Absolute and relative medical indications for caesarean section: list. Emergency caesarean section: indications for surgery

Caesarean section is a surgical operation intended for the delivery of a woman by laparotomy (an incision in the abdominal wall) and dissection of the uterine wall, when childbirth through her natural birth canal is impossible for some reason or is accompanied by various complications for the mother and fetus, after which the fetus is removed through these cuts.

Indications for cesarean section (CS) are determined during pregnancy (planned, emergency) or during childbirth.

Planned caesarean section

A planned caesarean section is considered when indications for it are established during pregnancy. In this case, the woman goes to the pathology department in advance; in preparation for a planned cesarean section, a detailed examination of the pregnant woman is carried out and the condition of the fetus is assessed. In this case, the anesthesiologist will discuss with you the type of anesthesia used and find out if you have allergies or hypersensitivity to certain medications.

Indications for elective caesarean section during pregnancy

  1. Placentation disorder:
    • placenta previa - complete or incomplete (partial) with severe bleeding in the unprepared birth canal. Premature abruption of a normally located placenta. The operation is performed at 38 weeks of pregnancy or earlier if bleeding occurs.
  2. Changes in the uterine wall:
    • failure of the uterine scar according to ultrasound (after CS, myomectomy, uterine perforation, removal of a rudimentary horn, excision of the uterine angle during tubal pregnancy, plastic surgery on the uterus). A uterine scar is considered invalid if, according to ultrasound, its thickness is less than 3 mm, its contours are uneven and there are inclusions of connective tissue;
    • two or more CS in history. May increase the risk of uterine rupture due to the scar during childbirth;
    • multiple uterine fibroids with the presence of large nodes, especially in the lower segment, malnutrition of the nodes, cervical location of the node.
  3. Obstruction to the fetus being born:
    • obstruction from the birth canal to the birth of a child (anatomically narrow pelvis of II or more degree of narrowing, deformation of the pelvic bones, tumors of the uterus, ovaries, pelvic organs);
    • congenital dislocation of the hip joints, after surgery on the hip joints, ankylosis of the hip joints;
    • expected large size of the fetus (more than 4500 g) during the first birth;
    • pronounced cicatricial narrowing of the cervix and vagina;
    • severe symphysitis (divergence of the pubic bones), with severe difficulty and pain when walking;
    • a history of plastic surgery on the cervix, vagina, suturing of genitourinary and enterogenital fistulas, third degree perineal rupture.
  4. Incorrect position and presentation of the fetus:
    • breech presentation, combined with a fetal weight of more than 3600 - 3800 g. (depending on the size of the patient’s pelvis) and less than 2000 g, III degree extension of the head according to ultrasound, mixed breech (gluteal-foot) presentation in primiparas;
    • in case of multiple pregnancy: breech presentation of the first fetus with twins in first-time mothers, triplets (or more fetuses), conjoined twins;
    • monochorionic monoamniotic twins;
    • stable transverse position of the fetus.
  5. Extragenital diseases:
    • extragenital and genital cancer (ovarian, cervical);
    • high degree of myopia (myopia), combined with changes in the fundus (threat of retinal detachment) (an ophthalmologist's opinion is required);
    • acute genital herpes (rashes in the external genital area) 2 weeks or less before delivery;
    • extragenital diseases (cardiovascular system, lung diseases, nervous system, etc.), deterioration of the pregnant woman’s condition;
    • history of kidney transplant, artificial heart valve.
  6. Fetal conditions:
    • chronic hypoxia and stage III fetal growth retardation, not amenable to therapy;
    • death or disability of a child associated with complications during a previous birth;
    • fetal malformations (gastroschisis, large coccyx teratoma, omphalocele, etc.).
  7. In Vitro Fertilization: IVF, especially repeated IVF, in the presence of additional complications.

Indications for EMERGENCY caesarean section during pregnancy

An emergency caesarean section is performed in cases where during pregnancy any unforeseen situation (complication) arises that threatens the health of the mother or child:

  • any variant of placenta previa, bleeding;
  • premature detachment of a normally located placenta;
  • symptoms of threatening, begun, accomplished uterine rupture along the scar;
  • acute fetal hypoxia;
  • severe forms of gestosis that cannot be treated, eclampsia;

Indications for caesarean section DURING CHILDREN

During childbirth, the indications for cesarean section are the same as during pregnancy. In addition, it may be necessary to perform a cesarean section in case of the following complications of childbirth:

  • disruption of uterine contractility that is not amenable to drug therapy (weakness, incoordination of labor);
  • clinically narrow pelvis. This is a discrepancy between the fetal head and the mother's pelvis;
  • incorrect insertion and presentation of the fetus (frontal, anterior view of the face, high straight position of the sagittal suture);
  • prolapse of a pulsating loop of the umbilical cord and/or small parts of the fetus with cephalic presentation, with breech presentation and incomplete opening of the cervix;
  • symptoms of threatening, incipient, or completed uterine rupture;
  • premature rupture of amniotic fluid and lack of effect from labor induction. When water breaks out before contractions begin, they try to induce them with the help of medications (prostaglandins, oxytocin), but this does not always lead to success;
  • foot presentation of the fetus.

