How to get an indication for a caesarean section. What are the indications for a caesarean section? Conditions for the operation

Obstetrician-gynecologist, endocrinologist, candidate of medical sciences Appointment

Obstetrician-gynecologist, highest category, endocrinologist, ultrasound diagnostician, specialist in aesthetic gynecology Appointment

Obstetrician-gynecologist, doctor of ultrasound diagnostics, candidate of medical sciences, specialist in the field of aesthetic gynecology Appointment

Like any surgical intervention in the human body, a caesarean section should be performed only according to indications for it. Indications for caesarean section can be absolute and relative.

Absolute indications for caesarean section are those situations in which natural childbirth is simply physically impossible. In these cases, the doctor is obliged to carry out the birth through a caesarean section and nothing else, regardless of all other conditions and possible contraindications.

The absolute indications for cesarean section on the part of the mother include an absolutely narrow pelvis, that is, such an anatomical structure of the female body, in which the presenting part of the fetus (even the head) cannot pass through the pelvic ring.

At the same time, we are talking about an absolutely narrow pelvis only when the features of conducting labor with a narrowed pelvis do not help. It is clear that a doctor can determine an absolutely narrow pelvis in a woman with the help of examinations and ultrasound during pregnancy.

Obstetricians have clear criteria for the normal size of the pelvis and narrow pelvis according to the degree of narrowing: the pelvis is considered to be absolutely narrow II - IV degree of narrowing. According to this indication, a planned, pre-prepared caesarean section is performed.

It is also possible to determine in advance such an indication for caesarean section as mechanical obstacles that interfere with childbirth through the natural birth canal.

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A mechanical obstruction can be, for example, uterine fibroids located in the isthmus, ovarian tumors, etc. Most often, this obstacle is determined by ultrasound, and on its basis, the doctor prescribes a planned caesarean. The same applies to tumors and deformities of the pelvic bones, which will also prevent the child from passing through the birth canal.

Another absolute indication for caesarean section is the threat of uterine rupture.

This situation occurs either during repeated births, if the first ones were performed using a caesarean section, or after other abdominal operations on the uterus, after which a scar remained. With normal healing of the uterine wall with muscle tissue, uterine rupture does not threaten. But it happens that the scar on the uterus turns out to be insolvent, that is, it has a threat of rupture.

The failure of the scar is determined by ultrasound data (the thickness of the scar is less than 3 mm, its contours are uneven and there are inclusions of connective tissue).

The failure of the scar on the uterus can also be indicated by the complicated course of the postoperative period after the first operation: fever, inflammation of the uterus, prolonged healing of the suture on the skin.

A caesarean section is also done after two or more previous caesarean sections, because this situation also increases the risk of uterine rupture along the scar in childbirth. Multiple births in history, which led to thinning of the uterine wall, can also create a threat of uterine rupture.

Of course, in each case, the condition of the scar is checked by ultrasound individually and repeatedly during pregnancy. So the doctor knows in advance about the insolvency of the scar on the uterus, and can prescribe a planned cesarean.

Absolute indications for caesarean section are also possible from the side of the fetus. These include placenta previa and placental abruption.

Placenta previa is its incorrect location, in which it is attached not to the back wall of the uterus, as usual, but above the cervix, thereby blocking the fetus's exit for the fetus. This threatens with severe bleeding, dangerous both for the life of the mother and for the child.

This is clearly a planned situation, visible on ultrasound throughout pregnancy. The caesarean section in this case is carried out at 38 weeks of gestation or even earlier if there is bleeding, indicating placental abruption.

Premature placental abruption, that is, a situation where the placenta separates from the uterine wall not after, but before childbirth, is also an absolute indication for caesarean section.

This is because during normal, natural childbirth, the baby receives oxygen through the blood flowing from the mother through the placenta to the umbilical cord. Detachment of the placenta makes breathing impossible for the fetus and requires an emergency caesarean section in his vital interests. In addition, placental abruption is a deadly situation for the mother, as it causes life-threatening bleeding.

