The operation of cesarean section is considered to be one of the most frequent in the practice of obstetricians in the world. The frequency of its implementation is steadily increasing. It is very important to correctly and accurately evaluate existing indications, possible obstacles and risks of delivery operatively. You should think about the benefits of such an operation for the mother and the potential negative consequences for the baby. What types of caesarean sections are there, should a future mother need to choose one, and how to behave after such an intervention? This can be found in this article.
What it is?
A caesarean section (CS) is a delivery operation in which a fetus and a doctor’s placenta are removed through an incision made on the uterus.
Each obstetrician-gynecologist is required to possess the skill of conducting such an operation. Sometimes a situation may arise when a Caesarean section will have to be performed by a doctor of any specialty who knows the operational technique.
CS is of great importance in modern obstetrics, because if the pregnancy proceeds with complications, it is just such an surgical intervention that will give a real chance to save both the health and the life of the mother and baby. It must be remembered that each such intervention can be fraught with serious adverse consequences in the immediate postoperative period (peritonitis, infection, bleeding) and with the subsequent pregnancy (placental ingrowth, presentation of the placenta, cicatricial changes may appear in the uterine incision). Now in the first place among the indications for caesarean section is the uterine scar that arose after the previous operation.
Trying to save ...
Although in recent years, advanced obstetric methods have been used in obstetric practice, using high-quality suture material, registration of complications of operations in mothers continues. And the subsequent reproductive function of a woman can be impaired due to CS. Infertility develops, the onset of pregnancy does not bear, the menstrual cycle is disturbed. In addition, even if such an operation is performed, there is not always a chance to maintain the health of the peanut, especially if the fetus has an infectious disease or severe hypoxia.
A doctor of any specialty is required to know well and adequately assess the indications for cesarean section, its benefits for both mother and baby. It is necessary to take into account the possible negative impact of the operation on the condition in which the female body will be. But if suddenly an emergency testimony from the side of the mother arises, the doctor is obliged to conduct surgery.
We classify operations
The following types of caesarean sections, in other words, surgical accesses, are available:
- laparotomy (abdominal, abdominal, retroperitoneal possible),
- vaginal.
To extract a viable child, doctors only perform a laparotomy, but if the fetus is not viable (period from 17 to 22 weeks of gestation), it is customary to use abdominal and vaginal accesses. Now practically no vaginal cesarean is used because of technical difficulties and common complications.
Regardless of access, the COP, which is carried out before the deadline of 17-22 weeks, is called a small caesarean section. It is done when, for medical reasons, it is necessary to terminate an early pregnancy. In recent years, abdominal access has been preferred in obstetric practice.
Separate according to localization
A fairly complicated procedure is a cesarean section. The types of operations performed depending on where the localization of the uterine incision is located, there are the following:
- corporal caesarean section (the uterus is cut along the midline);
- isthmicocorporeal (the uterus is cut in the middle a little in the lower segment and a little in the body of the uterus);
- in the lower segment of the uterus, a transverse section (there is a detachment of the bladder);
- in the lower segment of the uterus, a transverse incision (the bladder does not exfoliate).
In addition to these methods of CS, earlier (if the uterus was infected), doctors dissected it in the lower segment, temporarily isolating the abdominal cavity, or performed extraperitoneal CS. Today, due to the high quality of antibacterial drugs and suture material, there is no need to use these methods.
We divide by urgency and technique
Types of caesarean section can be divided not only into operations with respect to the peritoneum (as mentioned above), but also by urgency and technique.
According to the urgency of the COP is:
- planned;
- planned (with the onset of labor);
- emergency.
The planned should be six or seven tenths in relation to the emergency, because it is thanks to him that injuries are reduced by two times, complications in women are reduced by three, fetal hypoxia is reduced by three to four times, and perinatal mortality is also reduced.
By technique:
- vaginal cop;
- abdominal
- provided that the COP is aimed at terminating the pregnancy in the period 16-22 weeks, then it is performed as a corporal.
