situations: he will tell you how to cope with depression after an emergency cesarean with minimal losses.

When asked which caesarean is better - emergency or planned - doctors unequivocally state that the latter option is preferable. It allows both the woman and the doctors to thoroughly prepare for the upcoming operation. Despite the fact that delivery in any case is always an unexpected process and it is impossible to predict everything, planned surgical intervention gives confidence and psychological comfort. Yes, and in terms of physiology, according to statistics, after all, there are much more complications after an emergency CS.