Indications for caesarean section. Indications for caesarean section during pregnancy and childbirth

23.03.2021

Pregnant women always have some fears about the upcoming birth, especially if they are carrying their first children. Most doubts are experienced by women who have to go through a caesarean section. Meanwhile, this operation is considered one of the most frequently performed in the world. And cases when a caesarean section saved the life of both mother and baby are not at all uncommon.

Naturally, like any surgical intervention, a caesarean section is performed according to certain medical indications.

Indications for caesarean section

The need for a caesarean section arises if natural childbirth is not possible or dangerous to the life and health of the mother or baby.

Absolute and relative readings

Medical indications can be absolute, in which a pregnant woman is assigned delivery by cesarean section without fail, or relative, in the presence of which the doctor decides at his own discretion whether to perform a cesarean section or allow the woman to give birth herself. However, if there are several relative indications at once, surgical intervention becomes mandatory.

Absolute indications include:

Indications for emergency caesarean section

For caesarean, indications can occur both during pregnancy and directly during childbirth, so this operation can be both planned and emergency. The above indications may lead to planned surgery. The decision to conduct an emergency operation may occur in the following situations:

Narrow pelvis, scars, fibroids

One of the reasons for performing a caesarean section is the anatomical features of a woman, the so-called "anatomically narrow pelvis". This diagnosis speaks about the size of the pelvis that do not correspond to the norm (less than the norm). The diagnosis is made by an obstetrician-gynecologist who monitors the pregnant woman. In addition to the diagnosis of "anatomically narrow pelvis", there is a "clinically narrow pelvis". Doctors can put it by comparing the anatomical parameters of a woman and the size of the fetal skull.

With a narrow pelvis, there is a risk of that the baby will not pass through the birth canal, or may receive injuries incompatible with life. The same risks arise if the mother has scars from previous sections or various tumors and fibroids.

In addition, with a "narrow pelvis", the likelihood of malpositioning of the fetus increases significantly, which in itself is an indication for a caesarean section.

Myopia, serious pathology of the fundus

Myopia (nearsightedness) is one of the most common reasons for caesarean delivery. With myopia, the eyeballs enlarge, which leads to thinning of the retina. When the situation worsens in the network holes can form in the fabric, which, in turn, leads to an even greater deterioration in vision.

Natural childbirth can provoke such ruptures, and the risk increases with increasing degree of myopia. However, myopia is not always an absolute indication for a caesarean section, but only if there is a stable deterioration in vision, the woman has diabetes mellitus, operations have previously been performed due to retinal detachment, there is retinal detachment or dystrophy, as well as serious pathological changes in the fundus . Moreover, the determining factor is the condition of the fundus of the eye.

large fruit

A large fetus (macrosomia) is a concept that does not have a common definition for all women in labor. Here everything is calculated individually. So, for a thin, short woman with a narrow pelvis, the diagnosis of "large fetus" can be made when the fetus reaches only 3 kg.

However, a pregnant woman of any complexion has a risk of making such a diagnosis, and in most cases the cause of its occurrence will be the wrong regimen of the expectant mother herself. Macrosomia will contribute to the immobility of the pregnant woman, the use of a large amount of carbohydrate food. There may also be unrelated reasons from the behavior of a woman: diabetes mellitus, thickening of the placenta, taking drugs that improve placental blood flow. In addition, the risk of macrosomia increases if a woman is not expecting her first child, since with repeated births, as a rule, each baby is born larger than the previous one.

To avoid this situation, doctors recommend expectant mothers to do special exercises for pregnant women every day, not to consume excessive amounts of sweet, starchy, fried and fatty foods. Also, if the obstetrician sees a risk of developing macrosomia, he can refer the pregnant woman to an appointment with an endocrinologist and a blood test for glucose.

Late preeclampsia

Gestosis is early and late. Early manifested by nausea and vomiting in the first months of pregnancy. It does not harm the health of a woman. Late gestosis, manifested in the form of edema, increased pressure and the appearance of protein in the urine test, is more dangerous. It can provoke a deterioration in vision and blood clotting, disrupt the functioning of the kidneys.

Severe late preeclampsia may be an indication for a caesarean section, and with its mild and moderate forms, natural childbirth, in the absence of other indications, is not prohibited.

Malposition of the fetus

During pregnancy, various fetal upheavals are natural and should not cause concern. However, after 33 weeks the baby should take the correct position "upside down". If this does not happen, and the baby is located, as if sitting, then we can talk about the breech presentation of the fetus. If the child remains in this position until the very birth, doctors may decide to perform a caesarean section. This will also take into account the weight of the child, the age of the mother, the sex of the baby (if it is a boy, then a cesarean section will be scheduled), the size of the pelvis, how the fetus is located (with a foot presentation, a cesarean section will be scheduled).

