Medical indications for caesarean section. What are the indications for a caesarean section? When is the operation performed

The pinnacle of modern obstetrics is the completion of childbirth and the birth of a child through surgical intervention - a caesarean section.

Historians have established that the origin of this operation has a direct connection with the times of antiquity, but only now this type of childbirth is often a salvation, both for the woman in labor and for the child.

A significant number of indications for caesarean section today is due to the high risk of resolution from the burden of the expectant mother by the vaginal route.

Of course, abdominal delivery, like other interventions of surgeons, hides a huge number of possible complications/consequences, however, their occurrence is extremely rare, and the scales are tipped in the direction of the birth of a live child and the saved life of the mother, and not potential complications.

The history of the name of the operation is overgrown with a huge number of legends and myths. The most significant is the story of the birth of Gaius Julius Caesar, the autocrat of the Roman Empire. The death of Caesar's mother during childbirth caused his father to cut the woman's womb with a sword and extract his son. Hence the saying: "Caesar's is Caesar's."

Conditions for the operation

A caesarean section can be elective, scheduled, or emergency. They talk about a planned delivery operation when it is performed 6 to 15 days before the date of the expected birth with existing maternal and / or fetal indications and the absence of the first manifestations of labor activity (see).

A planned operation means that the indications for it are known in advance, often in the first weeks and even days of bearing the unborn baby. The need for an emergency emergency section arises due to urgent, immediate, approximately within one to two hours of delivery and is mainly indicated in the process of spontaneous childbirth. They talk about a planned caesarean section when labor has just begun or amniotic fluid has poured out prematurely, but there are relative indications for surgery. That is, a woman is allowed into childbirth, but according to the plan of childbirth, they end up with an operation.

So, the necessary factors for the surgical method of delivery:

the presence of a living fetus capable of existing outside the womb (considered a relative condition, since under some circumstances the operation is done in the interests of a woman in order to save her life);
written consent of the woman in labor for a caesarean section;
an empty bladder (it is desirable to install an indwelling catheter);
there are no signs of infection during childbirth (also a very conditional indication);
the presence of an experienced obstetrician-surgeon and operating room.

What are the indications for surgery?

All the reasons that lead to abdominal delivery can be divided into two subgroups.

Absolute indications literally force the doctor to give birth to a woman by surgery, that is, one cannot do without surgery.
They talk about relative indications when the situation is analyzed by a council of doctors and a conclusion is approved on one or another way to complete the birth. That is, a woman can give birth on her own, but the likely risks for her, as well as the baby, are taken into account.

In addition, there are factors that lead to forced surgery during pregnancy or directly in the process of childbirth. Another gradation of indications for operative delivery is their division into maternal and fetal factors.

Abdominal delivery: absolute indications

Factors on the part of the mother, in the presence of which it is impossible to do without a caesarean section, include:

Anatomically narrow pelvis (the degree of narrowing is taken into account, that is, 3-4, in which the true conjugate is 9 cm or less)

The narrow pelvis is divided into 2 groups according to the shape of the narrowing.

The first group includes: a transversely narrowed pelvis, a flat pelvis (a simple flat pelvis, flat rachitic and a pelvis with a decrease in the wide part of the cavity), and, of course, a generally uniformly narrowed pelvis. These are quite common forms of pelvic narrowing.
The second group (rare forms) includes oblique pelvis, oblique pelvis, pelvic deformity due to bone exostoses, bone tumors or fractures, kyphotic pelvis, funnel-shaped pelvis and other types of narrow pelvises.

An anatomically narrow pelvis with grade 3 or 4 can complicate the course of childbirth. During contractions, almost 40% of women in labor experience:

weakness of uterine contractions ()
early outpouring of water
possible prolapse of the umbilical cord or arms / legs of the fetus
development of chorioamnionitis, endometritis and infection of the unborn baby
as well as intrauterine fetal hypoxia

During the straining period, the following complications may occur:

secondary weakness of attempts
intrauterine hypoxia of the child
uterine rupture
tissue necrosis with the formation of genitourinary fistulas, intestinal fistulas
trauma of the pelvic joints and nerve plexuses
and if childbirth reaches the third stage, then subsequent and / or postpartum hemorrhage cannot be avoided.

Complete placenta previa

As you know, the placenta is the organ that communicates between the organisms of the mother and child. In a normal pregnancy, the placenta is located either in the fundus of the uterus, or along the anterior or posterior wall. If the placenta is located in the lower segment of the fetus, and completely covers the internal pharynx, then it becomes clear that the exit of the child from the mother's womb in a natural way becomes impossible. Moreover, complete placenta previa is a potential threat not only for the unborn baby, but also for his mother during the entire period of pregnancy, because bleeding can open at any moment, the intensity and duration of which cannot be predicted.