Positive sides
We have already considered what types of caesarean section exist. The advantages of such surgery, of course, are important. The most important advantage is the birth of a baby in cases where there is a probability of death of a baby or woman in childbirth during natural childbirth. Therefore, if a woman has an undeniable indication for a cesarean section, you don’t even need to think about the pros or cons of such an operation, but give consent to the COP. After all, the health of the child and his mother is most important.
The second plus of KS - on the genitals there are no seams or tears, they remain in the form as they were. Thanks to this, the woman will not have any problems with sexual life after childbirth. Exacerbation of hemorrhoids, prolapse of the pelvic organs, and cervical ruptures are completely excluded.
Another important point is speed. The operation is much faster than the natural birth process. After all, during natural childbirth, women endure labor for hours in anticipation of the opening of the birth canal. And with COP this is not required. A planned operation is usually scheduled for a time that is as close as possible to the expected date of delivery, therefore, the onset of labor activity is not of fundamental importance.
Regardless of what types of caesarean sections exist (a photo can give a detailed understanding of the whole process), and which one will be proposed in this particular case, if the COP is necessary, the expectant mother should agree with the doctor.
Existing contraindications to the COP
An important role in what the outcome of the surgical intervention for the woman in labor and for the baby will be played by contraindications and conditions for surgical delivery. If a decision is made on surgery, the doctor must take into account contraindications:
- the fetus died in utero, or the fetus has an anomaly that is incompatible with life;
- fetal hypoxia, along with the lack of urgent indications for CS on the part of the mother, and if there is confidence that a baby will be born (you can catch single palpitations) and a completely viable baby.
In the case of the presence of important indications for the COP from the mother, contraindications can be ignored.
Negative aspects of surgical intervention
Although various types of caesarean sections bring their undoubtedly positive aspects, disadvantages are also present in this operation. It just so happened that even if there is an absolute indication for such an operative measure, shortcomings also exist. First of all, this concerns the possible risk of complications - purulent processes with peritonitis, sepsis; bleeding; injuries of neighboring organs. Moreover, it should be borne in mind that if the operation is urgent, the risk of consequences will be several times higher.
In addition to complications, the scar also causes a disadvantage, which causes a woman psychological discomfort, especially if it is located along the abdomen. It can deform the abdominal wall, contribute to the occurrence of hernial protrusions. Not every young mother will be able to wear tight clothes due to the fact that such a scar through the fabric can be noticed by others.
Some mothers may have some difficulty breastfeeding. It is believed that due to the fact that childbirth did not end naturally, a woman may experience deep stress.
Judging by the reviews of women who underwent CS, the greatest discomfort was due to the fact that the wound was very painful in the early days, because of which they were prescribed analgesics, as well as due to the fact that a noticeable skin scar subsequently formed .
Preparation for surgery
Features of the preparation for such a delivery option will depend on whether it is carried out as planned, or according to emergency indications.
If the doctor prescribes a planned operation, then prepare for it should be the same as for any other:
- observe a light diet the day before;
- in the evening before the day of surgery and in the morning a couple of hours before it should clean the intestines with an enema;
- exclude any food and water twelve hours before surgery;
- carry out normal hygiene procedures (a woman takes a shower, shaves her pubic and abdomen hair) in the evening.
According to the list of examinations, to pass the necessary tests - general clinical blood, urine, ultrasound and CTG of the fetus, to determine blood coagulation, studies on sexual infections, HIV, hepatitis. Consultations of specialized specialists and therapist should also be appointed.
If there is an emergency intervention, you must enter a gastric tube, the doctor prescribes an enema. But from the analyzes, studies of urine, blood composition and its coagulability are necessary. Already in the operating room, the surgeon places a catheter in the bladder, and he also needs to install an intravenous catheter to infuse the necessary drugs.
Types of anesthesia for cesarean section are selected depending on the specific situation, the desire of the patient herself and the preparedness of the anesthetist. Moreover, a woman’s desire will be taken into account only if it is consistent with common sense.
