Cesarean section: indications as surgery, recovery, effects
Throughout the world there is a distinct tendency to careful delivery that allows you to maintain the health of both mother and child. A tool that helps accomplish this is the operation of cesarean section (CS). A significant achievement was the wide use of modern methods of pain relief.
The main disadvantage of this intervention is the increase in the frequency of postnatal infectious complications in 5-20 times. However, adequate antibiotic therapy significantly reduces the likelihood of their occurrence. However, until now there are disputes about how, in some cases, Caesarian section, and when a valid physiological delivery.
When operative delivery is
Cesarean section is a serious surgery, which increases the risk of complications compared to normal natural childbirth. It is administered only under strict indications. According to the patient’s COP can be made in a private clinic, but not all obstetrician-gynecologists will undertake such an operation without the need.
The surgery is performed in the following situations:
1. Complete placenta previa – a condition in which the placenta is in the lower part of the uterus and covers the internal throat, not allowing the child to be born. Partial previa is an indication for surgery when the appearance of bleeding. The placenta is richly supplied with vessels, and even a small injury it can cause blood loss, lack of oxygen and fetal death.
2. The incident ahead of time the detachment of a normal placenta from the uterine wall – a condition that threatens the life of a woman and child. Detached from the uterus, the placenta is the source of blood loss for the mother. The fruit stops receiving oxygen and can die.
3. Migrated earlier surgery on the uterus, namely:
- at least two caesarean sections;
- the combination of one operation of the COP and at least one of the relative indications;
- removal of intermuscular or subserous fibroids on a solid Foundation;
- correction of the defect structure of the uterus.
4. Transverse and oblique position of the child in the uterus, breech presentation («butt down») in combination with the expected weight of the fetus more than 3.6 kg or with any relative indication for operative delivery: the situation when the child is at the internal OS not the parietal region and the forehead (frontal) or person (pictorial presentation), and other features that contribute to birth trauma in a child.
5. Multiple pregnancy if:
- breech of the first (lower) of the fetus;
- wrong (transverse or oblique), the provisions of any of the fruits;
- Feto-fetal transfusion syndrome is a condition when the blood system of the fruit there is a message, causing the blood is redistributed, causing the underdevelopment of the «fruit of the donor».
6. Pregnancy 41 weeks or more, combined with inefficient drug preparation for childbirth.
7. Mismatched the size of the pelvis of the woman and of the baby’s head (an irregular shape of the pelvic ring, narrow pelvis, is too big fruit) – this indications for cesarean section are widely discussed, often allowed natural childbirth.
8. Obstructions in the birth canal, for example, cervical uterine fibroids, scarring of the cervix and vagina, including after severe breaks in the previous birth.
9. Uterine rupture – threatening or already started.
10. Severe preeclampsia and eclampsia – preeclampsia types, associated with impaired functioning of the nervous system, increased blood pressure, insufficient kidney function.
11. Diseases of the internal organs in which it is necessary to exclude attempts: complicated myopia, heart failure III – IV FC donor kidney and so on.
12. Severe oxygen deprivation, or distress of the fetus. It can quickly develop during birth or gradually develop in utero, including decompensated form of placental insufficiency. This pathology of the vessels of the placenta, when they are not able to provide the fetus with nutrients.
13. Prolapse into the birth canal the umbilical cord, danger of oxygen starvation of the child in the birth process.
14. Untreated during pregnancy HIV infection of the mother or a viral load above 1000 copies/ml; primary genital herpes, occurred in term 3 is also the indication for cesarean section.
15. Anomalies of fetal development, hindering its passage through the birth canal, and blood clotting from him.
Cesarean section is not used when fetal death, proved severe malformations incompatible with life, and also when infectious-inflammatory diseases of the skin in the area of the incision.
The types of transactions and the preparation for it
The types of cesarean section:
The planned COP is performed in advance at a known pathology, the need for emergency occurs when a threat to the health or even the life of a woman and her child during childbirth. The decision is taken by the obstetrician-gynecologist, often collectively.