Case Study: I have been observed by a woman of 38 years from the very beginning of pregnancy. Pregnancy was not the first, but very desirable. Despite the absence of any aggravating circumstances in her history, her placenta formed in the lower third of the uterus and blocked the internal os (full presentation). The woman was on sick leave for almost the entire pregnancy, under the supervision of doctors, she did not have a single bleeding. She successfully reached 37 weeks and was admitted to the pathology ward to prepare for a planned caesarean. Well, as usual, for some reason (or maybe fortunately) she began to bleed in the hospital and on the day off. Of course, we immediately went for an immediate cesarean, there was no time to lose. This is how a planned operation turned into an emergency one - the child was born healthy and with a normal weight.

Incomplete placenta previa with severe bleeding

An incomplete placenta previa is said to occur when the latter only partially covers the internal os. Distinguish marginal presentation and lateral.

With the marginal location of the placenta, it only slightly affects the internal pharynx
Whereas with the side it overlaps by half or 2/3 of the diameter.

Incomplete placenta previa also threatens with sudden bleeding, the massiveness of which is difficult to predict. The peculiarity of this localization of the placenta is interesting in that bloody issues more often appear during contractions, because it is at this time that the internal pharynx opens, and the placenta gradually exfoliates. The indication for urgent surgery with incomplete presentation is massive blood loss, which poses a danger to the life and health of the mother and child.

Premature detachment of a normally located placenta

Both during the period of expectation of the child, and during contractions (usually). The danger of this condition also lies in the occurrence of bleeding, which is external (that is, visible) - there are bloody discharges from the vagina, internal or hidden (blood accumulates between the placenta and the uterine wall, forming a retroplacental hematoma, and mixed (there is both visible and latent bleeding) Depending on the area of placental abruption, there are 3 degrees of severity.In moderate and, of course, severe degrees, it is necessary to deliver the woman in labor as soon as possible, otherwise you can lose not only the baby, but also the mother.

Threatening or incipient uterine rupture

There are a lot of reasons leading to the threat of uterine rupture. This may be the wrong conduct of childbirth, discoordination of tribal forces, and much more. In the absence of timely treatment (massive tocolysis, that is, relief of uterine contractions), the threat or the rupture that has begun will very quickly turn into an accomplished, that is, a completed rupture, while both "participants" of childbirth, a woman and an unborn child, die.

Incompetent scar on the uterus

A seam on the uterine wall occurs not only after abdominal delivery, but also after other gynecological operations (for example, conservative myomectomy). The usefulness of the scar is determined by ultrasound, and the thickness of the scarred surface should reach 3 mm or more, the contours of the scar are even in the absence of connective tissue. If there was a complicated course in postoperative period(for example, fever, endometritis, or prolonged healing of skin sutures) in the anamnesis, this indicates the inferiority of the scar.

Two or more scars on the uterus

If there are two or more caesarean sections in the anamnesis, the question of self-delivery is not worth it, since such a condition of the uterus significantly increases the risk of rupture along the scar.

Severe forms of preeclampsia in the absence of a positive effect from therapy and unfinished birth canal

Eclampsia (convulsive seizure) can be fatal for a woman and for her child (see). Therefore, this condition requires immediate relief from the burden. Exactly 2 hours are allotted for the treatment of preeclampsia (preconvulsive stage), if there is no effect, they proceed to an immediate operation. Nephropathy of severe and moderate degree should be treated for no more than two weeks, after which the issue of surgery is decided.

Severe extragenital diseases

The list of indications for surgery includes:

heart disease in the stage of decompensation
pathology of the nervous system
severe thyroid disease
diabetes
hypertension and more

A caesarean section for vision is performed in cases of myopia of the 3rd degree (6 or more), complicated myopia, vision surgeries, etc. In case of poor vision, it is necessary to exclude the period of attempts, since a significant exercise stress can lead to retinal detachment and blindness in a woman.

Anomalies in the structure of the uterus and vagina

In the presence of these defects, the contractile activity of the uterus is disrupted, and the fetus is not able to pass through the birth canal on its own during childbirth.

Tumors of the cervix, ovaries and other pelvic organs
Such tumors close the birth canal and create an obstacle for the baby to come out into the world.
Extragenital cancer and malignant tumor of the cervix
Age primiparous

The indication for caesarean section by age (over 30 years) should be combined with obstetric pathology and extragenital diseases. In age-related primiparas, the elasticity of the muscles of the vagina is reduced and pelvic floor, so the risk of perineal ruptures is high. In addition, such women in labor often develop anomalies of the birth forces that are not stopped by therapy.