Unlike absolute indications for caesarean section, relative indications mean that natural birth is physically possible, but may be associated with a threat to the life and health of the mother or child.

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The number of cases of caesarean section in the modern world is increasing precisely due to the relative indications in which childbirth can be carried out in a natural way, but this represents a much higher risk for both the mother and the fetus than operative delivery.

However, with relative indications for caesarean section, the issue is usually resolved individually, taking into account all the circumstances, conditions and contraindications.

Relative contraindications to caesarean section can also be both on the part of the mother and on the part of the fetus.

On the part of the mother, these are, first of all, her diseases not associated with pregnancy, in which the burden of natural childbirth threatens the life and health of the mother.

Such diseases include any cardiovascular pathology, kidney disease, high myopia with changes in the fundus, diseases of the nervous system, diabetes mellitus, cancer of any localization, and some other diseases.

In addition, indications for caesarean section are exacerbations in the mother of chronic diseases of the genital tract (for example, genital herpes), when the disease can be transmitted to the child during natural childbirth.

Relative indications for caesarean section are some complications of pregnancy, which can endanger the life of the child or the mother herself during natural childbirth.

First of all, it is preeclampsia - a late complication of pregnancy, in which there is a disorder in the function of vital organs, especially the vascular system and blood flow.

Severe manifestations of preeclampsia - preeclampsia and eclampsia. At the same time, microcirculation in the central nervous system is disturbed, which can lead to serious complications for both the mother and the fetus.

A relative indication for caesarean section is the persistent weakness of labor activity, when labor that has begun normally for some reason subsides, or goes for a long time without noticeable progress, and medical intervention does not bring success.

If at the same time the devices show that the condition of the fetus is deteriorating (for example, due to hypoxia), then operative delivery is possible.

The clinically narrow pelvis of the mother, that is, the situation when the size of the woman's pelvis does not correspond to the size of the presenting part of the child, is also a relative indication for caesarean section.

You can often hear that for a nulliparous woman, age over 35 is also an indication for a caesarean section. This is not entirely true.

This means that in a situation where a younger woman can try to risk giving birth herself, a woman after 35 years is better not to do this. The point is simply that after the age of 35, the general health of a woman is usually worse than in her first youth. However, everything is decided individually, and age itself is not an obstacle to natural childbirth.

Relative indications for caesarean section can be not only on the part of the mother, but also on the part of the fetus.

Relative indications for caesarean section are the transverse position and breech presentation of the fetus.

Moreover, with the transverse position of the fetus, a cesarean is almost always done, and a breech presentation is a situation in which a woman can try to give birth herself. Breech presentation of the fetus becomes an indication for cesarean only in combination with another pathology.

The same can be said about a too large (more than 4 kg) fetus - in combination with another pathology, this is a relative indication for a caesarean section.

An indication for caesarean section is also fetal hypoxia - that is, lack of oxygen.

Chronic hypoxia, as a rule, which is a consequence of maternal gestosis, leads to a delay in the development of the child, which can be seen on ultrasound. Acute hypoxia is detected during childbirth with the help of special equipment.

A sign of acute fetal hypoxia is, first of all, a sharp decrease in the fetal heart rate, which is not restored. In this case, a caesarean section is the safest delivery method for the baby.

There are other relative indications for caesarean section, most of which appear already in childbirth and serve as a reason for an emergency caesarean section.

It is important to remember that the name "relative indications" only means that childbirth can physically occur naturally. However, they were not invented to make it more convenient for doctors, as many maximalist expectant mothers believe. These are situations in which, taking into account all the disadvantages of operative delivery, the greater safety of planned caesarean section for both the mother and the child has been proven in comparison with childbirth through the natural birth canal.

In addition, there are so-called combined indications for caesarean section. Combined indications are a combination of several complications of pregnancy and childbirth, each of which individually does not serve as an indication for caesarean section, but together they create a real threat to the life of the fetus.

For example, breech presentation plus a large fetus; post-term pregnancy plus fetal hypoxia; a scar on the uterus plus the age of the mother over 30 years and a history of infertility, and so on.

