At what month is a caesarean section performed? Indications for cesarean section - in what cases is a CS prescribed? Important points during caesarean section. Planned caesarean

All over the world there is a clear trend towards gentle childbirth, which helps preserve the health of both mother and child. The tool that helps achieve this is the cesarean section (CS). A significant achievement has been the widespread use of modern pain management techniques.

The main disadvantage of this intervention is considered to be an increase in the incidence of postpartum infectious complications by 5-20 times. However, adequate antibacterial therapy significantly reduces the likelihood of their occurrence. However, there is still debate about in which cases a caesarean section is performed and when physiological delivery is permissible.

When is surgical delivery indicated?

A caesarean section is a major surgical procedure that increases the risk of complications compared to a normal vaginal birth. It is carried out only according to strict indications. At the request of the patient, a CS can be performed in a private clinic, but not all obstetricians-gynecologists will undertake such an operation unless necessary.

The operation is performed in the following situations:

1. Complete placenta previa is a condition in which the placenta is located in the lower part of the uterus and closes the internal os, preventing the baby from being born. Incomplete presentation is an indication for surgery when bleeding occurs. The placenta is abundantly supplied with blood vessels, and even slight damage to it can cause blood loss, lack of oxygen and fetal death.

2. Occurred prematurely from the uterine wall - a condition that threatens the life of the woman and child. The placenta detached from the uterus is a source of blood loss for the mother. The fetus stops receiving oxygen and may die.

3. Previous surgical interventions on the uterus, namely:

• at least two caesarean sections;
• combination of one CS operation and at least one of the relative indications;
• removal of intermuscular or on a solid basis;
• correction of a defect in the structure of the uterus.

4. Transverse and oblique position of the child in the uterine cavity, breech presentation (“butt down”) in combination with an expected fetal weight of over 3.6 kg or with any relative indication for surgical delivery: a situation where the child is located at the internal os in the non-parietal region , but the forehead (frontal) or face (facial presentation), and other location features that contribute to birth trauma in the child.

Pregnancy can occur even during the first weeks of the postpartum period. The calendar method of contraception is not applicable in conditions of an irregular cycle. The most commonly used condoms, mini-pills (gestagen contraceptives that do not affect the child during feeding) or regular ones (in the absence of lactation). Use must be excluded.

One of the most popular methods is. Installation of an IUD after a cesarean section can be performed in the first two days after it, however, this increases the risk of infection and is also quite painful. Most often, the IUD is installed after about a month and a half, immediately after the start of menstruation or on any day convenient for the woman.

If a woman is over 35 years old and has at least two children, at her request, during the operation, the surgeon can perform surgical sterilization, in other words, tubal ligation. This is an irreversible method, after which conception almost never occurs.

Subsequent pregnancy

Natural childbirth after a cesarean section is allowed if the formed connective tissue on the uterus is strong, that is, strong, smooth, and able to withstand muscle tension during childbirth. This issue should be discussed with your attending physician during your next pregnancy.

The likelihood of a subsequent birth normally increases in the following cases:

• the woman gave birth to at least one child vaginally;
• if the CS was performed due to incorrect fetal position.

On the other hand, if the patient is over 35 years old at the time of subsequent births, she has excess weight, concomitant diseases, and inappropriate fetal and pelvic sizes, it is likely that she will undergo surgery again.

How many times can you have a caesarean section?

The number of such interventions is theoretically unlimited, but to maintain health it is recommended to do them no more than twice.

Typically, the tactics for repeated pregnancy are as follows: the woman is regularly observed by an obstetrician-gynecologist, and at the end of the gestation period a choice is made - surgery or natural childbirth. During normal childbirth, doctors are ready to perform emergency surgery at any time.

Pregnancy after cesarean section is best planned at intervals of three years or more. In this case, the risk of suture failure on the uterus is reduced, pregnancy and childbirth proceed without complications.

How long after surgery can I give birth?