Fetal factors requiring operative delivery:

Malposition

At normal pregnancy the fetus should be located longitudinally, head towards the small pelvis. They say about the wrong position of the unborn child when he lies obliquely, transversely, or the pelvic end is present. A cesarean section with a breech presentation is performed with a child weighing more than 3600 g. or less than 1500 gr., as well as with a male fetus (compression of the testicles at birth of the pelvic end can cause infertility in a boy). Breech presentation (legs, pelvic end present) requires surgery, because the baby's head is larger than the pelvic end, and at the birth of the latter, the birth canal is not sufficiently dilated for unhindered advancement and birth of the head.

Example from practice: A woman with strong contractions was admitted to the maternity ward at night. The birth was the third, but she never had an ultrasound during the entire pregnancy. During the vaginal examination, I found that the legs are present, the opening of the cervical canal is 5 cm, and this is an absolute indication for delivery through surgery. When I cut open the uterus and removed the fetus, I was dumbfounded - the fetus was anencephalic with a split spine in cervical region(congenital deformity). Of course, he died immediately after cutting the umbilical cord. On the one hand, an operation with such an anomaly of development is contraindicated, but on the other hand, who knew if the woman was not examined?

Acute fetal hypoxia

This condition means that the child suffers in utero, he does not receive enough oxygen, and each contraction aggravates hypoxia. There is only one treatment - immediate delivery.

Case Study: This was my first independent caesarean after my internship. I spent the whole night fiddling with a primiparous woman, and in the morning I heard with my “ear” that the child was suffering - the heartbeat was slow and muffled, bradycardia. And we didn’t have a CTG (cardiotocograph) then, there’s nothing to check on. I went for the surgery at my own risk. And on time, as she took out the child, who did not even squeak and did not move his arms and legs. In my youth, I decided that he had died, but, fortunately, the child then recovered and was discharged healthy with his mother.

Presentation/prolapse of the umbilical cord

In this situation, the operation must be done immediately, since the dropped loop is pinched by the presenting part of the baby in the small pelvis, as a result of which the fetus is deprived of oxygen. Unfortunately, it is very rare to have time to operate on a woman and save a child.

The death of a woman with a live fetus

In cases of continued agony, the child remains alive for some time and can be saved by abdominal delivery. The operation in such a situation is carried out in the interests of the fetus.

Relative readings

Maternal factors in which the issue of the need for abdominal delivery is decided (relative):

Clinically narrow pelvis

A similar diagnosis is made during childbirth and means that the fetal head does not correspond to the size of the woman's pelvis (the entrance to the small pelvis is smaller than the head). The reasons for the development of such a situation are numerous: a large fetus, discoordination of tribal forces, improper insertion of the head, weakness of contractions, and so on.

Divergence of the pubic joint

During the gestation of the fetus long before childbirth (observed both 2 weeks and 12), a woman may experience a divergence of the symphysis or pubic joint. This pathology is characterized by pain in the area of the symphysis and when probing the pubis, clicking during palpation of the joint, edema is formed above the womb and swelling of the pubis.

The pregnant woman notes discomfort when walking, getting up from a low chair or bed, climbing stairs. The woman's gait also changes, she becomes like a duck, waddling. During palpation of the pubic joint, a cavity is found, where the pad of the fingers fits freely. If the diagnosis is confirmed by ultrasound (radiography of the pelvis is harmful to the fetus), the woman is prescribed bed rest, limitation of physical work and wearing a corset.

When the divergence of the pubic articulation is 10 mm or more, especially if the estimated fetal weight reaches 3800 g. and more, there is an anatomical narrowing of the pelvis, then the woman is prepared for a planned abdominal delivery in order to prevent rupture of the pubic symphysis during independent childbirth.

Weakness of tribal forces

When it is not possible to stimulate labor by opening the fetal bladder to reduce intrauterine volume and administering oxytocin, it is necessary to end the birth by caesarean section. The weakness of the labor force leads to fetal hypoxia, postpartum hemorrhage and birth trauma.

Postterm pregnancy

When the issue of abdominal delivery during a post-term pregnancy is being decided, the ability of the head to be configured in childbirth, the intensity of contractions and aggravating factors (the presence of extragenital diseases and gynecological pathology, there is no effect from labor induction, and others) are taken into account.

IVF, artificial insemination or

This indication must be combined with a complicated obstetric and gynecological history (), stillbirth, gynecological diseases, etc.).

Chronic fetal hypoxia, intrauterine growth retardation

Given that the fetus did not receive enough oxygen and nutrients throughout the pregnancy, and the treatment was ineffective, the question of operative delivery before the term is raised for the benefit of the child.