Like any operation, a caesarean section can only be performed under certain conditions. The conditions for performing a caesarean section are: the presence of an equipped operating room and a surgeon who knows the technique of the operation, a viable fetus, the absence of infections and the consent of the woman or her relatives to the operation.

In turn, intrauterine fetal death, fetal malformations and conditions incompatible with life, and the presence of infections in a woman in labor are contraindications for surgery.

During pregnancy management at the Euromedprestige Medical Center, an obstetrician-gynecologist conducts a thorough examination of the expectant mother to identify indications and contraindications for caesarean section. You can also be diagnosed by doctors of other specialties such as endocrinologist, cardiologist, gastroenterologist, etc.

The doctors of our center are confident that the conditions and contraindications for caesarean section are taken into account only in the absence of absolute indications for caesarean section. Otherwise, they lose their value.

Some pathologies of the mother and child can affect the natural course of childbirth or cause the death of the mother and fetus. To avoid serious consequences, gynecologists have developed indications for caesarean section.

This list is divided into absolute and relative indications.

Absolute - these are those in which a woman will not be able to give birth without surgical intervention.

Relative - all the reasons for which childbirth proceeds with complications and threatens with the death or injury of the child. Most often, cesareans are performed with relative indications in favor of the baby.

A caesarean section is a surgical abdominal operation. The purpose of which is the birth of a child, the preservation of the life and health of the mother and baby.

Absolute maternal and fetal indications

Mandatory indications identified in a woman in labor:

anatomically;
early with a normal location;
complete;
bleeding with incomplete presentation;
heavy and , ;
scarring of the tissues of the pelvis, vagina, walls of the uterus, cervix, pelvic organs, fistulas of the genital organs and intestines.

From the side of the fetus:

transverse, oblique, pelvic presentation;
incorrect entry of the head into the birth canal;
prolapse of the umbilical cord;
acute oxygen starvation;
near-death state or death of a woman in labor.

Relative maternal and fetal indications

From the pregnant side:

clinically narrowed pelvis;
preeclampsia, lasting from the 20th week of pregnancy and difficult to treat;
extragenital diseases, which, with natural delivery, will lead to a significant deterioration in health;
weak, pathologically proceeding generic process;
genital organs;
delayed pregnancy;
especially in first-time births.

From the side of the fetus:

chronic between fetus and placenta;
early in breech presentation or primiparous age over 30 years;
weight over 4 kg.

Indications for caesarean section for vision refer to relative maternal indications:

dystrophy of the fundus;
eye injury;
experienced surgery due to retinal detachment;
myopia;
severe myopia of minus seven diopters or more.

Indications for caesarean section by age are also relative. Depend on the general condition of the woman in labor and the course of pregnancy.

Indications for emergency surgery

A caesarean section is usually planned ahead of time. But sometimes there are situations in which - the only way to save the life of the mother and baby.

This is a life-saving operation:

head too large for the pelvis, detection of pathology during childbirth;
early outflow of amniotic fluid in the absence of labor;
weak birth uterus even after;
placental abruption during childbirth;
the threat of uterine rupture or a rupture that has begun - with such an injury, severe bleeding appears;
prolapse of the loops of the umbilical cord and blocking their head;
fetal hypoxia, threatening its death;
preeclampsia of a pregnant woman, appeared renal failure.

Cesarean without indications

A caesarean section is an abdominal operation in which the peritoneum is opened. It is associated with many dangers in the postoperative period. During the operation, there are difficulties with the selection of anesthesia, especially in case of emergency caesarean.

Complications are also in the form of bleeding and injuries of internal organs located near the uterus.

Surgical complications include the inconsistency of the head or body of the baby with the incision made.

Anesthesia, administered to the mother, one way or another penetrates to the baby, and has a toxic effect on him.

The postoperative period has its complications. With abdominal operations there is:

high risk of infection in the abdominal cavity and infection of internal organs;
bleeding inside the peritoneum;
rejection of suture material, divergence of seams, and others.

The postoperative period is accompanied by severe pain. Pain medication harms the baby, and weaker drugs do not help the mother.