This depends on the condition of the scar, the woman’s age, and concomitant diseases. Abortion after CS has a negative impact on reproductive health. Therefore, if a woman does become pregnant almost immediately after a CS, then with a normal course of pregnancy and constant medical supervision, she can carry a child, but delivery will most likely be operative.

The main danger of early pregnancy after a CS is suture failure. It is manifested by increasing intense pain in the abdomen, the appearance of bloody discharge from the vagina, then signs of internal bleeding may appear: dizziness, pallor, drop in blood pressure, loss of consciousness. In this case, it is necessary to urgently call an ambulance.

What is important to know when having a second caesarean section?

Elective surgery is usually performed at 37-39 weeks. The incision is made along the old scar, which somewhat lengthens the operation time and requires stronger anesthesia. Recovery after a CS may also be slower as scar tissue and abdominal adhesions prevent the uterus from contracting well. However, with a positive attitude of the woman and her family, and the help of relatives, these temporary difficulties are completely surmountable.

For many decades, this operation - caesarean section - has been saving the life and health of a mother and her baby. In the old days, such surgical intervention was performed extremely rarely and only if something threatened the life of the mother in order to save the child. However, caesarean sections are now being used more and more often. Therefore, many specialists have already set themselves the task of reducing the percentage of births performed through surgical intervention.

Who should perform the operation?

First of all, you should understand how a caesarean section is performed and what consequences await the young mother. Surgical birth itself is quite safe. However, in some cases, surgery is simply not practical. After all, no one is protected from risk. Many expectant mothers ask for a caesarean section only out of fear of severe pain. In this case, modern medicine offers epidural anesthesia, which allows a woman to give birth without pain.

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

• Obstetrician-gynecologist - directly removes the baby from the uterus.
• The surgeon makes an incision into the soft tissue and muscles of the abdominal cavity to reach the uterus.
• A pediatric neonatologist is a doctor who delivers and examines a newborn baby. If necessary, a specialist in this profile can provide first aid to the child and also prescribe treatment.
• Anesthesiologist - performs pain relief.
• Nurse anesthetist - helps administer anesthesia.
• Operating nurse - assists doctors if necessary.

The anesthesiologist should speak with the pregnant woman before the operation to clarify which type of anesthesia is preferable for her.

Types of caesarean section

Indications for caesarean section can be completely different, and the operation is performed differently in certain cases. Today, there are two types of births performed using surgical intervention:

Emergency surgical intervention 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 labor 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

Elective surgery (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 performing such a surgical procedure, the doctor makes a transverse incision. The child usually does not experience hypoxia.

Emergency caesarean section

As for emergency caesarean section, the operation is usually carried out using general anesthesia, since the woman may still have contractions, and they will not allow a puncture for epidural anesthesia. The incision for this type of surgery is mainly longitudinal. This allows you to remove the baby from the uterine cavity much faster.

It is worth noting that during emergency surgery, the child may already experience severe hypoxia. At the end of the cesarean section, the mother cannot immediately see her baby, since a cesarean section is performed 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. During subsequent pregnancies they may simply become torn. 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 bottom to top. To be more precise, to a level just below the navel from the pubic bone. Making such an incision is much easier and faster. Therefore, it is usually used during an emergency caesarean section in order to remove 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 practically invisible and heals well.

As for the repeated operation, the suture from the previous one is simply excised.
As a result, only one seam remains visible on the woman’s body.

How does the operation proceed?

If the anesthesiologist performs an epidural anesthesia, then the site of the operation (incision) is hidden from the woman by a septum. But let's look at how a caesarean section is performed. The surgeon makes an incision in the wall of the uterus and then opens the amniotic sac. After which the child is removed. Almost immediately, the newborn begins to cry heavily. The pediatrician cuts the umbilical cord and then performs all the necessary procedures on the child.

If the young mother is conscious, the doctor immediately shows her the baby and may even let her hold it. After this, the child is taken to a separate room for further observation. The shortest period of the operation is the incision and removal of the child. It only takes 10 minutes. These are the main advantages of a cesarean section.