Contraindications

There are no absolute medical contraindications to caesarean section. However, there are relative factors increase the risk of postoperative inflammation. These include:

the duration of natural childbirth before surgery is more than 12 hours;
anhydrous interval longer than 6 hours;
acute illness in the mother;
reduced immunity.

In the presence of these factors, caesarean is still prescribed, but it is carried out under more careful control. Doctors also more carefully monitor the condition of the woman after the operation, prescribe additional treatment with antibiotics and drugs that stabilize the immune system.

Recently, there have been cases when pregnant women ask for a caesarean section, despite the absence of medical indications. And although a cesarean section, like any other operation, should be prescribed only if there is evidence for this, doctors can make concessions and prescribe a cesarean section if the woman is psychologically unprepared to give birth naturally. If she is so afraid of childbirth that there is a risk of her inappropriate behavior during them.

A modern cesarean operation with spinal anesthesia allows the mother not to fall asleep and see her baby immediately after birth, and modern painkillers help to endure the postoperative period quite easily. Therefore, pregnant women those who have indications for this method of delivery should not be afraid of the operation.

It's no secret that a caesarean section is an operation that ends a significant percentage of pregnancies. Some future mothers know in advance that their baby will be born by cesarean, others are preparing for natural childbirth, but problems arise in the process, and an operative outcome becomes the only possible one. A conscientious doctor will not prescribe a caesarean just like that; there must always be good reasons for such an outcome of pregnancy. In this article we will talk about indications and contraindications for caesarean section. Traditionally, indications for CS are divided into absolute and relative indications on the part of the mother and on the part of the fetus. Below are lists of indications for both planned and emergency caesarean sections.

Absolute indications for caesarean section

The decision on the need for a caesarean section in each case is made by the doctor. Despite the unpredictability of the birth process, in a number of situations it is known in advance that a woman cannot give birth naturally, therefore a planned caesarean section is prescribed. Indications on the part of the mother and child, physically making natural childbirth impossible, are called absolute.

Absolute indications for caesarean section on the mother's side:

Absolutely narrow pelvis - this is a narrowing of the pelvic bones of a woman, through which the child cannot physically pass during natural childbirth. Obstetricians refer to the size of the pelvis as either normal or narrowed. The anatomically narrow pelvis has an objectively reduced size, and natural delivery in such a situation is impossible. Absolutely narrow is the pelvis II-IV degree of narrowing. With III-IV degree, a caesarean section will be planned, and with II degree, the decision will most likely be made already during natural childbirth.

With a normal size of the pelvis or with I degree of narrowing, normal childbirth is possible, but if a woman is carrying a large child, there is a possibility that her pelvis will be clinically narrow. The dimensions of the pelvic ring in this case simply do not correspond to the dimensions of the fetal head.

Careful measurement of the true size of the pelvis using ultrasound and X-ray pelvimetry (X-ray of the pelvic bones) allows you to find out whether a woman can give birth herself or if a planned caesarean section is required.

Even with the normal size of the pelvic ring, the baby may turn incorrectly during childbirth. If a vaginal examination reveals frontal or facial insertion of the head, this means that natural childbirth is not possible, since the head cannot pass through the pelvis with its largest size. This situation is an absolute indication for an emergency caesarean section.

Mechanical obstacles for natural delivery (uterine fibroids in the isthmus, ovarian tumors, deformities of the pelvic bones) are also an absolute indication for a planned caesarean section. This factor is usually diagnosed by ultrasound.
Threat of uterine rupture exists in women who have already undergone a caesarean section or have a history of any operations on the uterus. The doctor determines the probability of rupture according to the condition of the scar. If it has a thickness of less than 3 mm, uneven contours and inclusions of connective tissue, the risk of uterine rupture along this suture is too great for a woman to give birth on her own. For reliability, the scar is examined both before and during childbirth. Additional factors in favor of caesarean are the presence of two or more caesarean sections in the past; severe postoperative period after the previous caesarean - with fever, inflammatory processes in the uterus; long healing of the seam on the skin; numerous natural childbirth, thinning the wall of the uterus.