Hemolytic disease of the fetus

A caesarean section for this indication is performed in the presence of an unprepared (immature) cervix.

large fruit

They talk about a large fetus when its estimated weight exceeds 4 kg, and about a giant one, if the mass reaches 5 or more kg. Childbirth ends with an operation with existing comorbidities (complications in childbirth, gynecological problems and extragenital diseases).

Multiple pregnancy

Abdominal delivery is performed with the presentation of the pelvic end of the first fetus or in the presence of three or more fetuses.

Significant varicose veins in the vulva and vagina

There is a certain risk of damage to varicose veins in the pressing period, which is fraught with intense bleeding.

Pregnant woman's request for surgery

In the West, for example, in England, the expectant mother has the freedom to choose the delivery. That is, it is possible to deliver a pregnant woman by caesarean section at her request. In Russia, this indication is not officially recognized, but there are no documents prohibiting abdominal delivery at the request of the pregnant woman. As a rule, this indication is combined with other relative indications.

Contraindications for abdominal delivery

All contraindications to caesarean section are relative, since the operation is always performed either in the interests of the mother or in the interests of the baby:

unfavorable condition of the fetus (death in utero, prematurity of 3-4 degrees, fetal malformations incompatible with life);
probable or apparent clinical picture infection (long anhydrous interval - over 12 hours);
prolonged labor (over 24 hours);
more than 5 vaginal examinations;
fever during childbirth (chorioamnionitis, etc.);
unsuccessful attempt at natural delivery (obstetrical forceps, vacuum extraction of the fetus).

Childbirth is a process to which a woman's body is fully adapted. But sometimes, for one reason or another, natural childbirth can pose a danger to the health or even life of both the child and the mother. In such cases, an operative delivery is performed - a caesarean section.

Indications for caesarean section

Caesarean section may be planned and urgent. A planned caesarean section is prescribed during pregnancy: according to indications or at will future mother. The decision on an urgent caesarean section is made if complications arise already during childbirth, or dangerous situations that require urgent intervention (acute fetal hypoxia, placental abruption, etc.).

Indications for caesarean section are divided into absolute and relative. Those are considered absolute, on the basis of which the doctor unconditionally prescribes the operation, and there can be no talk of natural childbirth. These indications include the following.

Narrow pelvis of the woman in labor. Because of this anatomical feature, a woman simply will not be able to give birth on her own, as there will be problems with the passage of the child through the birth canal. This feature is detected immediately upon registration, and the woman from the very beginning prepares and adjusts for operative delivery;

Chance of uterine rupture. This indication for caesarean section occurs if there are any sutures and scars on the uterus, for example, after previous caesarean sections and abdominal operations.

Premature placental abruption. Pathology is expressed in the fact that the placenta, even before the onset of labor, is separated from the uterus, depriving the child of nutrition and access to oxygen.

Relative indications for caesarean section

Emergency caesarean section: in what cases do and possible consequences

If immediately before the birth, doctors diagnose that the child cannot be born naturally, an emergency caesarean section is prescribed, the purpose of which is to eliminate complications that threaten the health and life of the woman in labor and the fetus. It is resorted to extremely rarely, when, already in the process of the birth of a baby, facts are discovered that were previously hidden from the eyes of physicians.

No one can predict how everything will happen, so everyone should be ready for such a turn of events: both the medical staff and the woman. Emergency surgery is performed only if there are certain medical indications.

Indications

Doctors, by virtue of their professional competence, know in which cases an emergency caesarean section is performed: the medical indications for this operation are clearly spelled out.

If there is a serious threat to the life, health of the mother and baby during natural childbirth, which the body of the woman in labor cannot cope with on her own, a decision is made on surgical intervention. This is an extreme measure taken by doctors in the name of saving lives.

Clinically narrow pelvis: discrepancy between the size of the pelvis of the woman in labor and the parameters of the fetus, when the head of the child does not squeeze into the birth canal without injury - in this case, an emergency caesarean section is performed with full disclosure of the cervix;

premature rupture of amniotic fluid, in which drug stimulation of labor is ineffective: the fetus cannot be left in the uterus defenseless from infections;

another indication for an emergency cesarean is a violation of the connection between the uterine wall and the placenta: detachment of the latter causes severe bleeding, due to which the mother or child may die;

detection of anomalies during labor: it can be very weak

C-section

Unfortunately, not in all cases, pregnancy ends with physiological childbirth. There are a number of reasons why natural childbirth poses a serious threat to the health and even life of both the fetus and the woman in labor. In such cases, experts prescribe a caesarean section for a woman. Let's talk about what it is, in which cases it is the only one possible way the birth of a child, and when it is contraindicated, what types are there, what kind of anesthesia is used, etc.