Abdominal operations also have a postoperative complication in the form of adhesions - the appearance of connective tissue that fuses the internal organs with the walls of the peritoneum.

They disrupt the patency of the fallopian tubes and intestines. As a result, secondary infertility and diseases of the digestive system develop.

A baby born by cesarean is not burdened by the mother's microflora and immunity does not form immediately after birth. He does not experience the difference in pressure during the passage of the birth canal, which is designed to start his life processes.

With natural delivery, the child passes through the narrow birth canal and at the same time are included in the work:

his lungs, kidneys;
digestive and nervous systems;
the second circle of blood circulation;
the opening between the atria is closed.

A caesarean section is not an alternative way to have a baby, but an operation designed to save the life of the mother and child. It is not carried out without evidence. The decision on surgical intervention in the natural process is made by the doctor.

How is the operation performed

Usually one week before the proposed operation, they are hospitalized. In a hospital, she is examined, the vessels of the pregnant woman, placenta, and fetus are carried out.

At this stage, the woman will need the help of relatives.

Contraindications for surgery

With complete placenta previa and an anatomically narrow pelvis, the refusal of a caesarean section means the death of the child and the woman in labor.

Refusal of surgical intervention can only be justified by the high risk of purulent complications and sepsis in the postoperative period.

Typically, such complications occur if the patient has an acute inflammatory disease - endometritis,.

Also, relative contraindications for caesarean section include:

long course of childbirth - longer than a day;
discharge of amniotic fluid more than 12 hours ago;
frequent vaginal examinations;
failed attempts at delivery;
death of a child in the womb, severe fetal pathology.

Pregnancy after cesarean

The dissection of the peritoneum is carried out between the muscles of the peritoneum along the tendon plate. After healing, a scar remains.

With subsequent pregnancies and childbirth, there is a danger of its rupture.

Having more than three pregnancies in a surgical delivery is prohibited.

Each subsequent excision reduces the area of the body of the uterus.

A new pregnancy is allowed after 2 years.

Video: indications for caesarean section list

The birth of a child can be not only a great happiness, but also no less a health problem. Caesarean section avoids possible complications in childbirth for the mother and fetus. At what kind of vision such an operation is needed - the answer depends on what caused the pathology.

In healthy women, pregnancy is easy and rarely causes complications. But if a woman has health problems, then during pregnancy they will only get worse - this should be remembered at the stage of conception planning in order to cure or lead to remission of all possible diseases.

How does childbearing affect vision? If a woman already has eye diseases, then in most cases it is bad, namely:

There is an elongation of the eyeball, amplified, most often, temporarily. Perhaps the appearance of a slight passing myopia in a healthy woman.
Dry eye syndrome.
Increased intraocular pressure, deterioration in patients with glaucoma, the appearance of flies before the eyes in healthy women.
Deterioration of the blood supply to the retina, as a result - deterioration in color vision, blurred vision, etc.

Most of the symptoms mentioned above are temporary and vision returns to normal after childbirth, especially in healthy women. But patients suffering from severe myopia or glaucoma may find that negative changes persist after pregnancy.

Especially dangerous are circulatory disorders - this shell of the eye is the most difficult to recover, and if degenerative processes have begun in it, then they are irreversible.

Diagnosis of vision in pregnant women

In order to prevent pathology in a timely manner, a mandatory diagnosis of vision in pregnant women is carried out. If there are no complaints, and the woman feels well, then the examination is carried out twice during pregnancy.

At 10–14 weeks, visual acuity is diagnosed and the fundus is examined with a dilated pupil. This allows you to determine the early signs of preeclampsia, which can be dangerous for the mother and baby in the future. The same studies are repeated at 34–36 weeks to ensure that the delivery is safe for the woman and she retains her sight.

If a woman has complaints, then she needs to undergo repeated examinations. The deadline for their implementation is as soon as possible after the appearance of complaints. The diagnostic program includes a visual acuity test, an examination of the fundus, according to indications, color vision diagnostics and other examinations.