Absolute indications for caesarean section on the part of the fetus:

placenta previa - an extremely dangerous situation, which, fortunately, is easy to diagnose during pregnancy with the help of ultrasound. The placenta previa is not attached to the back of the uterus, as it should be, but in its lower third and sometimes even directly above the cervix, thereby blocking the exit for the fetus. Placenta previa can cause severe bleeding that can put both mother and baby at risk. This anomaly, in the absence of blood discharge, indicating placental abruption, becomes a diagnosis for a planned caesarean section only in late pregnancy. Earlier - there is no need to panic, the placenta can still rise to its normal position.
Premature placental abruption - separation of the placenta before the onset of labor or during their process is dangerous for both the woman (profuse blood loss) and the fetus (acute hypoxia). It is an absolute indication for an emergency caesarean section.
Cord prolapse can occur during childbirth with polyhydramnios, when a large amount of amniotic fluid is poured out (water is leaving), and the baby's head has not yet been inserted into the small pelvis. The prolapsed umbilical cord is squeezed between the pelvic wall and the head, which means that the blood flow between mother and child is disturbed. If the obstetrician diagnoses such a condition during a vaginal examination after the discharge of water, this is a reason for an emergency caesarean section.
Transverse position of the fetus becomes an absolute indication for caesarean section already during childbirth. In a natural way, a child can be born only if he is located with his head or buttocks down, i.e. has head or pelvic presentation. In the transverse position, children of multiparous women most often find themselves (due to weakening of the muscles of the uterus and abdominal wall), and factors contributing to the transverse position of the fetus are placenta previa and polyhydramnios. If the baby does not turn over during labor, even with the help of obstetric manipulations, doctors have no choice but to perform an emergency caesarean section.

Relative indications for caesarean section

The name "relative indications" speaks for itself: they include such conditions in which natural childbirth is physically possible, but has a theoretical risk to the health and even the life of the woman in labor and the baby.

Relative indications for caesarean section on the mother's side:

Extragenital pathologies - concomitant diseases of a woman not related to her gynecological health and pregnancy. The significant stress that a woman in labor experiences during childbirth can cause an exacerbation of existing pathologies that is dangerous for her health. Therefore, doctors attribute a number of diseases to relative indications for a caesarean section:

cancer of any localization;
cardiovascular diseases;
diabetes;
high myopia with a risk of retinal detachment;
kidney disease;
diseases of the nervous system and a number of others.

In addition, relative indications for caesarean section include diseases that can be transmitted from mother to child during its passage through the birth canal, for example, genital herpes.

Preeclampsia of pregnant women is a dangerous pathology that occurs in some women in the second half of pregnancy. With gestosis, the work of the kidneys, blood vessels and brain of the expectant mother is disrupted. This deviation is manifested by high blood pressure, the appearance of protein in the urine, swelling, headaches, flashing "flies" before the eyes and sometimes convulsions. Preeclampsia in its severe forms (preeclampsia and eclampsia) is a medical indication for emergency caesarean section, because it causes fetal hypoxia.
Clinically narrow pelvis - this is a discrepancy between the size of the pelvic ring of a woman and the size of the presenting part of the child (head). In this case, the baby's head does not enter the birth canal with full disclosure of the cervix and the presence of active contractions. The danger of this pathological condition is the risk of uterine rupture, acute fetal hypoxia (which can even lead to his death). The size of the baby's head cannot be absolutely accurately determined before delivery, and in addition, incorrect insertion or distortion of the head is possible, so a clinically narrow pelvis is diagnosed already in the process of childbirth and is an indication for an emergency caesarean section.
Woman's age over 30 or 35 and first birth . The dangerous factor in this case is not the age, but the state of health of the woman in labor. It is logical that a 20-25-year-old primipara is likely to be healthier than one who is already 30-35 or more. However, not everything is so simple, and doctors know about it. Age over 35 can only be a relative indication for caesarean section. If a woman is healthy at 35, and the pregnancy is easy and safe, it is likely that she will be able to give birth naturally.
Persistent weakness of labor activity . If for some reason the natural childbirth that has already begun has subsided, there is no increase in contractions or they have completely disappeared, and medical assistance does not bring results, doctors talk about the persistent weakness of labor activity. If the child suffers at the same time (devices show the presence of hypoxia), a caesarean section will appear to doctors as a more favorable outcome than waiting for the resumption of natural childbirth.
Scar on the uterus in itself is only a relative indication for caesarean section. But this is a risk factor for uterine rupture, which the obstetrician always pays attention to. Scars on the uterus are not always associated with a previous caesarean section, they may be the result of an artificial abortion or removal of fibroids. The condition of the scar must be monitored, especially after 36-37 weeks of pregnancy, and if it is complete, the woman has every chance of giving birth naturally.