An emergency C-section is much more dangerous than planned. It occurs when complications arise during childbirth: the formation of the clinically narrow pelvis, severe weakness of the labor force, acute fetal hypoxia and so on. Quite often the choice to pursue a natural childbirth or to perform the operation. The decision is made jointly by the physician and the patient.
How many weeks do elective caesarean section?
In one fetus the operation is performed in the 39th week of pregnancy in multiple pregnancy (twins, triplets, and so on) – in the 38th week. Earlier delivery is dangerous for the child the fact that he had underdeveloped lungs, they haven’t adapted to breathing atmospheric air.
Preparing for a planned caesarean section contains two stages: in the antenatal clinic and in the hospital.
In the antenatal clinic, the patient is issued directions to the hospital, carry out the following tests:
- General analysis of blood;
- in the absence of exchange in the map – determination of group and RH factor of blood;
- if a woman has a uterine scar, need a copy of your discharge from the hospital;
- coagulation (blood clotting);
- according to the testimony of biochemical analysis of blood.
It is recommended to purchase compression stockings, or at least elastic bandage. Admission is carried out on the day of surgery or the evening before. 12 hours before the intervention is recommended not to eat, 4 hours to stop taking and water.
In the hospital the training is in the design history and voluntary informed consent. From the use of cleansing enemas for all patients currently refuse. If the doctor gives a recommendation, you should remove hair in the area of intervention (lower abdomen, pubis). This is required not in all hospitals.
Wear compression stockings or elastic bandages on the legs. No sooner than an hour before the start of surgery antibiotic prophylaxis of purulent-inflammatory complications in emergency surgery antibiotics are injected before the skin incision.
One of the important issues for caesarean section – anaesthesia. What kind of anesthesia is best? When spinal or epidural anaesthesia the patient is unconscious or in a state of slight drowsiness, but she doesn’t feel pain. The operating field from her closed curtain. With General anesthesia using endotracheal anesthesia, during which a woman is asleep and feels nothing. Awaken her still in surgery, but final in itself, it comes already in the intensive care unit or in intensive care.
The treatment of choice is spinal, or spinal anesthesia – injection of the drug under the sheath of the spinal cord in the lumbar region. If it is impossible, contraindicated, or the patient denies it, used General anesthesia. If the indications for General anesthesia do not exist – cesarean section epidural anesthesia is used. The anesthetic is injected more superficially, not under the shell of the spinal cord, and above it.
Modern anaesthesia almost do not harm the child, but he could be a bit lethargic, sleepy, scream a little later than normal children.
In the operating room should be warm. The position of women on the operating table lying on your back or with a slight slope. Pregnant catheter into the bladder, listen to the fetal heartbeat. After anesthesia treat surgical field, choose the type of incision on the uterus, based on obstetric situation.
Operating access for caesarean section
The skin incision may be vertical in the middle of the abdomen or horizontal in the suprapubic region. A horizontal incision is preferred because it is less painful after delivery, its cosmetic effect is much better. Nizhneserginsky laparotomy (incision extending vertically in the lower part of the abdomen) often used in emergency operations when at the expense of every second.
The uterine incision may be transverse, vertical, at the bottom or in the middle of the uterus, in the shape of a letter T or J. Preferably hold a T-shaped incision as it heals worse. After cesarean section with the use of classical, T — or J-shaped incisions subsequent childbirth it is also recommended that with the operation, because these types of cuts are often untenable. It is desirable to use a low vertical or low transverse incisions which heal well and the woman could then give birth in a natural way.
After the cut is first carefully removed the baby’s head and then shoulders and the rest of the body, cut the umbilical cord.
At the birth of his first child was assigned to a midwife for a warm diaper, which obrushivaet and swaddle the baby; after the first cry of the child it is desirable to attach to the breast. If caesarean section is performed under General anesthesia in the operating room and present the father of the baby, is encouraged to contact «skin to skin» with a relative.