What is a caesarean section

A caesarean section is a delivery method in which the baby is removed from the mother's body through an incision in the wall of the uterus. This is an abdominal operation, during which the doctor, with the help of a special medical instruments makes an incision in the abdominal wall, then an incision in the uterine wall, and then takes the baby out into the world. The history of caesarean section goes back a long way. They say that Caesar himself was the first to be born in this way ... A couple of centuries ago, this operation was performed only on dead women in order to save the life of a child. A little later, cesarean was also used in women who, during natural childbirth, encountered any complications that prevented the safe birth of a child. But if we take into account that then people had no idea about antibacterial drugs and antiseptics, then it becomes obvious that cesarean in those days in the vast majority of cases led to the death of a woman in labor. Today, when medicine has developed so much that it is quite capable of curing a variety of diseases and performing the most complex operations, caesarean section has ceased to be a dangerous surgical intervention. Moreover, today it is becoming more and more popular. According to statistics, more than 15% of all pregnancies end in non-physiological childbirth. This may be due to the fact that many women

Preparing for a caesarean section

There are not so many reasons why a woman may be shown a planned caesarean section, but any of these indications for surgery can be detected in any woman in labor at any stage of pregnancy. In some cases, a woman, even during pregnancy planning, knows that she will have to give birth to a child only by caesarean section, and in another pregnant woman, indications for surgical intervention may already be found at 38-40 weeks of pregnancy. In any case, it makes sense to prepare for the operation in order to reduce the number of force majeure situations and simplify this procedure for yourself.

If you are worried about the operation or have any questions, then ask your doctor in advance. Feel free to ask questions, even if they seem insignificant, but still concern you.

A caesarean section involves a rather long stay in the hospital - about a week on average, so you should decide in advance who the older children will stay with or, for example, who will look after the pets.

Be sure to check with your doctor what you can eat before the operation. Due to the use of anesthesia for 12 hours before surgery, it is recommended to refrain from eating and drinking. The day before the operation, you can treat yourself to a delicious hearty dinner or lunch, because after the operation you will not eat for another 48 hours, and then you will stick to the diet for a few more days.

Take a relaxing bath - next time you will not be able to afford such a luxury soon. For quite a long time, before the healing of the postoperative incision, the bath is contraindicated.

Specify whether it is possible to perform the operation under local anesthesia, i.e. with spinal anesthesia. In this case, during the operation, the woman in labor remains conscious and can immediately see her baby.

Indications and contraindications for caesarean section

Bulatova Lyubov Nikolaevna Obstetrician-gynecologist, highest category, endocrinologist, ultrasound diagnostician, specialist in aesthetic gynecology

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

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

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

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

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

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

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

Despite the pain of childbirth, many women, so to speak, prefer natural delivery. However, not everyone succeeds in giving birth "as nature intended" and, according to statistics, 18.7% of all children in the world were born through a caesarean section. This operation is currently the most popular in obstetrics, and it has saved many lives: both mothers and their babies. In this article, we would like to tell you about the absolute and relative medical indications for the aforementioned procedure. Read carefully, because you will learn a lot!

Under what conditions can the operation be performed?

A caesarean section can be elective, planned, or emergency. The first is done in advance at 38-39 weeks, if the woman has indications for the operation. The procedure is urgently performed at the time of the onset of childbirth, if a situation arises when they need to be urgently completed: for example, the placenta exfoliated in the laboring woman and severe bleeding from the genital tract began. A planned cesarean is done after the onset of labor or after the moment when the waters have broken. The procedure is performed if there are relative indications: for example, the expectant mother decided to give birth on her own, but complications arose in the process, so the doctors, according to a pre-drawn plan, prepare her for the operation.

Indications for caesarean section, in the presence of which the operation is mandatory

The list of absolute indications, in the presence of which a caesarean section is mandatory, includes:

a woman has a very narrow pelvis (an indication is a narrowing of 3-4 degrees);
manifested acute fetal hypoxia;
the fetus is located obliquely or transversely;
the placenta partially or completely obscures the internal os, which creates obstacles for the passage of the child;
the expectant mother has a scar on the uterus (if she had previously had a caesarean section or other operation in the mentioned area);
eclampsia began;
there are cancerous tumors in the genital area and nearby organs;
there is a threat of uterine rupture;
the woman is in a state of agony or dying, and the fetus is still alive;
the lady has vaginal varicose veins;
a woman has a high degree of myopia (natural childbirth can lead to retinal detachment);
there is severe illness heart and blood vessels.

What indications are relative?