Relative indications for a planned caesarean section on the part of the child:

Breech presentation of the fetus allows a woman to give birth herself, but still it is considered pathological. Natural birth with breech presentation carries the risk of fetal hypoxia and birth trauma. The situation is aggravated if the child is large (more than 3.6 kg), and the mother is the owner of an anatomically narrowed pelvis.
large fruit (more than 4 kg) is an indication for caesarean section only if there are other relative indications.
Identified chronic or acute fetal hypoxia (oxygen starvation) can serve as a good enough reason for operative delivery. The causes of hypoxia can be different: chronic hypoxia usually caused by gestosis of pregnant women and leads to a delay in the development of the fetus; acute hypoxia may occur during prolonged or, on the contrary, too fast and active labor, with placental abruption or prolapse of the umbilical cord. To diagnose oxygen starvation, which is extremely dangerous for the life of a child, use:

listening with an obstetric stethoscope,
Doppler ultrasound (study of blood circulation between the fetus, placenta and uterus),
cardiotocography (registration of the heartbeat and fetal movements using a special apparatus),
amnioscopy (examination of amniotic fluid using an optical device).

If hypoxia is detected, and the treatment does not bring results, a decision is made on the need for a caesarean section to preserve the health of the child.

Each of the relative indications separately cannot serve as a reason for prescribing a caesarean section, however, when deciding on the outcome of a pregnancy, the doctor weighs all the pros and cons of each option. If the operation seems to the doctor as a safer way of delivery for the health of the woman and the child, the choice will be made in her favor, taking into account only relative indications. In addition, there are so-called combined indications for caesarean section. They are a combination of factors, each of which in itself is not an indication for caesarean section, but together they turn into a real threat to life and health during natural childbirth. For example, this is a post-term pregnancy and identified hypoxia; large fetus and breech presentation; over 35 years of age and a serious illness.

Conditions for a caesarean section

A caesarean section can only be performed if a number of conditions are met. These include:

fetal viability;
the consent of the woman or her legal representatives (relatives) to the operation;
availability of an operating room equipped with all necessary instruments and a qualified surgeon;
no infections.

Contraindications for caesarean section

Like any operation, caesarean section has a number of possible contraindications. However, they are not absolute, since the reasons for the operation are usually quite good. Surgical delivery is undesirable in the following cases:

the possibility of purulent-septic complications in a woman in the postoperative period;
intrauterine fetal death;
the presence of deformities and malformations in the fetus that are incompatible with life;
deep prematurity of the fetus (respectively, its non-viability outside the uterus);
prolonged severe fetal hypoxia, when it is no longer possible to deny the possibility of stillbirth or death of the newborn.

With the probability of fetal death, the choice of the method of delivery is aimed primarily at preserving the life and health of the woman. The operation, especially in the presence of risk factors, can cause infectious and septic complications (inflammation of the uterus or appendages, purulent peritonitis - acute inflammation in the peritoneum), since the dead fetus becomes a focus of infection.

Doctors identify the following risk factors for the development of purulent-septic complications:

A variety of immunodeficiency states (HIV, weakened immunity after taking potent drugs, etc.).
The presence of an infectious disease in a woman in an acute or chronic form (inflammatory processes in the appendages, caries, chronic pyelonephritis, cholecystitis, infections of the upper respiratory tract, etc.).
Gynecological diseases and complications of pregnancy that worsen blood microcirculation (gestosis of pregnant women, anemia, hypotension and hypertension, etc.).
The duration of labor is more than 12 hours or the anhydrous period (after the discharge of amniotic fluid) is more than 6 hours.
Significant blood loss, not replenished in a timely manner.
High frequency of vaginal (especially instrumental) studies.
The presence of a corporal incision on the uterus (across the muscle fibers).
Unfavorable infectious environment in the hospital.

However, in the presence of absolute indications for caesarean section, even with an acute infectious process that threatens with septic complications, the woman must still be operated on. Until recently, in such a situation, only one option was possible - fetal extraction with simultaneous removal of the uterus in order to avoid purulent peritonitis. However, now there is a more favorable technique that allows you to save the uterus - caesarean section with temporary isolation of the abdominal cavity (extraperitoneal caesarean section).

Myths about caesarean section

In modern medicine, unfortunately, there has been a dangerous trend towards an increase in the number of caesarean sections. This is especially true for developed, prosperous countries. Some women really dream of a caesarean as an easy way to deliver. The reason for this attitude is ignorance or misunderstanding of what a caesarean section is. Let's dispel popular myths about this operation:

1. It is painless, unlike natural childbirth . Not true. A caesarean section is an operation during which several layers of tissue are cut. Yes, general anesthesia or epidural anesthesia “turns off” pain during surgery (by the way, not always completely). But after recovering from anesthesia, pain in the suture area can make the postoperative period, especially its first days, completely unbearable. But you need to get up to go to the shower and toilet, and take care of the baby - feed, take him in your arms. Some women experience pain for several months.