Establish intravenous oxytocin infusion for uterine contractions and stop bleeding, facilitate the separation of the placenta. The placenta separated with pulling the umbilical cord, and manual examination of the uterus, scraping her it is usually not possible.
The incision on the uterus is sutured synthetic absorbable thread slowly. Suturing of the abdominal muscles is often not carried out, it is believed that the muscles then recover on their own. The fascia covering the muscles on top, is sutured with a thread, which dissolves not less than 180 days. The skin is sewn up a separate, non-deletable or removable sutures at the surgeon’s discretion.
Seam after cesarean section is usually almost invisible, it has a length of 10-12 cm, is in the crease under the belly. In a planned caesarean, always trying to impose a neat cosmetic seam. The best results are achieved when using absorbable suture material.
How long time this operation?
The first COP takes about an hour later – a little more due to technical difficulties in choosing the incision site, dissection of adhesions between the uterine walls and abdominal muscles.
What are the risks of cesarean section
Complications in the postoperative period:
- bleeding associated with delayed contraction of the uterus and its vessels;
- purulent-inflammatory diseases, in particular inflammation of the inner lining — endometritis;
- thromboembolic processes, of which the most dangerous is thrombosis of the vessel carrying blood to the lungs to saturate it with oxygen, and pulmonary artery. Its blockage can be deadly.
To prevent them used low molecular weight heparins, antibiotics in the pre — and postoperative period, elastic bandaging of the lower extremities, monitoring of laboratory parameters and monitoring of the patient.
Caesarean section increases the risk of need for emergency intervention during the next childbirth physiological.
Damage to the bladder and other organs is possible but rare. There is a risk of death of mothers due to anaphylactic shock, profuse bleeding, acute cardiovascular insufficiency (1 case per 12,000 transactions). During subsequent pregnancies increases the likelihood of placenta previa, fetal death, bleeding, rupture of the uterus.
You have to understand that after surgery the woman has quite severe pain in the postoperative wound. A few days after COP she can’t quickly get out of bed, and then child care for her more difficult than in physiological delivery. Since COP often formed adhesions in the abdominal cavity, slowing the recovery of the figure and sexual activity, often there are difficulties with lactation, and additional problems during subsequent pregnancies.
Surgery carries potential risks not only for the mother but for the fetus. There are pros and cons for your child, which should be aware of the woman.
The advantages of operative delivery are the absence of birth trauma, as the baby passes through the genital tract. So, not formed postpartum hematoma on the head of the baby is not injured neck, there is no threat of severe hypoxia due to suffocation or loss of the umbilical cord. Less risk of Contracting STIs, such as genital herpes.
However, the child during anesthesia gets through the blood a certain amount of anesthetic, which is slightly depressing his nervous system. There is also the risk of injury during extraction of the fetus from the uterus. However, it is proven that children born by caesarean section in the future do not lag behind their peers in growth and development.
The postoperative period and discharge
The patient after surgery regularly examined by a doctor and midwife, is adequate pain relief. After a routine COP typically, a woman is observed in the intensive care unit for 6-12 hours and then transferred to the postnatal ward. If the epidural, get the woman be allowed after 6 hours after administration of the final portion of the anesthetic agent, and after General anesthesia after 12 hours. Immediately after the activation of the female remove a urinary catheter and transferred to the postnatal ward.
The patient continues to receive antibiotics – most often it is inhibitor-protected penicillins (Amoxiclav) or cephalosporins (Cefazolin), which do not harm the baby during breastfeeding. On the first day of anesthesia carried out with the help of narcotic analgesics (Promedol), then offer a regular injection of painkillers, which if desired can be dispensed with.
Sometimes, after the introduction of Promedol vomit is a fairly common side effect of the drug. The patient is experiencing very unpleasant sensations: pretty severe pain in the joint area does not give quick to get up and walk to the toilet and vomit in the movements of the abdominal muscles tense up and the pain becomes even stronger. So if soreness of the seam is not very big, you can ask the doctor not to prescribe narcotic analgesic, and to do the usual pain-killing drug. When the pain in the future at the woman’s request may be again applied Promedol.