After this, doctors must remove the placenta, thoroughly treating all the necessary vessels so that bleeding does not start. The surgeon then stitches up the cut tissue. The woman is placed on a drip, giving a solution of oxytocin, which speeds up the process of uterine contractions. This phase of the operation is the longest. From the moment the baby is born until the end of the operation, approximately 30 minutes pass. In terms of time, this operation, a caesarean section, takes 40 minutes.

What happens after childbirth?

After the operation, the new mother is transferred from the operating room to the intensive care unit or intensive care unit, since a caesarean section is performed 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 contracts, how much discharge there is and what nature it has. The functioning of the urinary system must be monitored.

After a caesarean section, the mother is prescribed antibiotics to avoid inflammation, as well as painkillers to relieve discomfort.

Of course, the disadvantages of a cesarean section may seem significant to some. However, in some situations, it is precisely such childbirth that allows the birth of a healthy and strong baby. It is worth noting that the 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 consequences occur, you should immediately consult a doctor. Complex treatment of divergence of the edges of the suture located between the rectus muscles includes a set of exercises specially developed by many specialists, which can be performed after a cesarean section.

Of course, there are consequences to this surgical intervention. The very first thing worth highlighting is the ugly seam. You can fix it by visiting a cosmetologist or surgeon. Typically, to give the seam an aesthetic appearance, procedures such as smoothing, grinding and excision are carried out. Considered to be quite rare keloid scars- reddish growths form above the seam. It is worth noting that the treatment of this type of scars takes a very long time and has its own characteristics. It must be carried out by a professional in his field.

For a woman, the condition of the suture made on the uterus is much more important. After all, it depends on him how the next pregnancy will go and what method the woman will give birth to. A suture on the abdomen can be corrected, but a suture on the uterus cannot be corrected.

Menstruation and sex life

If no complications arise during the operation, then the menstrual cycle begins and proceeds in the same way as after childbirth naturally. If a complication does arise, the inflammatory process can last for several months. In some cases, menstruation may be painful and heavy.

Start off sexual life after childbirth, carried out using a scalpel, it is possible after 8 weeks. Of course, if the surgery went without complications. If there were complications, then you can begin sexual activity only after a thorough examination and consultation with a doctor.

It is worth considering that after a caesarean 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 within two years, as well as abortions, including vacuum ones, since such an intervention makes the walls of the organ 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 breastfeeding after a cesarean section. But this is absolutely not true.

A young mother produces milk in the same time frame as women after natural childbirth. Of course, establishing 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 receive some of the antibiotic through mother's milk. Therefore, in the first week the baby is fed formula from a bottle. As a result, the baby gets used to it and it becomes much more difficult to wean him to the breast. Although today babies are often put to the breast immediately after surgery (on the same day).

If you do not have an indication for delivery by cesarean section, then you should not insist on surgery. 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.

As you know, a caesarean section is nothing more than a surgical intervention during which the fetus is removed from the mother’s womb through an incision in the anterior abdominal wall and uterus. The decision to carry out such a planned operation is made depending on the presence of indications that do not allow childbirth to occur naturally.

At what stage of pregnancy is a planned caesarean section performed and what are its advantages?

With this type of surgical intervention, the likelihood of uterine rupture is sharply reduced. Besides? Various types of complications observed during natural childbirth occur less frequently during cesarean. The operation also reduces the risk of uterine prolapse, which prevents heavy, uterine bleeding during childbirth.

If we talk about the period at which a planned cesarean section is performed, it is most often the 39th week. The thing is that it is by this time that the fetus’s body begins to produce a substance called surfactant, which helps to open the lungs with the baby’s first breath. If the operation is performed earlier than the specified period, the baby needs artificial ventilation.

This kind of surgical intervention is not always prescribed. The main principles for its implementation are:

• features of the anatomical structure (narrow pelvis);
• the presence of mechanical obstacles to natural childbirth (fibroids, bone deformities, tumor);
• previous cesarean section.

