Caesarean section refers to a number of surgical medical interventions in the human body. This operation is designed to resolve childbirth and fetus through an incision in the abdominal wall of a woman and the subsequent dissection of the uterine wall. Indications for cesarean section is a series of pathologies and diseases of a pregnant woman. They entail the impossibility of the birth of a natural way due to various kinds of complications that are dangerous to the life and health of the mother and the unborn child.
The need for this type of intervention can be established during pregnancy (then it can be planned or emergency), as well as already during childbirth. In this article we will consider indications for planned and emergency surgery of the COP, as well as her testimony during childbirth. But perhaps many readers will first be interested in learning a little from a story that has its roots in the distant past.
The history of the Caesarean section is associated with the name of the great ancient Roman figure – commander Guy Julius Caesar. According to legend, he was removed from the womb of the mother through an incision on her stomach. For the first time, a real operation of the COP performed by the famous doctor J. Trautman from Wittenberg in 1610 is documented for the first time. As for Russia, in our country the first such births were performed by V. M. Richter in 1842 in the city of Moscow.
A cesarean section is called planned, the indications for which were established by the observing physician during the course of pregnancy. A woman enters the pathological department in advance of the day of surgery and undergoes the necessary examination and preparation. During this period, specialists must assess the physiological condition of the woman, identify all possible violations and risks, and also assess the condition of the fetus.
An anesthetist will talk with a woman in labor, talk about acceptable types of anesthesia, their benefits and possible consequences, and help you choose the most suitable option. He needs to be informed about the presence or absence of allergies or hypersensitivity to certain components of the drug.
For a planned cesarean section, the indications may be as follows:
- Placenta previa. This violation lies in the fact that the placenta (the location of the baby) moves to the lower part of the uterus and blocks the entrance to it. With this diagnosis, there is a risk of severe bleeding, which is dangerous for both the mother and the unborn child. Therefore, the intervention is carried out at 39 weeks of pregnancy, but it is possible earlier if the appearance of secretions with blood is noticed.
- According to the results of ultrasound, the scar on the uterus was declared insolvent, that is, its thickness is less than 3 mm, its contours are uneven. This pathology may be a consequence of previous CS or other surgical interventions on the uterus. Various complications after the operation testify to this diagnosis – increased body temperature in the recovery period, long-term healing of the external suture, inflammatory processes in the pelvic organs.
- A few history of COP. If a woman has previously had two or more such interventions, she is usually not allowed to give birth, as this threatens with a uterine rupture in the scar. The operation is scheduled, waiting for the start of natural resolution should not be.
- Uterine fibroids. When it is multiple and characterized by the location of the node in the neck or the presence of large nodules, the nutrition of which is disturbed, caesarean births are indicated.
- Pathologies of the pelvic organs, including tumors of the uterus or its appendages, II and higher degree of narrowing of the pelvis and others.
- Pathology of the hip joints: ankylosis, congenital dislocation, surgery.
- The size of the fetus during the first birth is more than 4 and a half kilograms.
- The cervix and vagina have pronounced cicatricial narrowing.
- Severe symphysitis. This disease is characterized by a divergence in the pubic bones. Clinical manifestations – difficulty walking, accompanied by pain.
- Fused twins.
- The number of fruits is more than two.
- Improper location of the fetus in the late stages of primiparous (gluteal-leg).
- The fruit is transverse.
- Cancer of the uterus and its appendages.
- Genital herpes in the acute stage, which occurred 1-14 days before the end of gestation. CS is indicated when there are blister-like rashes on the surface of the external genitalia.
- Severe diseases of the kidneys, nervous, cardiovascular systems, lung diseases, as well as a sharp deterioration in the general state of health of a pregnant woman.
- Chronic hypoxia of the fetus, its malnutrition (growth retardation), which is not amenable to drug therapy. In this case, the fetus does not receive the required amount of oxygen, and natural birth can result in severe trauma.
- The age of the woman during the first birth is over thirty years old, combined with any other pathology.
- Malformations of the fetus.
- In vitro fertilization (especially if it has occurred more than once) in combination with other complications.