Women at risk - suffering from myopia, increased arterial, intracranial and glaucoma, impaired vascular tone, kidney disease and diabetes - should contact an ophthalmologist at the stage of pregnancy planning.

What is the danger of childbirth with eye diseases?

An ophthalmological examination is an obligatory part of the regular examination of pregnant women.

Natural childbirth is always associated with high physical activity, increased blood pressure, as a result, both intraocular and intracranial pressure can rise. This threatens with irreversible consequences - detachment and degenerative changes in the retina, which are irreversible, vascular ruptures and hemorrhages in the eye, dislocation, ruptures.

To avoid these pathologies, a caesarean section is done - it eliminates physical activity.

It is important to ensure that the last examination before childbirth at 34–36 weeks may show a normal value, but during childbirth, under the influence of stress, dystrophic changes and retinal detachment may begin. Women at risk need to be prepared for such a development of events.

Pathologies of vision in which a caesarean section is performed

A caesarean section is done for pathologies that threaten retinal detachment or other eye injuries. It may be indicated by:

Retinal degeneration, retinal detachment.
Progressive myopia during pregnancy.
Edema of the optic nerve.
History of eye surgery within a year prior to pregnancy.
Any progressive condition leading to visual impairment during pregnancy.

It should be noted that the degree (myopia) does not affect the need for a caesarean section, it is only important how much the patient's vision has changed during pregnancy.

Even a weak but rapidly progressing myopia may be an indication for surgery, and with a strong but stable myopia, a woman can cope with childbirth on her own.

Often, doctors advise a cesarean section for women who have severe eye diseases - myopia greater than 6.0, caused by diabetes mellitus or kidney disease, high intraocular pressure. These conditions give a high risk of development in childbirth, and this disease is irreversible. To avoid the risk, it is better to do a caesarean section - this will help the woman maintain her vision.

When can you give birth on your own?

There are relative and absolute indications for caesarean section.

Is it always necessary to do a caesarean section? No, there are a number of conditions that seem dangerous, but allow you to give birth on your own, as well as a number of diseases that can be quickly and without complications cured during pregnancy.

Diseases in which there are no indications for caesarean section - stable mild to moderate myopia, inflammatory diseases of the auxiliary apparatus of the eye (,), uncomplicated diabetes mellitus, arterial hypertension with normal intraocular pressure.

During pregnancy, laser vision correction and laser photocoagulation of the retina can be performed. This allows you to correct myopia and reduce the risk of retinal pathologies. The time for such operations is up to the 30th week of pregnancy, during which time the eye has time to fully recover. After such operations, natural delivery is possible.

As for glasses and lenses during childbirth, the opinions of obstetricians differ here. Most often, glasses on the face interfere quite strongly, so a woman is advised to take them off and put them where it will be convenient to take them in order to feel comfortable. It is better to remove the lenses before childbirth - they irritate the eyes and can increase discomfort.

In the video below, ophthalmologists explain under what pathological conditions of vision in pregnant women it is recommended, and sometimes mandatory, to perform a caesarean section:

All my patients (I am now exclusively talking about expectant mothers) are divided into two types. The first are those who believe that a woman is simply obliged, even though she has all the indications for a caesarean section, to give birth herself.

And when the ladies from this category find out that surgical intervention cannot be avoided, until the baby is born, they torture themselves with remorse: “How is it, why me, because I tried so hard to make everything “correct” .

The other category includes women who, already at the first consultation, categorically declare: “Doctor, you do as you wish, but I will not give birth myself. Cut me and better under general anesthesia. Otherwise, I simply won’t survive all the torment that they write about on the forums and talk about while sitting in line with the doctor. ”

FirstSecond

If you recognize yourself in one of the situations I have described, then it will be very useful and interesting for you to learn everything about the absolute and relative indications that indicate the need for surgical delivery. So, let's figure out when you can't do without an operation at all, and when a doctor can agree to carry it out even without any prerequisites for that.