2. It's even better for the baby - he does not need to pass through the tight birth canal, risking birth trauma. Absolute delusion. Babies born by caesarean section are traumatized by default. Neurologists always refer them to the risk group for speech disorders and other developmental delays. Nature created the mechanism of natural childbirth for a reason. A sharp change in the process of pressure acting on the child during the operation, the effect of anesthesia, the baby's passivity in the birth process, less contact with the mother due to restrictions after cesarean, a high probability of artificial feeding - all this cannot but affect the child's adaptation to the environment. It is more difficult for him to learn to scream, breathe, suck. There is no way to talk about any advantages of a caesarean section for a baby (unless, of course, we are talking about saving life and health).

3. At 30 or 35, health is no longer good enough to give birth on your own, especially for the first time. . This is not true. Age is only a relative indication for caesarean section, which cannot be decisive. The doctor must take into account the state of health of a particular patient, and not her passport age.

4. After caesarean - always caesarean . The presence of a scar on the uterus from a previous delivery operation also refers to relative indications for caesarean section. Modern diagnostics allows you to establish the viability of the scar and predict the possibility of natural childbirth.

As you can see, a caesarean section is not something to strive for at any cost. However, if there are indications for surgery, there is no need to panic. The method of delivery is undoubtedly important, but it is even more important that the mother and the newborn baby are alive and well. This is what should be the priority goal of the doctor who prescribes you a caesarean section or gives you the go-ahead for natural childbirth. We wish you good health and a happy meeting with your baby soon!

If we believe the information that has come down to us from the past, the history of the caesarean section is rooted in antiquity. The myths of ancient Greece say that it was in this way that Dionysus and Asclepius were extracted from the womb of dead mothers. At the end of the 12th century BC, a law was passed in Rome, according to which the burial of a deceased pregnant woman was carried out only after the removal of the child by means of ablation. Soon this experience was adopted by doctors from other countries, but the operation was performed exclusively on dead women. In the 16th century, Ambroise Pare, a French court surgeon, first began performing caesarean sections on live patients, but the outcome was always fatal. The mistake made by Pare and his followers was that the incision on the uterus was not sewn up, relying on the contractility of this organ. Caesarean section was for the doctors of that time an opportunity to save the child, when there was no chance to save the life of the mother.

Only in the 19th century was it proposed to remove the uterus during surgical delivery, due to which the mortality rate was reduced to 20-25%. After some time, the organ began to be sewn up using a special three-story suture, which made it possible to perform cesarean not only for dying women in labor - it began to be carried out to save the lives of women. In the middle of the 20th century, with the beginning of the era of antibiotics, deaths due to surgery became rare. This was the impetus for expanding the list of indications for caesarean section, both on the part of the mother and the fetus.

Absolute indications for caesarean section

Today, absolute indications for caesarean section are situations where delivery in another way is impossible or endangers the life of a woman. Among them:

Anatomically narrow pelvis (III-IV degree of narrowing). The causes of this pathology are different: excessive physical activity or malnutrition in childhood, trauma, rickets, tuberculosis, poliomyelitis, etc. The formation of an anatomically narrowed pelvis is also facilitated by hormonal imbalance during puberty;
Premature detachment of a normally located placenta (in the absence of the possibility of urgent delivery in a natural way). Physiologically, the placenta separates (exfoliates) from the uterine walls after the birth of the baby. Premature is called placental abruption, which began during gestation, as well as in the first or second stage of labor;
Complete placenta previa or open bleeding with incomplete presentation;
Threatening or incipient uterine rupture. Such an anomaly occurs in 0.1-0.5% of cases of the total number of births;
Eclampsia during pregnancy or in the first stage of labor; the inability to carry out a quick delivery of a patient with severe current preeclampsia, not amenable to therapy; onset of renal and hepatic failure;
Cicatricial changes in the genital organs and pelvis (rare cases of stenosis of the vagina and cervix that occur against the background of infectious diseases (diphtheria, scarlet fever, etc.), as well as various kinds of manipulations); the presence of urogenital and intestinal-genitourinary fistulas. Fibromyomas, tumors of the ovaries, as well as soft and bone elements of the pelvis, in case of unfavorable localization, can become an obstacle to the natural extraction of the fetus;
Incorrect presentation of the fetus (transverse, oblique or pelvic) in combination with a large weight;
Incorrect insertion of the fetal head into the entrance to the small pelvis. It is noteworthy that such a condition does not always become an absolute indication for the appointment of a cesarean. Surgical intervention is indicated for frontal, anterior facial, posterior parietal insertion and posterior high straight standing. In other cases, the choice of delivery method is made depending on the presence of concomitant complications;
Presentation and prolapse of the umbilical cord;
Acute fetal hypoxia;
A state of agony or death of a woman in labor with a live fetus.