Seams and cuts
And now about what types of cuts are possible with cesarean section. During the operation, the doctor makes two cuts.
The first will be the external, which cuts the abdominal wall (connective tissue, subcutaneous fat, abdominal skin).
The second is carried out on the uterus.
Naturally, it will be the first incision that will subsequently turn into a “scar after CS”. And the second incision is not visible with the ordinary eye - an ultrasound specialist will see it. Both cuts may coincide according to the cut line, or they may not coincide. There are two main combinations.
A classic (either vertical or corporal) external cut. It either combines with a similar vertical on the uterus, or - which happens more often - with a transverse uterine incision.
Cross external section. Its shape is arched. It is located immediately above the pubis in the skin fold. Combined with a similar cross section on the uterus, and with a vertical uterine.
Now let's talk about what types of sutures are in Caesarean section.
Cosmetic, as a rule, is applied when cut according to Pfannenstiel (skin and subcutaneous tissues are cut longitudinally, along the suprapubic fold). The strength in the connection of tissues with a corporal incision should be very high, and this requires nodal joints. Cosmetic after such a COP will not work.
Internal sutures placed on the wall of the uterus suggest various options. The most important thing here is to reduce blood loss, to make the uterus heal well. The outcome of the following pregnancies will depend on the strength of such sutures.
Methods of anesthesia
Doctors use various types of anesthesia for cesarean section. Reviews of women who have undergone such an operation indicate that for each case a strictly defined anesthesia was selected. Regional anesthesia is considered to be one of the best options for anesthetizing CS.
In preparing for cesarean section (this is the difference from a large number of other operations), the doctor must take into account not only the need for pain relief. He needs to think about the possible consequences of the introduction of certain drugs for the baby. That is why not all types of anesthesia are suitable for cesarean section. Optimal is considered spinal anesthesia, which excludes the toxic effect of drugs necessary for anesthesia on the child.
It should be noted that the possibility of spinal anesthesia is not always there. In this case, obstetricians perform surgery using general anesthesia. It is imperative to make medication prophylaxis of throwing gastric contents into the trachea. Since it is necessary to cut the tissues of the abdomen, it will be necessary to use muscle relaxants and a ventilator (mechanical ventilation).
Try to foresee everything
Since this operation is accompanied by significant blood loss, it will not be superfluous to take blood from a pregnant woman and prepare plasma from her when preparing for it, returning the red blood cells. If the need arises, a woman will be transfused with her own frozen plasma.
To compensate for lost blood, pregnant women are prescribed blood substitutes, donor plasma, and uniform elements. In some cases, if it is known in advance about a possible significant blood loss due to obstetric pathology, washed red blood cells will be returned to the woman during the operation through the reinfusion apparatus.
If a fetal pathology was diagnosed during pregnancy, the presence of a neonatologist is necessary in the operating room during preterm delivery. He will immediately be able to examine the newly born baby and, if necessary, to carry out resuscitation measures.
After operation
Types of sutures after cesarean section differ externally from each other. One is quite noticeable: it goes along the abdomen from the navel to the pubic region - in case the operation was performed by median laparotomy. Another scar will be much less visible - if suprapubic transverse access has been made. This is what is considered to be one of the advantages of the Pfannenstiel section.
Women who have undergone such an operation need the help of their family. The first weeks, while the internal seams heal and the pain is still strong, it is difficult for them to take care of the baby at home. After discharge from the maternity hospital, doctors do not recommend young mothers who have had a COP to stay in the sauna and take a bath. But the daily shower is not worth giving up.
So, we learned what types of caesarean sections, cuts, sutures are, which anesthesia is used. Based on the foregoing, every woman seeking to experience the miracle of motherhood should understand that it’s not worth going to the COP just because of “not to suffer for a long time”. But if there is a need for this, the question will be about saving the life of the baby and his mother, you can not think. Indeed, in this case, the doctor will help the baby to see this world.