List of indications for caesarean section 2019

Every day there are changes in the medical protocols regarding CS. For example, not so long ago, in vitro fertilization was the first item on the list of indications for a planned caesarean section. Today, this prescription is not so categorical, and when deciding on the advisability of surgical intervention in the process of childbirth, the reasons for which the patient underwent IVF are considered first of all. If, for example, assistance in assisted reproductive technologies arose due to the male factor, and the woman is quite healthy, then why can't she give birth on her own?

Many heart diseases, vision pathologies, etc. were also excluded from the list of indications for caesarean section. However, over the past period of 2019, more than 30% of children left the mother's womb through an incision on the abdomen, and not naturally. Let us consider in more detail what this fact is due to.

Absolute readings

Absolute indications for caesarean section include clinical circumstances in which natural delivery poses a threat to the life of the patient.

A woman cannot avoid surgery if she has:

Narrow pelvis.
Neoplasms were found in the ovaries, uterus or bladder, which block the birth canal and can prevent the baby from being born.
Placental presentation.
The placenta began to exfoliate ahead of time, which caused bleeding.
The fetus is in an oblique or transverse position.
Previously, there was an operation on the uterus (for example, childbirth).
Eclampsia is a late toxicosis with a severe course.
Oncological diseases of the abdominal cavity, genital or genitourinary system.
There is a risk of uterine rupture.
The dimensions of the pelvis do not correspond to the parameters of the fetal head.
Varicose veins of the vulva or vagina.

Almost all of these factors become known already during pregnancy, so the fact that a caesarean will be performed will not come as a surprise to a woman.

Relative readings

The list of relative (indirect) indications for caesarean section for each doctor may vary depending on his professional experience, accepted standards and protocols in a particular clinic.

A narrow pelvis in combination with a large fetus or its.
Asynclitic insertion of the head.
High straight or low transverse swept seam.
Oxygen starvation of the fetus.
Weak or discoordinated labor activity that cannot be corrected.
The fetus is in breech presentation.
The pregnancy has already been postponed, and the body does not give signals of readiness for childbirth.
Moderate or mild degree of late toxicosis.
First birth, age 35+.
The fruit is too large.
Serious pathologies of the development of the uterus.
The umbilical cords fall out.

In addition to those listed above, there are also situations when there is an urgent need for surgery.

Indications for emergency caesarean section

As a rule, the need for urgent surgical intervention arises in situations where the patient cannot give birth on her own without risking her own life and that of the child. That is, most often, indications for an emergency caesarean section are found during natural childbirth or almost at the last moment before such.

Here are the most common examples:

The labor activity of a woman is normal, the contractions are “on schedule”, the uterus has opened, and the baby’s head is not moving along the birth canal.
Drug stimulation has no effect, there is no labor activity, but the amniotic fluid has already departed, which makes the fetus vulnerable to infections.
The connection between the placenta and the walls of the uterus is broken.
There was a uterine rupture.
The placenta exfoliated, and bleeding began.
There was an acute fetal hypoxia.
The child has turned in such a way that the loops of the umbilical cord prevent its exit.
Arose acute preeclampsia due to impaired renal function.
The mother's blood pressure rose sharply, and convulsions began.

I have listed only the most frequent cases that occur in my practice, and are indications for an emergency caesarean section. But there may be other situations that no doctor, unfortunately, is able to foresee.

Main list of contraindications

In some situations, surgical intervention in the process of childbirth is highly undesirable.

The operation is dangerous:

if there is a risk of complications of a purulent-septic nature in the patient;
the fetus has malformations or deformities that are incompatible with life;
the fetus in the womb froze (died);
the fetus is very premature and cannot survive outside the uterus.

When there is no longer any doubt that the fetus is not viable, we, doctors, direct all efforts to save the woman's life. In such cases, even if there is a section, the operation is still done, but according to a special technique. Previously, the dead fetus had to be removed along with the uterus in order to prevent purulent-inflammatory complications. But today we have the opportunity to save women's main reproductive organ, thanks to the extraperitoneal technique, which involves the temporary isolation of the abdominal cavity during surgery.