Early activation of the patient – a way to reduce adhesions, prevent the development of stagnation in the lungs, and thromboembolic complications. Contraindications to early mobilization:
- thrombophlebitis of the veins in the legs, manifested by pain in the leg, her edema, discoloration of the skin, decrease in skin temperature;
- bleeding from the genital tract associated with disorders of the blood coagulation system;
- severe pain after cesarean section, however, even in case of pain syndrome it is advisable though to turn over in bed, sit down, stand up, do a few steps in the ward.
It is desirable that the mother and child were together, if she can care for the baby. Encouraged by the assistance of close relatives in the postpartum unit, it is desirable that the woman with the child was in a private room, or allow a privacy screen. If in the first days the patient felt quite a strong pain, only bring the baby for feeding, and then is completely transferred to her room.
Food after caesarean section
When using spinal or epidural anesthesia you can drink the water from there – an hour after the intervention. Allowed all products, excluding bread, vegetables and fruits. You can enter them into the diet later after 3-5 days. If carried out General anesthesia, you can drink the water 2 hours after the C-section, there is a broth – 6 hours, eat regular foods through the day. Of course, in the first hours it is better not to eat plenty, so you do not have problems with bowel movements. During the first days it is possible to restrict light broth or porridge.
The bandage is removed the day after delivery, not allowed to handle the surgical wound. In some hospitals the seam every day treated with a solution of brilliant green and cover with a bandage.
Performing an enema or stimulation of the intestine by medications is carried out only on strict conditions, often in the absence of defecation after 3 days after COP.
Breastfeeding after cesarean section is the best option for mother and child. The uterus is well contracted, which prevents the formation of adhesions, the child receives all the necessary nutrients and antibodies. Unfortunately, sometimes after such an operation breast milk or not appearing, or very little. If you want you can try to establish breast feeding after 4-5 days, when the milk will be. If milk does not appear – establish artificial feeding.
With the consent of the woman is discharged home 3-4 days after delivery, it reduces the frequency of postoperative purulent complications caused by drug-resistant hospital flora. The stitches will be removed at the place of residence for 6-8 day (if you have used non-absorbable material). Early discharge allowed under normal body temperature, adequate involution (contraction) of the uterus according to the ultrasound, no cracked nipples and lactostasis, good condition of skin joint without signs of infection.
Memo to the patient after discharge
How to heal a seam?
Within 14-20 days the wound on the skin is delayed. However, lifting weights more than 5 kg, wash the floor, to bend, to lift the stroller up the stairs is possible only after 2-3 months, and it is better to avoid such stress in the first six months.
How long discharge after caesarean section?
Slight spotting or brownish allocation usually last up to 2 weeks but can persist for 6-8 weeks. At this time, should not visit bath, sauna, swimming pool, take a hot bath. Sexual relations are advised to renew after the termination of vaginal discharge.
How to handle a seam?
It is proved that the processing of the seam disinfectants reduces the risk of infectious complications. Enough to maintain good hygiene, avoid contact with unhealed wound water, close it light bandage, cloth to the household chores not to damage the formed connective tissue. Of course, you can lubricate the edge of the seam with a solution of brilliant green, with tincture of iodine, if recommended by the physician or on this treatment demanded by the relatives of the harm from it will not.
Complications that require immediate medical care (call ambulance):
- the appearance of pain in the chest, legs, coughing and shortness of breath (probably the development of thromboembolic complications);
- sudden bleeding after cesarean section, the use of more than two sanitary pads in an hour;
- temperature more than 38°C, especially in combination with purulent discharge from the genital tract;
- skin rash, headache, dizziness, convulsions.
Signs requiring female consultation:
- redness, induration, pain in the breast;
- difficulties with breastfeeding;
- irritation in the region of the seam, the divergence of its edges, the discharge from the wound;
- persistent swelling in the legs;
- irritability, tearfulness, mood instability;
- aggravation of hemorrhoids.