Regarding the last point, previously, if a woman had already given birth by cesarean section, then the subsequent ones were carried out as well. Today, if there is a dense scar on the uterus, childbirth can be carried out through natural means. However, a repeat cesarean section is mandatory in the presence of complications such as a vertical incision of the uterus, uterine rupture, or abnormal placenta or fetal previa.

If we talk about the period at which a planned cesarean section is performed, then it is usually the same as for the first one - 39 weeks. However, if there is a risk of complications, it can be done earlier.

Like any surgical procedure, cesarean section is associated with certain risks of complications. These primarily include:

• the development of adhesions and scars, which subsequently fasten together the organs located in the pelvis and the muscles of the abdominal wall. This is accompanied by unpleasant sensations and discomfort;
• violation of placenta previa during subsequent births.
• placenta accreta. This complication occurs when the placenta cannot detach itself from the wall of the uterus. Therefore, manual separation is required, which is accompanied by severe bleeding. This kind of violation is observed in cases where a woman has already had 3 or more cesarean sections in the past.

The first day after the operation, the woman is under the supervision of doctors in the postpartum ward. She is prescribed painkillers for several days after the operation. In this case, special attention is paid to the condition of the uterus, observing its contractility.

Sutures placed on the anterior abdominal wall are treated daily with antiseptic solutions and then removed on days 7-10. If the mother has no complications, and if the baby does not have any disorders and was born absolutely healthy, discharge home occurs a week after the cesarean section.

Thus, doctors determine the choice of the best time to do a planned cesarean section based on the condition of the fetus and the pregnant woman. In the absence of any risks, such an operation can be performed with the onset of the first contractions in a pregnant woman.

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

The cesarean section operation is considered one of the most common in the practice of obstetricians around the world, and its frequency is steadily increasing. At the same time, it is important to correctly assess the indications, possible obstacles and risks for surgical delivery, its benefits for the mother and potential adverse consequences for the fetus.

Recently, the number of unjustified childbirth operations has increased, and Brazil is among the leaders in their implementation, where almost half of women do not want to give birth on their own, preferring transection.

The undoubted advantages of operative delivery are the ability to save the life of both the child and the mother in cases where natural childbirth poses a real threat or is impossible for a number of obstetric reasons, the absence of perineal ruptures, and a lower incidence of hemorrhoids and uterine prolapse subsequently.

However, one should not ignore many disadvantages, including serious complications, postoperative stress, long-term rehabilitation, therefore a cesarean section, like any other abdominal operation, should be performed only on those pregnant women who really need it.

When is a transsection necessary?

Indications for a caesarean section can be absolute, when independent childbirth is impossible or involves an extremely high risk for the health of mother and baby, and relative, and the list of both is constantly changing. Some relative reasons have already been transferred to the category of absolute ones.

Reasons for planning a cesarean section arise during pregnancy or when labor has already begun. Women are eligible for elective surgery indications:

Emergency transection is performed in case of obstetric hemorrhage, placenta previa or abruption, probable or incipient rupture of the fetal sac, acute fetal hypoxia, agony or sudden death of a pregnant woman with a living child, severe pathology of other organs with deterioration of the patient’s condition.

When labor begins, circumstances may arise that force the obstetrician to make a decision about emergency surgery:

1. Pathology of uterine contractility that does not respond to conservative treatment - weakness of labor forces, discoordinated contractility;
2. Clinically narrow pelvis - its anatomical dimensions allow the fetus to pass through the birth canal, but other reasons make this impossible;
3. Loss of the umbilical cord or parts of the baby's body;
4. Threatened or progressive uterine rupture;
5. Leg presentation.

In some cases, surgery is performed due to a combination of several reasons, each of which in itself is not an argument in favor of surgery, but in the case of their combination there is a very real threat to the health and life of the baby and the expectant mother during normal childbirth - prolonged infertility, earlier miscarriages , IVF procedure, age over 35 years.