Cesarean section without indications

Perhaps you will find an obstetrician-gynecologist who will perform a cesarean without indications. But I always refuse such requests to my patients, because I consider such a decision of a woman to be nothing more than a whim and a desire to get a result without effort on my part.

I justify my refusal with the following facts:

Every healthy woman is able and should give birth on her own.
With CS, the risk of complications 12 times higher.
Narcosis has a bad effect on the body of mother and child.
it will take a long time, and having given birth on your own, you will be able to return to your usual way of life the very next day.
If you go for a caesarean section without indications, it is not a fact that you will be able to have children in the future, and if you can, then not earlier than in 3 years.
The postoperative suture will disturb for quite a long time.
It is not a fact that after the CS it will normalize, the child may have to grow up on artificial mixtures, which will definitely not help strengthen his immunity.

In addition, the "cesarean" lacks the hormones necessary to adapt to the new environment. Therefore, before making such decisions, think about whether it is worth risking your health, if not yours, then that little man that you will bring into the world.

I try not to give too many recommendations to patients who are going to have surgery. After all, a woman during pregnancy is very impressionable, and may regard my advice as a warning, than to cause unnecessary worries. Everything that is required from a future mother for a successful caesarean section:

Follow the routine.
Eat right, especially in the last days before childbirth (exclude solid, fatty, salty, spicy foods and carbonated water).
Prepare in advance everything you need for yourself and the baby (a detailed list of things and hygiene products is provided in the antenatal department).
Get enough sleep.
Walk more outdoors.
Follow all doctor's orders.

If a woman does not have serious health problems, then following these six simple recommendations is enough for the CS and the recovery period to pass without any complications.

How is the operation

If the indications for a caesarean section are established at the stage of pregnancy, and a planned operation is ahead, the technique for its implementation is as follows:

Anesthesia is administered - local or (the decision on which anesthesia to use is made by the doctor together with the patient).
The operating field is treated with an antiseptic.
Step by step, layer by layer, the skin on the abdomen, muscles and the abdominal wall are cut.
The uterine cavity is opened.
The child is removed.
The umbilical cord is cut
Manipulations are carried out to clear the mucus from the mouth and nose of the newborn.
The placenta is removed.
The cut layers are sutured in reverse order.
The seam is treated with special preparations.

In terms of time, these 10 stages last a total of no more than an hour. After that, the mother is transferred to the intensive care unit literally for a day. If there are no complications, the woman goes to the general department the very next day, where she can fully enjoy the joy of motherhood.

What you need to be ready for

Many of my patients who find out during pregnancy that they have indications for a caesarean section ask me the same question: “Doctor, what should I expect, what should I prepare for?”. I answer almost everyone the same way: “Get ready to become a happy mother!”. Yes, surgery is difficult. Yes, you need to follow all the doctor's prescriptions for all 9 months, lead a healthy lifestyle, etc.

There is a risk of complications as a result of prolonged anesthesia and surgical intervention - this is also a fact. As well as the fact that the recovery period in this case is longer and not the easiest. But all this can and should be experienced in order to give life to another person and subsequently enjoy all the joys of motherhood.

Conclusion

If you have indications for a caesarean section, whether direct or indirect, it's definitely not worth the risk. Especially since your life and your child's are at stake. Despite all the difficulties of the operation, if there are even the slightest risks, it is better to completely eliminate them.

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If we believe the information that has come down to us from the past, the history of the caesarean section is rooted in antiquity. The myths of ancient Greece say that it was in this way that Dionysus and Asclepius were extracted from the womb of dead mothers. At the end of the 12th century BC, a law was passed in Rome, according to which the burial of a dead pregnant woman was carried out only after the removal of the child by means of ablation. Soon this experience was adopted by doctors from other countries, but the operation was performed exclusively on dead women. In the 16th century, Ambroise Pare, a French court surgeon, first began performing caesarean sections on live patients, but the outcome was always fatal. The mistake made by Pare and his followers was that the incision on the uterus was not sewn up, relying on the contractility of this organ. Caesarean section was for the doctors of that time an opportunity to save the child, when there was no chance to save the life of the mother.