Relative indications for caesarean section

Relative indications for caesarean section include situations that do not exclude the possibility of spontaneous childbirth, but the likelihood of complications for the woman and / or fetus in this case is greater than in the case of surgical delivery. These include:

Clinically narrow pelvis - discrepancy between the child's head and the size of the mother's pelvic bones;
Long-term gestosis of the second half of pregnancy, resistant to therapy, or a complicated course of this condition;
Diseases of organs and systems not related to reproductive function, in which spontaneous childbirth is accompanied by an increased danger to the health of the pregnant woman (epilepsy, myopia with dystrophic changes in the fundus, post-traumatic disorders of the brain, endocrine, cardiovascular pathologies, etc.);
Persistent weakness and other anomalies of labor activity;
Deviations in the development of the uterus and vagina, which impede the course of natural childbirth (vaginal septum, bicornuate or saddle uterus, etc.);
Postponed pregnancy. Pregnancy is recognized as postponed if it lasts 14 days longer than physiological;
The presence of a woman before this pregnancy habitual miscarriage, infertility and other problems in the reproductive sphere;
The age of the primiparous is more than 30 years;
Chronic placental insufficiency (impaired blood exchange between the fetus and the placenta during the entire period of gestation). According to statistics, in every 5th case, such a pathology leads to the death of a child;
Premature discharge of amniotic fluid;
The presence of a large fetus (weighing more than 4000 g). Typically, this problem is faced by women with diabetes, obesity, who are tall, have a large weight gain during pregnancy, and who have given birth multiple times in the past.

For some women and children, caesarean section is safer than vaginal delivery. Such an operation is most often required for medical reasons or when a woman cannot give birth on her own. But even if the pregnancy is proceeding normally, knowing the indications for a caesarean section is quite important, because it may be needed in the process of natural childbirth.

Recently, some women will forgive doctors to perform a caesarean section without medical indications. Some people want such an operation because they are terrified of pain. Others - for their own convenience, because it looks so tempting to be able to deceive nature and give birth to a child on the day you wish. Still others fear breakups and sexual dysfunction after vaginal delivery.

Read also:

Is this choice safe for the child? Is such a decision ethical? The answer is unclear. Only further observation of mother and child can clarify this issue. Therefore, before making a final decision, you need to soberly assess the situation and weigh the pros and cons.

If you rely on medicine, then all indicators for caesarean section can be divided into 2 groups:

absolute;
conditional.

Absolute indications for surgery:

malposition;
abnormal structure of the pelvis in a woman;
complications during pregnancy;
labor activity is very weak;
uterine bleeding;
the presence of scar tissue on the uterus;
severe toxicity.

Conditional indications:

visual impairment in the mother;
vaginal infections;
severe forms of chronic diseases;
high blood pressure;
late birth.

Many obstetricians rightly believe that caesarean section should be performed only on the basis of medical conditions, if there are no other alternatives.

Indications for caesarean section can occur both during pregnancy and during childbirth. Let's look at each of the possible cases.

When is a planned operation scheduled?

Caesarean sections are generally planned long before birth, so the baby has enough time to develop in the womb. Usually, 39 weeks of pregnancy is enough for the normal development of the fetus, and surgery before this period is extremely rare and only in emergency cases.

A gynecologist may advise you to schedule a caesarean section based on several conditions:

If the previous birth was carried out by caesarean section. Such an indicator significantly increases the risk of uterine rupture during natural childbirth due to the presence of scar tissue.
If the woman has had other uterine surgery, such as a myomectomy.
With multiple pregnancy. Of course, twins can also be born vaginally, but three or more children require a caesarean section.
The fetus is expected to be too large. In medicine, this phenomenon is called macrosomia and is especially possible in women who have gained more than the recommended weight during pregnancy.
Breech or transverse presentation of the fetus, when the baby is born forward with legs or is generally located horizontally in the mother's stomach.
If there is a placenta previa or when it is so low that it overlaps the cervical region of the uterus.
When a child has a genetically incorrect or abnormal development.
If the woman in labor has chronic diseases such as diabetes, heart disease, high blood pressure or kidney disease.
When the mother is HIV positive or has genital herpes on the labia. A planned caesarean section in this case is considered a necessity, since the virus can be transmitted to the child during natural childbirth.
The impossibility of natural delivery due to an anatomically narrow pelvis or other injuries and defects of the musculoskeletal system.
Mutually exclusive Rh factor in mother and child, as a result of which the fetus receives an insufficient amount of oxygen. Vaginal delivery in this case is a big stress for a small organism.

In addition to the main indications for a planned caesarean section, the doctor may recommend such an operation to a woman if this is the first birth and her age is over 30 years. However, in any case, ask your obstetrician-gynecologist to explain the reasons and be sure to ask about alternative options.