Relative indications Severe myopia, kidney pathology, diabetes mellitus, sexually transmitted infections in the acute stage, the age of the pregnant woman over 35 years if there are abnormalities during pregnancy or fetal development, etc. are considered.

If there is the slightest doubt about the successful outcome of the birth, and, even more so, if there are reasons for surgery, the obstetrician will prefer a safer route - transection. If the decision is in favor of an independent birth, and the result is serious consequences for the mother and baby, the specialist will bear not only moral, but also legal responsibility for neglecting the condition of the pregnant woman.

Available for surgical delivery contraindications, however, their list is much smaller than the testimony. The operation is considered unjustified in case of death of the fetus in the womb, fatal malformations, as well as hypoxia, when there is confidence that the child can be born alive, but there are no absolute indications on the part of the pregnant woman. If the mother's condition is life-threatening, the operation will be performed one way or another, and contraindications will not be taken into account.

Many expectant mothers who are about to undergo surgery worry about the consequences for the newborn. It is believed that children born by cesarean section are no different in their development from babies born naturally. However, observations show that the intervention contributes to more frequent inflammatory processes in the genital tract in girls, as well as type 2 diabetes and asthma in children of both sexes.

Types of abdominal surgery

Depending on the characteristics of the surgical technique, there are different types of caesarean sections. Thus, access can be by laparotomy or through the vagina. In the first case, the incision goes along the abdominal wall, in the second - through the genital tract.

The vaginal approach is fraught with complications, is technically difficult and is not suitable for delivery after 22 weeks of pregnancy in the case of a living fetus, so it is now practically not used. Viable babies are removed from the uterus only through a laparotomy incision. If the gestational age did not exceed 22 weeks, then the operation will be called small caesarean section. It is necessary for medical reasons - severe defects, genetic mutations, threat to the life of the expectant mother.

incision options for CS

The location of the incision on the uterus determines the types of intervention:

• Corporal cesarean section - midline incision of the uterine wall;
• Isthmicocorporal - the incision goes lower, starting from the lower segment of the organ;
• In the lower segment - across the uterus, with/without detachment of the bladder wall.

A living and capable fetus is considered an indispensable condition for surgical delivery. In case of intrauterine death or defects incompatible with life, a cesarean section will be performed in case of a high risk of death for the pregnant woman.

Preparation and methods of pain relief

Features of preparation for surgical delivery depend on whether it will be carried out as planned or for emergency reasons.

If a planned intervention is prescribed, the preparation resembles that for other operations:

1. Light diet the day before;
2. Cleansing the intestines with an enema the evening before surgery and in the morning two hours before it;
3. Exclusion of any food and water 12 hours before the scheduled intervention;
4. Hygiene procedures (shower, shaving pubic and abdominal hair) in the evening.

The list of examinations includes standard general clinical blood and urine tests, determination of blood clotting, ultrasound and CTG of the fetus, tests for HIV, hepatitis, sexually transmitted infections, consultations with a therapist and specialists.

In case of emergency intervention, a gastric tube is inserted, an enema is prescribed, tests are limited to urine, blood composition and coagulation. The surgeon in the operating room places a catheter in the bladder and installs an intravenous catheter for infusion of the necessary drugs.

The method of anesthesia depends on the specific situation, the preparedness of the anesthesiologist and the desire of the patient, if it does not go against common sense. Regional anesthesia can be considered one of the best ways to relieve pain during a caesarean section.

Unlike most other operations, during a caesarean section the doctor takes into account not only the need for pain relief as such, but also the possible adverse effects of administering drugs to the fetus, therefore spinal anesthesia is considered optimal, eliminating the toxic effect of anesthesia on the baby.

spinal anesthesia

However, it is not always possible to perform spinal anesthesia, and in these cases, obstetricians perform the operation under general anesthesia. It is mandatory to prevent the reflux of gastric contents into the trachea (ranitidine, sodium citrate, cerucal). The need to cut abdominal tissue requires the use of muscle relaxants and a ventilator.