If a girl has relative indications for a caesarean section during pregnancy, doctors are preparing to perform the operation if complications begin during childbirth. These indications include:

narrow pelvis (narrowing of 1-2 degrees);
delayed pregnancy;
late toxicosis (mild or moderate);
too large fruit;
prolapse of the umbilical cord;
the age of the woman (if the lady is over 30, and there is also any indication from this list);
fetal hypoxia (oxygen starvation that began during childbirth);
anomalies in the development of the uterus;
any diseases of the mother, in which an early and accurate delivery is desirable (one of these diseases is diabetes mellitus).

Contraindications for caesarean section

Any operation has contraindications, and caesarean section is no exception. It should be understood that this operation has no absolute contraindications, however, below we will present a list of cases when operative delivery is not recommended.

So, under what circumstances can a caesarean be not done? Reasons must be good enough:

if a woman has a risk of complications of an infectious nature after surgery;
if the fetus died inside the womb;
if the fetus has deformities or defects incompatible with life;
if the fetus is premature and there is no doubt that it will not be viable outside the uterus;
if the fetus showed acute and prolonged hypoxia, which is why it will definitely be born dead or die in a short period after childbirth.

If there is a possibility of the death of a child, doctors will be interested in preserving the health and life of a woman. In this case, it is better not to perform a caesarean section, as serious complications may develop. infectious diseases, after all, a dead fetus is a source of infection.

Now you know more about the caesarean section operation. We hope that the material was useful and interesting for you!

The article lists all absolute and relative indications for caesarean section, as well as the most common reasons for operative delivery.

If, for any reason, vaginal delivery is not recommended, doctors suggest a caesarean section, but the expectant mother in some cases can determine the way her child is born. But when a caesarean section is the only safe option, the woman is left with no choice.

Indications for caesarean section may include:

absolute- circumstances on the part of the mother or fetus that preclude the possibility of vaginal delivery
conditional- when, despite the indications, the doctor can perform a vaginal birth at his discretion

IMPORTANT: Caesarean section, like any other operation, can be performed with the consent of the woman in labor and her relatives. In addition, the obligatory conditions are the absence of infections in the mother, a live fetus, the presence of a doctor practicing this type of delivery and a prepared operating room.

Absolute medical indications for caesarean section: list

For absolute readings standard childbirth is not carried out due to physiological characteristics.

These include:

narrow pelvis (2-4 degree)
malformations and injuries of the musculoskeletal system
mechanical obstacles that will prevent the baby from being born (tumors or deformities)
chance of uterine rupture if there is an incompetent scar less than 3 mm with uneven contours from recent uterine surgery
two or more previous births by caesarean section
thinning of the uterus due to repeated births in the past
placenta previa, dangerous with a high probability of occurrence
bleeding during childbirth
placental abruption
multiple pregnancy(three or more children)
macrosomia - large fetus
abnormal fetal development
Mother's HIV positive status
the presence of herpes rashes on the labia
repeated entanglement of the fetus with the umbilical cord, entanglement around the neck can be especially dangerous

Indication for caesarean section - repeated entanglement of the child with the umbilical cord

Medical indications relative to caesarean section: list

Relative readings to caesarean section do not exclude the possibility of vaginal delivery, however, they are a serious reason to think about their necessity.

In this case, vaginal birth may be associated with the likelihood of a serious threat to the health and life of the woman in labor and her baby, but this issue must be resolved individually.

Relative medical indications are:

diseases and pathologies of the cardiovascular system in the mother
kidney disease
myopia
diabetes
malignant tumors
exacerbation of any chronic disease
nervous system damage
preeclampsia
mother's age over 30 years
malpresentation
large fruit
entanglement

IMPORTANT: A combination of several relative readings can be regarded as an absolute reading. In such cases, a caesarean section is performed.

Large fetus - relative indication for caesarean section

Emergency caesarean section: indications for surgery

Decision to conduct emergency caesarean section (ECS) taken during childbirth, when something went wrong and the current situation poses a real threat.

Such a situation could be:

cervix stopped dilating
baby stopped moving down
stimulation of contractions does not bring results
the child lacks oxygen
fetal heart rate is significantly higher (lower) than normal
baby tangled in the umbilical cord
there was bleeding
threat of uterine rupture

IMPORTANT: EX must be carried out on time. Untimely operational actions can lead to the loss of the child and the removal of the uterus.

Indications for caesarean section due to vision, due to myopia

Myopia, in other words myopia, one of the most common reasons doctors recommend that pregnant women have a cesarean delivery.

With myopia, the eyeballs change somewhat in size, namely, they increase. This entails stretching and thinning of the retina.