A caesarean section during childbirth is necessary if there is a significant threat to the life of the woman and the child. These complications of vaginal delivery include:

The cervix has not fully dilated or the baby stops moving down the birth canal. Attempts to stimulate contractions and resume the process were unsuccessful.
The heart rate worries the doctor. In medicine, this phenomenon is also called fetal distress - a condition in which the child lacks oxygen or has other complications.
The umbilical cord slides into the cervix, there is a so-called prolapse. If this happens, the baby in the womb can become entangled and die from lack of oxygen.
During childbirth, the placenta begins to separate from the walls of the uterus and bleeding occurs.
Threat or incipient uterine rupture. An untimely caesarean section will lead not only to the removal of the uterus, but also to the loss of the child.

In addition, the doctor may decide on an emergency caesarean section if labor began more than 24 hours ago, and the cervix has not yet opened.

In this article:

Caesarean section refers to a number of surgical medical interventions in the human body. This operation is designed to resolve childbirth and extract the fetus through an incision in the abdominal wall of the woman and the subsequent dissection of the uterine wall. Indications for cesarean section are a number of pathologies and diseases of a pregnant woman. They entail the impossibility of natural childbirth due to various complications that are dangerous to the life and health of the mother and unborn child.

The need for this type of intervention can be established during pregnancy (then it can be planned or emergency), as well as already during childbirth. In this article, we will consider the indications for planned and emergency CS surgery, as well as its indications during childbirth. But perhaps many readers will first be interested in learning a little about the history, which is rooted in the distant past.

The history of childbirth caesarean section is associated with the name of the great ancient Roman figure - the commander Gaius Julius Caesar. According to legend, he was brought to light from the mother's womb through an incision in her abdomen. For the first time, a real KS operation was documented, performed by the famous doctor J. Trautman from Wittenberg, in 1610. As for Russia, in our country the first such childbirth was performed by V. M. Richter in 1842 in the city of Moscow.

Planned operation

A planned caesarean section is called, the indications for which were established by the attending physician during the course of pregnancy. A woman enters the pathology department in advance of the day of the operation and undergoes the necessary examination and preparation. During this period, specialists must assess the physiological state of the woman, identify all possible violations and risks, and also assess the condition of the fetus. The anesthesiologist will talk to the woman in labor, explain the types of anesthesia that are acceptable, their benefits and possible consequences, and help you choose the most appropriate option. He needs to be informed about the presence or absence of allergies or hypersensitivity to some components of the drugs.

For a planned caesarean section, the indications may be as follows:

. This violation lies in the fact that the placenta (the location of the child) moves to the lower part of the uterus and blocks the entrance to it. With such a diagnosis, there is a risk of severe bleeding, which is dangerous for both the mother and the unborn child. Therefore, the intervention is carried out at the 39th week of pregnancy, but it is possible even earlier if the appearance of discharge with blood is noticed.
The scar on the uterus, according to the results of ultrasound, was recognized as insolvent, that is, its thickness is less than 3 mm, its contours are uneven. This pathology may be the result of a previous CS or other surgical interventions on the uterus. This diagnosis is evidenced by various complications after the surgery - elevated body temperature during the recovery period, long-term healing of the external suture, inflammatory processes in the pelvic organs.
Several CS in history. If a woman has previously had two or more such interventions, she is usually not allowed to give birth, as this threatens to rupture the uterus along the scar. The operation is scheduled, you should not wait for the start of a natural resolution.
Myoma of the uterus. When it is multiple and is characterized by the location of the node in the cervix or the presence of large nodules, the nutrition of which is impaired, cesarean delivery is indicated.
Pathologies of the pelvic organs, including tumors of the uterus or its appendages, II and higher degree of narrowing of the pelvis, and others.
Pathologies of the hip joints: ankylosis, congenital dislocation, surgery.
The size of the fetus at the first birth is more than 4 and a half kilograms.
The cervix and vagina have pronounced cicatricial narrowing.
Expressed symphysitis. This disease is characterized by a divergence to the sides of the pubic bones. Clinical manifestations - difficulty walking, accompanied by pain.
Conjoined twins.
The number of fruits is more than two.
Incorrect location of the fetus in the later stages in primiparas (gluteal-leg).
The fruit is located transversely.
Cancers of the uterus and its appendages.
Genital herpes in the acute stage, which occurred 1-14 days before the end of the pregnancy. CS is indicated when there is a blister-like eruption on the surface of the vulva.
Severe diseases of the kidneys, nervous, cardiovascular systems, lung diseases, as well as a sharp deterioration in the general health of a pregnant woman.
Chronic hypoxia of the fetus, its malnutrition (growth retardation), which is not amenable to drug therapy. In this case, the fetus does not receive the amount of oxygen it needs, and natural childbirth can result in severe injury.
The age of a woman at the first birth is over thirty years old, combined with any other pathology.
Malformations of the fetus.
In vitro fertilization (especially if it happened more than once) in combination with other complications.
Also, a serious visual impairment is an indication for a caesarean section. It is valid for myopia (diagnosis of myopia), which occurs in a woman in labor in a complex form, where there is a threat of retinal detachment.