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Some pathologies of the mother and child can affect the natural course of childbirth or cause death of the mother and fetus. To avoid severe consequences, gynecologists have developed indications for cesarean section.

This list is divided into absolute and relative indications.

Absolute births are those in which a woman will not be able to give birth without surgery.

Relative - all reasons in which childbirth occurs with complications and threatens the death or injury of the child. Most often, Caesarean sections are performed when there are relative indications in favor of the baby.

Caesarean section is a surgical abdominal operation. The purpose of which is the birth of a child, preserving the life and health of mother and baby.

Absolute maternal and fetal indications

Mandatory indications identified in a woman in labor:

  • anatomically;
  • early with normal location;
  • full ;
  • bleeding with incomplete presentation;
  • heavy and;
  • scarring of the tissues of the pelvis, vagina, walls of the uterus, cervix, pelvic organs, fistulas of the genitals and intestines.

From the fetus:

  • transverse, oblique, pelvic presentation;
  • incorrect entry of the head into the birth canal;
  • umbilical cord prolapse;
  • acute oxygen starvation;
  • near-death condition or death of a woman in labor.

Relative indications from mother and fetus

From the pregnant woman:

  • clinically narrowed pelvis;
  • gestosis, which continues from the 20th week of pregnancy and is difficult to treat;
  • extragenital diseases, which during natural delivery will lead to a significant deterioration in health;
  • weak, pathological birth process;
  • genitals;
  • post-term pregnancy;
  • , especially for those giving birth for the first time.

From the fetus:

  • chronic between the fetus and placenta;
  • early in breech presentation or primigravida over 30 years of age;
  • weight more than 4 kg.

Indications for cesarean section based on vision refer to relative indications on the part of the mother:

  • fundus dystrophy;
  • eye injury;
  • undergone surgery due to retinal detachment;
  • myopia;
  • severe myopia of minus seven diopters or more.

Indications for caesarean section by age are also relative. Depends on the general condition of the woman in labor and the course of pregnancy.

Indications for emergency surgery

Caesarean sections are usually planned in advance. But sometimes situations arise in which it is the only way to save the life of the mother and baby.

This is an operation for life-saving reasons:

  • the head is too large for the pelvis, detection of pathology during childbirth;
  • early discharge of amniotic fluid in the absence of labor;
  • weak labor uterus even after;
  • placental abruption during childbirth;
  • the threat of uterine rupture or the beginning of a rupture - with such an injury severe bleeding occurs;
  • loss of umbilical cord loops and blocking of their head;
  • fetal hypoxia, threatening its death;
  • gestosis of a pregnant woman, emerging renal failure.

Caesarean without indication

A caesarean section is an abdominal operation in which the peritoneum is opened. It is associated with many dangers during the postoperative period. During surgery, there are difficulties with selecting anesthesia, especially during emergency caesarean.

Complications also occur in the form of bleeding and injuries to internal organs located near the uterus.

Surgical complications include the discrepancy between the baby’s head or body and the incision made.

The anesthesia administered to the mother somehow penetrates to the baby and has a toxic effect on him.

The postoperative period has its complications. During abdominal operations there is:

  • high risk of infection in the abdominal cavity and infection of internal organs;
  • bleeding inside the peritoneum;
  • rejection of suture material, suture dehiscence, and others.

The postoperative period is accompanied by severe pain. Pain management harms the baby, and weaker drugs do not help the mother.

Abdominal operations also have a postoperative complication in the form of adhesions - the appearance of connective tissue that fuses the internal organs with the walls of the peritoneum.

They disrupt the patency of the fallopian tubes and intestines. As a result, secondary infertility and diseases of the digestive system develop.

A baby born by Caesarean section is not burdened with the mother’s microflora and does not develop immunity immediately after birth. He does not experience a pressure difference during the passage of the birth canal, which is designed to launch his vital processes.

During natural delivery, the child passes through the narrow birth canal and at the same time is involved in the work:

  • his lungs, kidneys;
  • digestive and nervous systems;
  • second circle of blood circulation;
  • the opening between the atria closes.

Caesarean section is not an alternative way of delivering a baby, but an operation designed to save the life of mother and child. It is not carried out without evidence. The decision about surgical intervention in the natural process is made by the doctor.

How is the operation performed?

Usually one week before the intended operation you are hospitalized. In a hospital setting, she is examined and the blood vessels of the pregnant woman, placenta, and fetus are examined.

At this stage, the woman will need help from her family.

Contraindications for surgery

With complete placenta previa and an anatomically narrow pelvis, refusal of a cesarean section means the death of the child and the woman in labor.

Refusal of surgical intervention can only be justified by the high risk of purulent complications and sepsis in the postoperative period.