Only in the 19th century was it proposed to remove the uterus during surgical delivery, due to which the mortality rate was reduced to 20-25%. After some time, the organ began to be sewn up using a special three-story suture, which made it possible to perform cesarean not only for dying women in labor - it began to be carried out to save the lives of women. In the middle of the 20th century, with the beginning of the era of antibiotics, deaths due to surgery became rare. This was the impetus for expanding the list of indications for caesarean section, both on the part of the mother and the fetus.

Absolute indications for caesarean section

Today, absolute indications for caesarean section are situations where delivery in another way is impossible or endangers the life of a woman. Among them:

Anatomically narrow pelvis (III-IV degree of narrowing). The causes of this pathology are different: excessive physical activity or malnutrition in childhood, trauma, rickets, tuberculosis, poliomyelitis, etc. The formation of an anatomically narrowed pelvis is also facilitated by hormonal imbalance during puberty;
Premature detachment of a normally located placenta (in the absence of the possibility of urgent delivery in a natural way). Physiologically, the placenta separates (exfoliates) from the uterine walls after the birth of the baby. Premature is called placental abruption, which began during gestation, as well as in the first or second stage of labor;
Complete placenta previa or open bleeding with incomplete presentation;
Threatening or incipient uterine rupture. Such an anomaly occurs in 0.1-0.5% of cases of the total number of births;
Eclampsia during pregnancy or in the first stage of labor; the inability to carry out a quick delivery of a patient with severe current preeclampsia, not amenable to therapy; onset of renal and hepatic failure;
Cicatricial changes in the genital organs and pelvis (rare cases of stenosis of the vagina and cervix that occur against the background of infectious diseases (diphtheria, scarlet fever, etc.), as well as various kinds of manipulations); the presence of urogenital and intestinal-genitourinary fistulas. Fibromyomas, tumors of the ovaries, as well as soft and bone elements of the pelvis, in case of unfavorable localization, can become an obstacle to the natural extraction of the fetus;
Incorrect presentation of the fetus (transverse, oblique or pelvic) in combination with a large weight;
Incorrect insertion of the fetal head into the entrance to the small pelvis. It is noteworthy that such a condition does not always become an absolute indication for the appointment of a cesarean. Surgical intervention is indicated for frontal, anterior facial, posterior parietal insertion and posterior high straight standing. In other cases, the choice of delivery method is made depending on the presence of concomitant complications;
Presentation and prolapse of the umbilical cord;
Acute fetal hypoxia;
A state of agony or death of a woman in labor with a live fetus.

Relative indications for caesarean section

Relative indications for caesarean section include situations that do not exclude the possibility of spontaneous childbirth, but the likelihood of complications for the woman and / or fetus in this case is greater than in the case of surgical delivery. These include:

Clinically narrow pelvis - discrepancy between the child's head and the size of the mother's pelvic bones;
Long-term gestosis of the second half of pregnancy, resistant to therapy, or a complicated course of this condition;
Diseases of organs and systems not related to reproductive function, in which spontaneous childbirth is accompanied by an increased danger to the health of the pregnant woman (epilepsy, myopia with degenerative changes in the fundus, post-traumatic disorders of the brain, endocrine, cardiovascular pathologies, etc.);
Persistent weakness and other anomalies of labor activity;
Deviations in the development of the uterus and vagina, which impede the course of natural childbirth (vaginal septum, bicornuate or saddle uterus, etc.);
Postponed pregnancy. Pregnancy is recognized as postponed if it lasts 14 days longer than physiological;
The presence of a woman before this pregnancy habitual miscarriage, infertility and other problems in the reproductive sphere;
The age of the primiparous is more than 30 years;
Chronic placental insufficiency (impaired blood exchange between the fetus and the placenta during the entire period of gestation). According to statistics, in every 5th case, such a pathology leads to the death of a child;
Premature discharge of amniotic fluid;
The presence of a large fetus (weighing more than 4000 g). Typically, this problem is faced by women with diabetes, obesity, who are tall, have a large weight gain during pregnancy, and who have given birth multiple times in the past.