Such pathological changes lead to the formation of holes in the retina, the size of which increases with the deterioration of the situation. Then comes a noticeable deterioration in vision, and in critical situations - blindness.

The risk of breaks in the retina during childbirth is greater, the higher the degree of myopia. Therefore, doctors do not recommend giving birth naturally to pregnant women with an average and high degree of myopia.

The indications for caesarean section are:

permanent visual impairment
myopia of 6 or more diopters
serious pathological changes in the fundus
retinal tear
previous surgery for retinal detachment
diabetes
retinal dystrophy

IMPORTANT: It is the condition of the fundus that determines. If it is satisfactory or has minor deviations from the norm, it is possible to give birth independently and with a high degree of myopia.

Myopia is an indication for a caesarean section

Conditions in which a pregnant woman can give birth on her own, regardless of whether she has myopia:

no abnormalities in the fundus
improvement of the retina
rupture healing

IMPORTANT: Women with myopia during natural childbirth in without fail carry out episiotomy.

Indications for caesarean section by age

However, if the state of health of the future mother allows you to give birth on your own, this chance should be taken.

IMPORTANT: Age alone is not an indication for caesarean section. A planned operation should be performed if there are concomitant circumstances that can interfere with the normal course of childbirth: a narrow pelvis, an immature cervix after 40 weeks, etc.

If complications occur during vaginal delivery, such as weakening of labor, an emergency caesarean section is performed to eliminate the risk of further complications and deterioration of the fetus.

Indications for caesarean section due to hemorrhoids, varicose veins

natural childbirth with hemorrhoids dangerous due to the risk of rupture of external nodes. This can happen during attempts, when the blood overflows the bumps and tears them under strong pressure. Severe bleeding occurs, internal bumps fall out.

If the obstetrician does not have time to set the internal nodes before the anus is compressed, they will pinch, which is fraught with the transition of the disease to an acute form. The woman is in severe pain.

To prevent this situation, doctors may recommend a caesarean section for hemorrhoids. However, natural childbirth is possible even with chronic hemorrhoids.

IMPORTANT: If a decision is made to give birth vaginally, a woman should prepare for a rather painful and time-consuming process.

Hemorrhoids - one of the indications for a caesarean section

A similar situation with the choice of method of delivery in varicose veins. If during pregnancy a woman took measures to prevent thrombosis, and the doctor did not notice deterioration, it is likely that natural childbirth will be carried out.

Immediately before childbirth, a woman's legs are bandaged with an elastic bandage. This helps to avoid reflux of blood at the moments of greatest pressure - with attempts.

A few hours before the expected birth, the woman in labor is given special drugs that will help avoid the complications of varicose veins.

IMPORTANT: Varicose veins themselves are not an absolute indication for caesarean section. However, in women suffering from varicose veins veins, there are frequent cases of premature rupture of amniotic fluid, placental abruption and bleeding during or after childbirth.

Then a caesarean section is the safest for both the mother and the baby. Given these factors and the condition of the woman, the doctor makes a decision and chooses the method of delivery.

Indications for a caesarean section due to a large fetus

"Big fruit"- the concept is individual for each pregnant woman. If the expectant mother is a miniature thin woman of small stature with a narrow pelvis, even a child of 3 kg can be large for her. Then the doctor will recommend that she give birth by caesarean section.

However, for a woman of any complexion, there is a danger of “feeding” a child in the womb, which will deprive her of the opportunity to give birth on her own.

Development macrosomia possible for the following reasons:

expectant mother moves a little
a pregnant woman receives improper high-carbohydrate nutrition and quickly gains weight
second and subsequent pregnancy - often each child is born larger than the previous one
diabetes in the mother, leading to the child receiving a large amount of glucose
taking medications to improve placental blood flow
enhanced fetal nutrition through a thickened placenta
post-term fetus

IMPORTANT: If the doctor detects signs of the development of macrosomia at any time, he first of all tries to find out the causes of this phenomenon and normalize the situation. If this succeeds and the weight of the fetus returns to normal before delivery, a caesarean section is not prescribed.

To normalize the weight of the fetus of a pregnant woman, it is necessary:

complete recommended examinations
consult an endocrinologist
donate blood for glucose
exercise every day
stop eating sweet, starchy, fatty and fried foods

Large fetus - indication for caesarean section

Indications for caesarean section due to narrow pelvis

Each woman, her figure and body is unique, so it is difficult to answer the question of whether a pregnant woman with certain parameters can normally give birth naturally.

When prescribing a cesarean due to a narrow pelvis, doctors are guided not only by standard tabular indicators, but also by such an important factor as the size of the child's head.