Effects not requiring treatment to the doctor – a slight aching sensation in the abdominal wall and the abdomen. They are associated with tissue healing, scar formation in the uterus and adhesions. The symptoms are the formation of adhesions after cesarean section – continued pain in the joint area and lower abdomen for several months, bloating, tendency to constipation. To prevent them important activity in the first month after delivery, when there is an intense tissue healing.
Rehabilitation includes measures such as:
- complete rest, if someone is willing to help with the housework or care for the baby, it is better to use such assistance;
- a balanced diet with the obligatory content of animal proteins, vitamins, fiber and enough water;
- restricting visits of guests – not only can they bring the infection, but add the hassle of a young mother;
- a short walk to relaxing;
- light gymnastics no earlier than the second month after childbirth;
- workout to restore the press – not earlier than six months after the COP.
Full recovery after cesarean section occurs within 2-3 months.
Family planning and contraception
Month after cesarean section are restored after 1-3 months, in the absence of breastfeeding. If lactation is established, the menstrual cycle will be restored after its completion. After the onset of menstruation may again occur pregnancy. Within three years after KC is desirable, therefore, advisable before delivery, while there is time, consult with your doctor about postpartum contraception methods.
Pregnancy can occur even during the first weeks of the postpartum period. The calendar method of contraception in terms of irregular cycle not applicable. Most often used a condom, and minipill (progestin contraceptives that do not affect the child during feeding) or conventional oral contraceptives (in the absence of lactation). The use of emergency contraception should be excluded.
One of the most popular methods of intrauterine contraception. Installation of spiral after cesarean section can be performed in the first two days after it, however, it increases the risk of infection, in addition, quite painful. Most often, the spiral set after about a month and a half, immediately after menstruation or at any time convenient for women day.
If the woman is more than 35 years and she has at least two children, at her request during the operation, the surgeon may perform a surgical sterilization, in other words, the ligation. It is an irreversible method, after which the conception is almost never comes.
Natural childbirth after cesarean section are allowed if formed connective tissue in the uterus is consistent, that is strong, smooth, capable of withstanding the tension of muscles during childbirth. This issue with the next pregnancy should be discussed with a doctor watching.
The probability of subsequent childbirth normally increases in the following cases:
- the woman gave birth to at least one child through the natural way;
- if the COP was held due to the malposition of the fetus.
On the other hand, if the patient at the time of subsequent childbirth has more than 35 years, she has extra weight, comorbidities, mismatched sizes of the fetus and the pelvis, it is likely that she will have surgery.
How many times can you do a caesarean?
The number of such interventions is theoretically not limited, however, to maintain health, it is recommended to do not more than two times.
Usual tactic if you re pregnancy the following: a woman regularly observed the obstetrician-gynecologist, and at the end of the period of gestation is a choice – surgery or natural childbirth. During normal childbirth, the doctors are ready at any moment to do emergency surgery.
Pregnancy after caesarean section is better to plan at intervals of three years or more. In this case, reducing the risk of insolvency of the seam on the uterus, pregnancy and childbirth occur without complications.
How many can you have children after surgery?
It depends on the consistency of the scar, woman’s age, concomitant diseases. Abortion after the COP have a negative impact on reproductive health. Therefore, if the woman is still pregnant almost immediately after the CW, during the normal course of pregnancy and constant medical supervision she can bear a child, but delivery is likely to be operational.
The main risk of early pregnancy after COP is the failure of the joint. It shows the increasing intense pain in the abdomen, bleeding from the vagina, then there may be signs of internal bleeding include dizziness, pallor, drop in blood pressure, loss of consciousness. In this case, it is necessary to call «Ambulance».
What is important to know when the second C-section?
The planned operation is usually carried out in the period 37-39 weeks. The incision is made through the old scar that slightly lengthens the operation time and requires stronger anesthesia. Recovery of KS can also occur slowly, as the scar tissue and adhesions in the abdominal cavity let a good uterine contractions. However, when positive women and her family, help the relatives of these difficulties can be overcome.