Since the operation of transection is accompanied by quite a large blood loss, at the preparatory stage it is advisable to take blood from the pregnant woman herself in advance and prepare plasma from it, and return the red blood cells. If necessary, the woman will be transfused with her own frozen plasma.

To replace lost blood, blood substitutes, as well as donor plasma and formed elements, can be prescribed. In some cases, if it is known about possible massive blood loss due to obstetric pathology, during the operation, washed red blood cells are returned to the woman through a reinfusion apparatus.

If a fetal pathology is diagnosed during pregnancy, in case of premature birth, a neonatologist should be present in the operating room who can immediately examine the newborn and perform resuscitation if necessary.

Anesthesia for caesarean section carries certain risks. In obstetrics, the majority of deaths during surgical interventions still occur during this operation, and in more than 70% of cases, the culprit is the entry of stomach contents into the trachea and bronchi, difficulties with inserting an endotracheal tube, and the development of inflammation in the lungs.

When choosing a method of pain relief, the obstetrician and anesthesiologist must evaluate all existing risk factors (the course of pregnancy, concomitant pathology, unfavorable previous births, age, etc.), the condition of the fetus, the type of proposed intervention, as well as the desire of the woman herself.

Caesarean section technique

The general principle of performing a transsection may seem quite simple, and the operation itself has been practiced for decades. However, it is still classified as an intervention of increased complexity. The most appropriate is considered to be a horizontal incision in the lower uterine segment and from the point of view of risk, and from the standpoint of aesthetic effect.

Depending on the characteristics of the incision, lower median laparotomy, Pfannenstiel and Joel-Cohen sections are used for caesarean section. The choice of a specific type of operation occurs individually, taking into account changes in the myometrium and abdominal wall, the urgency of the operation, and the skills of the surgeon. During the intervention, self-absorbable suture material is used - vicryl, dexon, etc.

It is worth noting that the direction of the incision of the abdominal tissue does not always and does not necessarily coincide with the dissection of the uterine wall. Thus, with lower median laparotomy, the uterus can be opened as desired, and the Pfannenstiel incision involves isthmicocorporeal or corporal transection. The simplest method is considered to be a lower median laparotomy, which is preferable for a corporal section; a transverse incision in the lower segment is more conveniently made through the Pfannenstiel or Joel-Cohen approach.

Corporal caesarean section (CCS)

Corporal caesarean section is rarely performed when there are:

• Severe adhesive disease, in which the path to the lower segment is impossible;
• Varicose veins in the lower segment;
• The need for hysterectomy after removing the child;
• Insolvent scar after a previously performed corporal transection;
• Prematurity;
• Conjoined twins;
• A living fetus in a dying woman;
• Transverse position of the child, which cannot be changed.

The approach for CCS is usually a lower median laparotomy, in which the skin and underlying tissues are dissected to the aponeurosis at the level from the umbilical ring to the pubic joint strictly in the middle. The aponeurosis is opened longitudinally over a short distance with a scalpel, and then enlarged with scissors up and down.

suturing the uterus during corporal CS

The second caesarean section must be carried out very carefully due to the risk of damage to the intestines and bladder. In addition, the existing scar may not be dense enough to maintain the integrity of the organ, which is dangerous for uterine rupture. The second and subsequent transsections are often carried out on the finished scar with its subsequent removal, and the remaining aspects of the operation are standard.

With CCS, the uterus is opened exactly in the middle; for this, it is rotated so that a cut of at least 12 cm in length is located at an equal distance from the round ligaments. This stage of the intervention should be carried out as quickly as possible due to extensive blood loss. The amniotic sac is opened with a scalpel or fingers, the fetus is removed by hand, the umbilical cord is pinched and intersected.

To speed up uterine contraction and evacuation of the placenta, oxytocin is administered into a vein or muscle, and broad-spectrum antibiotics are used intravenously to prevent infectious complications.