- Also a serious visual impairment is an indication for cesarean section. It is valid with myopia (the diagnosis of myopia), which occurs in the mother in a complex form, where there is a risk of retinal detachment.
Emergency Cesarean section during pregnancy
Indications for urgent surgical intervention may be unforeseen situations or serious complications during pregnancy, when the life and health of the mother and fetus are at risk. Among them:
- Detachment of the placenta. If the placenta is located normally, then its separation from the uterine wall should occur at the end of labor. But there are cases when the placenta exfoliates during pregnancy and is accompanied by severe bleeding that threatens the life of the fetus and mother.
- Symptoms of uterine rupture on the scar. When there is a risk of rupture, it is important to do an urgent operation in time, as fetal loss and removal of the uterus are possible.
- Acute hypoxia of the fetus, when the baby’s heartbeat decreases sharply and cannot be restored.
- The transition of gestosis to a severe form, the occurrence of preeclampsia and eclampsia.
- Placenta previa, bleeding suddenly revealed.
Caesarean during childbirth
If during childbirth pathologies and abnormalities are detected, which are indications of a cesarean section during pregnancy, and also complications suddenly arise, an operation is necessary. Complications that may occur during childbirth:
- Uterine rupture on the scar.
- Violation of the correspondence between the pelvis of the woman in labor, which turned out to be clinically narrow, and the head of the child.
- In contractions of the uterus, there are violations, which can not be corrected or impossible.
- Presentation of the fetus with legs forward.
- Umbilical cord loops.
- The outflow of amniotic fluid ahead of time, labor stimulation does not give any effect.
Possible effects of cesarean section
Before, during, and after cesarean section, many women feel much better than if they had to resolve naturally. This is explained by the fact that they do not have to worry about birth pains in advance. The second reason – during artificial resolution, a woman does not experience pain and torment. And due to the fact that there are no stretch marks and ruptures of the perineum, after discharge from the hospital, the female body recovers much faster. Of course, if there were no undesirable complications.
However, do not flatter yourself, because no one is safe from complications and unforeseen situations.
Despite the fact that this operation in combination with modern methods and medical equipment is reliable, proven and fairly safe, its complications are possible.
- Surgical complications. During the operation, an accidental entry into the vascular branch during an uterine incision is possible, as a result of which bleeding may occur. Also, bladder or intestines can be affected, and in rare cases the fetus itself is wounded.
- Complications on the background of anesthesiology. After surgery, there is a risk of uterine bleeding. It can occur because the contraction of the uterus is impaired due to an operating injury. It can also be caused by medication. A change in the physico-chemical composition of the blood, which necessarily occurs under the influence of anesthesia, can lead to thrombosis and clogging of blood vessels.
- Purulent complications and infection. After the delivery of cesarean section, the sutures can fester, their discrepancy is still possible.
You should also beware of endometritis (occurs due to inflammation of the uterus), adnexitis (when the appendages are exposed to inflammation), parametritis (perinatal fiber is inflamed). To prevent these diseases, antibiotic treatment is necessary during and after surgery.
As for the child, after medical intervention, he may have problems with the respiratory system and their pathology. In order to partially prevent this threat, the date of the planned operation is set as close as possible to the date that is the end of the gestation period. Also, CS may be a consequence of the difficulties of breastfeeding.
The formation of lactation occurs late, since there has been a significant loss of blood, the mother needs to move away after surgical stress, the child’s adaptation to the new mode of existence is impaired. In addition, a woman needs to find a convenient position for feeding, since the standard one – sitting with the baby in her arms – causes pain and discomfort, as the child presses on the seam.
After CS, disturbances in the baby’s heart can occur, a reduced level of glucose and thyroid hormones is observed. Excessive lethargy and drowsiness of the child are noticeable, muscle tone is reduced, the wound on the navel heals more slowly, and the immune system copes with its activity worse than in children born naturally. But the use of the achievements of modern medicine leads to the restoration and normalization of the physiological parameters of the baby by the day of discharge.
To the question that arises quite rightly in women, which is better – childbirth or a cesarean – a definite answer cannot be given. Of course, it is always better what is laid down by nature itself, which is called natural and does not require additional intervention. Therefore, a caesarean section is not performed at the request of a woman, but only if there is the necessary evidence.