Emergency caesarean section during pregnancy

Indications for urgent surgical intervention may be unforeseen situations or severe complications during pregnancy, when the life and health of the mother and fetus are at risk. Among them:

Placental abruption. If the placenta is located normally, then its separation from the uterine wall should occur at the end of childbirth. But there are cases when the placenta exfoliates during pregnancy and is accompanied by severe bleeding that threatens the life of the fetus and mother.
Symptoms of uterine rupture along the scar. When there is a threat of rupture, it is important to perform an urgent operation on time, since fetal loss and removal of the uterus are possible.
Acute fetal hypoxia, when the child's heart rate decreases sharply and cannot be restored.
The transition of preeclampsia into a severe form, the occurrence of preeclampsia and eclampsia.
Placenta previa, sudden bleeding.

caesarean section during childbirth

If during childbirth pathologies and disorders are found that are indications of a caesarean section during pregnancy, as well as complications suddenly arise, it is necessary to perform an operation. Complications that may occur during childbirth:

Rupture of the uterus along the scar.
Violation of correspondence between the pelvis of the woman in labor, which turned out to be clinically narrow, and the head of the child.
In the contractions of the uterus, there were violations, which cannot be corrected or impossible.
Presentation of the fetus legs forward.
Prolapse of the loops of the umbilical cord.
The outflow of amniotic fluid ahead of time, labor induction does not give any effect.

Possible consequences of a caesarean section

Before, during, and after a caesarean section, many women feel much better than they would if they had to have a natural delivery. This is explained by the fact that they do not have to worry about labor pains in advance. The second reason is that during the artificial resolution, the woman does not experience pain and torment. And due to the fact that there are no stretch marks and ruptures of the perineum, after discharge from the hospital, the female body recovers much faster. Of course, if there are no undesirable complications.

However, do not flatter yourself, because none of the people is immune from complications and unforeseen situations. Despite the fact that this operation, combined with modern methods and medical equipment, is reliable, proven and quite safe, complications are possible.

Surgical complications. During the operation, an accidental entry into the vascular branch during the incision of the uterus is possible, as a result of which bleeding may occur. It is also possible that the bladder or intestines are affected, and in rare cases the fetus itself is injured.
Complications on the background of anesthesiology. After surgery, there is a risk of uterine bleeding. It can occur for the reason that the contraction of the uterus is disturbed due to surgical trauma. It can also be caused by the action of medications. A change in the physicochemical composition of the blood, which necessarily occurs under the influence of anesthesia, can lead to thrombosis and blockage of blood vessels.
Purulent complications and infection. After the birth of a caesarean section, the sutures may fester, and their divergence is still possible.

You should also beware of endometritis (due to inflammation of the uterus), adnexitis (when the appendages are inflamed), parametritis (the periuterine tissue becomes inflamed). To prevent these diseases, antibiotic treatment is necessary during and after surgery.

As for the child, after medical intervention, he may have problems with the respiratory organs and their pathologies. In order to partly prevent this threat, the date of the planned operation is scheduled as close as possible to the date that is the end of the pregnancy. Also, CS can be a consequence of the difficulties of breastfeeding.

The formation of lactation occurs late, since there has been a significant loss of blood, the mother needs to move away after surgical stress, the child's adaptation to a new way of existence is impaired. In addition, a woman needs to find a comfortable position for feeding, since the standard position - sitting with the baby in her arms - causes pain and discomfort, as the child presses on the seam.

After CS, disturbances in the work of the baby's heart may occur, there is a reduced level of glucose and thyroid hormones. Excessive lethargy and drowsiness of the child are noticeable, muscle tone is lowered, the wound on the navel heals more slowly, and the immune system copes with its activities worse than in children born naturally. But the use of the achievements of modern medicine leads to the restoration and normalization of the physiological parameters of the baby by the day of discharge.

The question that arises quite rightly among women, which is better - childbirth or caesarean - cannot be given an unambiguous answer. Of course, it is always better what is laid down by nature itself, what is called natural and does not require additional intervention. Therefore, the caesarean section is not performed at the request of the woman, but only if there are necessary indications.