To form a durable scar, prevent infections, and ensure safety during subsequent pregnancies and childbirth, it is extremely important to adequately align the edges of the incision. The first suture is placed 1 cm away from the corners of the incision, and the uterus is sutured in layers.

After removing the fetus and suturing the uterus, it is mandatory to examine the appendages, appendix and nearby abdominal organs. When the abdominal cavity is washed, the uterus has shrunk and become dense, the surgeon sutured the incisions layer by layer.

Isthmicocorporeal caesarean section

Isthmiccorporeal transection is carried out according to the same principles as CCS, with the only difference that before opening the uterus, the surgeon cuts transversely the fold of the peritoneum between the bladder and the uterus, and the bladder itself moves downwards. The uterus is dissected 12 cm in length, the incision goes longitudinally in the middle of the organ above the bladder.

Incision in the lower uterine segment

During a caesarean section in the lower segment, the abdominal wall is cut along the suprapubic line - according to Pfannenstiel. This access has some advantages: it is cosmetic, it is less likely to cause subsequent hernias and other complications, the rehabilitation period is shorter and easier than after a median laparotomy.

incision technique in the lower uterine segment

The incision of the skin and soft tissues goes in an arcuate manner across the pubic symphysis. The aponeurosis is opened slightly above the skin incision, after which it is peeled off from the muscle bundles down to the pubic symphysis and up to the navel. The rectus abdominis muscles are pulled apart with the fingers.

The serous cover is opened with a scalpel at a distance of up to 2 cm, and then enlarged with scissors. The uterus is exposed, the folds of peritoneum between it and the bladder are cut horizontally, the bladder is retracted to the womb with a mirror. It should be remembered that during childbirth the bladder is located above the pubis, so there is a risk of injury to it if you use a scalpel carelessly.

The lower uterine segment is opened horizontally, carefully so as not to damage the baby's head with a sharp instrument, the incision is increased with the fingers to the right and left to 10-12 cm, so that it is enough to pass the newborn's head.

If the baby's head is low or large, the wound can be enlarged, but the risk of damage to the uterine arteries with severe bleeding is extremely high, so it is more advisable to make the incision in an arcuate manner slightly upward.

The amniotic sac is opened together with the uterus or with a scalpel separately, spreading the edges apart. With his left hand, the surgeon penetrates the fetal sac, carefully tilts the baby’s head and turns it towards the wound with the occipital region.

To facilitate the extraction of the fetus, the assistant gently presses on the fundus of the uterus, and the surgeon at this time carefully pulls the head, helping the baby’s shoulders to come out, and then pulls him out by the armpits. In a breech presentation, the baby is removed by the groin or leg. The umbilical cord is cut, the newborn is handed over to the midwife, and the placenta is removed by traction on the umbilical cord.

At the final stage, the surgeon makes sure that there are no fragments of membranes or placenta left in the uterus, and that there are no myomatous nodes or other pathological processes. After the umbilical cord is cut, the woman is given antibiotics to prevent infectious complications, as well as oxytocin, which accelerates the contraction of the myometrium. The tissues are sutured tightly in layers, matching their edges as accurately as possible.

1. The baby is removed quickly;
2. The duration of the intervention is significantly reduced;
3. Blood loss is less than with bladder detachment and CCS;
4. Less pain;
5. Lower risk of complications after the intervention.

With this type of cesarean section, the incision is made transversely 2 cm below the line conventionally drawn between the anterior superior iliac spines. The aponeurotic leaf is dissected with a scalpel, its edges are retracted with scissors, the rectus muscles are moved back, and the peritoneum is opened with the fingers. This sequence of actions minimizes the risk of bladder injury. The wall of the uterus is cut over a length of 12 cm simultaneously with the vesicouterine fold. Further actions are the same as with all other methods of transection.

When the operation is completed, the obstetrician examines the vagina, removes blood clots from it and the lower part of the uterus, and rinses it with sterile saline, which facilitates the recovery period.