If the child has a large skull, he will not be able to pass through the birth canal in a natural way, even if the cervix is well prepared for childbirth, and the contractions will intensify. At the same time, if the pelvis of the woman in labor is narrow, but the child corresponds to the size of the pelvis, natural childbirth will be quite successful.

IMPORTANT: A pathologically narrow pelvis, not intended for natural childbirth, occurs only in 5-7% of women. In other cases, the definition of "narrow pelvis" implies a discrepancy between its size and the size of the fetal skull.

In any case, when the pregnant woman is registered, pelvic measurements will be taken. The data obtained will allow predicting the likelihood of complications.

IMPORTANT: Even a slight narrowing of the pelvis often leads to the fact that the child takes the wrong position - oblique or transverse. This position of the child is in itself an indication for a caesarean section.

Also, an absolute indication for surgical intervention is a combination of a narrow pelvis with:

prematurity of the fetus
hypoxia
a scar on the uterus
over 30 years of age
pathologies of the pelvic organs

Narrow pelvis - indication for caesarean section

Indications for caesarean section due to preeclampsia

early and late preeclampsia are a complication of pregnancy. But if early gestosis is practically harmless and does not lead to pathological changes in the body of a pregnant woman, then later ones can lead to serious consequences and even death of the mother.

IMPORTANT: Early gestosis manifested by nausea and vomiting early dates, late ones can be recognized by severe edema, increased pressure and the appearance of protein in the urine test.

deceit late gestosis lies in the unpredictability of the development of the disease. They can be successfully stopped, or they can lead to serious complications, such as:

kidney dysfunction
blurred vision
hemorrhage in the brain
deterioration in blood clotting
ecplasia

IMPORTANT: Preeclampsia is treated in a hospital, where a woman is under the supervision of medical personnel around the clock.

Preeclampsia of pregnancy - an indication for caesarean section

Indications for caesarean section breech presentation

breech presentation- an unfavorable position for natural delivery, which the child occupied in the womb. On the ultrasound images, you can see that the child seems to be sitting with his legs up or tucked up, instead of lying head down.

Up to 33 weeks all coups of the fetus inside the mother's abdomen are quite natural and do not cause concern. but after 33 weeks the baby should roll over. If this does not happen and the child sits on the priest even before the very birth, the doctor may decide to perform delivery by caesarean section.

Several factors influence the way in which childbirth will be carried out in this situation:

mother's age
baby's weight
gender of the child - if a boy, then only a cesarean, so as not to damage the male genital organs
type of presentation - the most dangerous - foot, as there is a real danger of loss of limbs during childbirth in a natural way
pelvis size - if narrow, then cesarean

Breech presentation and multiple pregnancy - indications for caesarean section

Is it possible to ask for a caesarean section without indications?

Caesarean section is performed for medical reasons. But if the expectant mother has no desire to give birth on her own, she is set only for the operation, in the maternity hospital, most likely, they will go to meet her.

Psychological readiness is one of the important factors determining the way of childbirth. Having a negative experience of natural childbirth in the past, a woman may be so afraid of repeating the experience that she will lose control of herself and her actions at the most inopportune moment. In such cases, a caesarean section will be the safest delivery option for both mother and child.

IMPORTANT: If a woman, despite the lack of evidence, intends to give birth only by caesarean section, you need to inform the doctor in advance. Then the woman in labor will have time to prepare for childbirth, and the doctors will have the opportunity to perform a planned rather than an emergency operation.

Expectant mothers who are going to have a caesarean section should not be afraid.

Modern technologies allow not to put the woman in labor to sleep, but to apply spinal anesthesia and carry out childbirth in her presence, and good postpartum care and pain medications will help you survive the first few difficult days after the operation.

Video: C-section. Operation caesarean section. Indications for caesarean section

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

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

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

FirstSecond

If you recognize yourself in one of the situations I have described, then it will be very useful and interesting for you to learn everything about the absolute and relative indications that indicate the need for surgical delivery. So, we figure out when it is absolutely impossible to do without an operation, and when a doctor can agree to carry it out even without any prerequisites for this.

List of indications for caesarean section 2020

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

Many heart diseases, vision pathologies, etc., were also excluded from the list of indications for caesarean section. However, over the past period of 2020, more than 30% of children left the mother's womb through an incision on the abdomen, and not naturally. Let us consider in more detail what this fact is due to.

Absolute readings

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

A woman cannot avoid surgery if she has:

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

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

Relative readings

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

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

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

Indications for emergency caesarean section

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

Here are the most common examples:

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

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

Main list of contraindications

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

The operation is dangerous:

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

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

Cesarean section without indications

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

I justify my refusal with the following facts:

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

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

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

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

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

How is the operation

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

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

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

What you need to be ready for

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

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

Conclusion

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

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