Recovery after abdominal surgery and possible consequences of the operation

If delivery took place under spinal anesthesia, the mother is conscious and feeling well, the newborn is placed on her chest for 7-10 minutes. This moment is extremely important for the formation of a subsequent close emotional connection between mother and baby. The exception is severely premature babies and those born with asphyxia.

After all wounds are closed and the genital tract is cleaned, an ice pack is placed on the lower abdomen for two hours to reduce the risk of bleeding. The administration of oxytocin or dinoprost is indicated, especially for those mothers whose risk of bleeding is very high. In many maternity hospitals, after surgery, a woman spends up to a day in the intensive care unit under close supervision.

During the first days after the intervention, the introduction of solutions that improve the properties of blood and replenish its lost volume is indicated. According to indications, analgesics and drugs to increase uterine contractility, antibiotics, and anticoagulants are prescribed.

To prevent intestinal paresis, cerucal, neostigmine sulfate, and enemas are prescribed 2-3 days after the intervention. You can breastfeed your baby on the first day if there are no obstacles to this from the mother or the newborn.

The sutures from the abdominal wall are removed at the end of the first week, after which the young mother can be discharged home. Every day before discharge, the wound is treated with antiseptics and examined for inflammation or impaired healing.

The scar after a caesarean section can be quite noticeable, running longitudinally along the abdomen from the navel to the pubic region, if the operation was performed by median laparotomy. The scar after the suprapubic transverse approach is much less visible, which is considered one of the advantages of the Pfannenstiel incision.

Patients who have had a cesarean section will need help from loved ones when caring for the baby at home, especially during the first few weeks while the internal sutures heal and there may be pain. After discharge, it is not recommended to take a bath or visit the sauna, but a daily shower is not only possible, but also necessary.

suture after caesarean section

The technique of cesarean section, even if there are absolute indications for it, is not without its drawbacks. First of all, the disadvantages of this method of delivery include the risk of complications, such as bleeding, injury to neighboring organs, purulent processes with possible sepsis, peritonitis, and phlebitis. The risk of consequences is several times greater during emergency operations.

In addition to complications, one of the disadvantages of a cesarean section is a scar, which can cause psychological discomfort to a woman if it runs along the abdomen, contributes to hernial protrusions, deformities of the abdominal wall and is noticeable to others.

In some cases, after surgical delivery, mothers experience difficulties with breastfeeding, and it is also believed that the operation increases the likelihood of deep stress, even postpartum psychosis, due to the lack of a feeling of completion of childbirth naturally.

According to reviews from women who have undergone surgical delivery, the greatest discomfort is associated with severe pain in the wound area in the first week, which requires the use of analgesics, as well as with the formation of a noticeable skin scar subsequently. An operation that does not result in complications and is performed correctly does not harm the child, but the woman may have difficulties with subsequent pregnancies and childbirth.

Caesarean section is performed everywhere, in any obstetric hospital if there is an operating room. This procedure is free and available to any woman who needs it. However, in some cases, pregnant women wish to undergo childbirth and surgery for a fee, which makes it possible to choose a specific attending physician, clinic and conditions of stay before and after the intervention.

The cost of operative delivery varies widely. The price depends on the specific clinic, comfort, medications used, and the qualifications of the doctor, and the same service in different regions of Russia can differ significantly in price. State clinics offer paid caesarean sections in the range of 40-50 thousand rubles, private clinics - 100-150 thousand and above. Abroad, surgical delivery will cost 10-12 thousand dollars or more.

A caesarean section is performed in every maternity hospital, and, according to indications, it is free of charge, and the quality of treatment and observation does not always depend on financial costs. Thus, a free operation can go quite well, but a pre-planned and paid operation can have complications. It’s not for nothing that they say that childbirth is a lottery, so it’s impossible to predict its course in advance, and expectant mothers can only hope for the best and prepare for a safe meeting with the little person.

Video: Dr. Komarovsky about caesarean section