Typically, such complications occur if the patient has an acute inflammatory disease - endometritis,.

Relative contraindications for cesarean section also include:

  • prolonged labor - longer than a day;
  • discharge of amniotic fluid more than 12 hours ago;
  • frequent vaginal examinations;
  • failed attempts at delivery;
  • death of a child in the womb, severe pathologies of the fetus.

Pregnancy after cesarean

The dissection of the peritoneum is carried out between the muscles of the peritoneum along the tendon plate. After healing, a scar remains.

During subsequent pregnancies and childbirth, there is a risk of rupture.

It is prohibited to have more than three pregnancies during delivery through surgical intervention.

Each subsequent excision reduces the area of ​​the uterine body.

A new pregnancy is allowed after 2 years.

Video: indications for caesarean section list


Perhaps every pregnant woman has heard about the operation of caesarean section: some are afraid of its purpose like fire, others are happy to take the opportunity to “facilitate” the process of bringing a baby into the world. What is the essence of this operation, what are the indications and contraindications for cesarean section, is it possible to avoid this method of delivery, and is it worth objecting in principle if the doctor recommends cesarean section? Let's figure it out and try to make the right decision.


· Caesarean section: indications and contraindications


Just 10 years ago, a caesarean section was performed in barely a third of childbirth cases - both when necessary and when not at all necessary - now in the majority of cases it is performed according to absolute indications, and with much lower risks. Absolute indications for cesarean section are conditions or diseases that pose a mortal danger to the life of the baby and mother. And, alas, there are many of them. These are the very cases when the mother should have no doubts or objections - a caesarean section must be done. In particular, absolute indications for cesarean section are placenta previa, umbilical cord prolapse, transverse position of the fetus in the uterus, gestosis in pregnant women, premature placental abruption, and more.

However, even today the reason for many operations are relative indications for cesarean section - these are clinical situations in which the birth of a child through the natural birth canal is associated with significant risk, in particular greater than with surgery. For example, relative indications for cesarean section are breech presentation of the fetus, the age of the first-time mother is over 30 years, the presence of a scar on the uterus, etc.

In addition, there is often a combination of indications for a cesarean section - a combination of several complications of pregnancy or childbirth. Individually, they are often not significant, but overall they pose a significant threat to the condition of the baby during vaginal delivery.

· Caesarean section: absolute and relative indications

PLACENTA PREVIA: this situation means that the placenta in which the baby is located is blocking the exit from the uterus. Placenta previa most often occurs in multipregnant women, especially after previous abortions or postpartum illnesses.

A sign of this condition can be bright bloody discharge that appears from the genital tract in the last stages of pregnancy or directly during childbirth. As a rule, they are not accompanied by pain and most often occur at night. To clarify the location of the placenta in the uterus, an ultrasound examination is performed. If the diagnosis is confirmed, pregnant women with placenta previa are observed and treated exclusively in an obstetric hospital, since this condition is threatening and is an absolute indication for a cesarean section.

UMBRICAL CORD PROPRESSION: Similar indications for cesarean section arise in case of polyhydramnios at the time of rupture of amniotic fluid, when the baby’s head is not inserted into the pelvic inlet for a long time. The reason for this may be a large fetus or a narrow pelvis of the woman in labor. Then the umbilical cord loop can slip into the vagina along with the flow of water and even end up outside the genital slit of the woman in labor, especially if it is long enough. As a result, the umbilical cord becomes compressed between the fetal head and the walls of the pelvis, that is, blood circulation between mother and baby is disrupted, which threatens the health and life of both. To diagnose such a complication in a timely manner, after the rupture of amniotic fluid, the obstetrician performs a vaginal examination. In case of umbilical cord prolapse, cesarean section becomes an absolute indication and is performed as an emergency.

TRANSVERSE POSITION OF THE FRUIT: This is an absolute indication for cesarean section. A child can be born naturally only if at the time of birth he is in a longitudinal position (parallel to the uterine axis), that is, with his head down, or in the pelvic position - with his buttocks down towards the entrance to the mother’s pelvis. As for the transverse position of the fetus, it often occurs in multiparous women, due to decreased tone of the uterus and abdominal anterior wall, as well as with placenta previa and polyhydramnios. In most cases, with the onset of labor, the baby spontaneously turns into the correct position. But, if this does not happen, the water has already broken, and the external techniques used in obstetrics did not help turn the fetus into a normal longitudinal position, then the birth of the baby through the natural birth canal becomes impossible and you have to resort to surgical intervention.

GESTOSIS IN PREGNANT: is a serious complication of the second half of pregnancy. It is manifested by high blood pressure, edema, and the appearance of protein in the urine of a pregnant woman. This condition may be accompanied by headache, blurred vision in the form of “floaters” flashing before the eyes, pain in the upper abdomen, and in some cases even convulsions. Such symptoms require immediate delivery, since with this complication not only the mother, but also the child suffers.

PREMATURE DETACHMENT OF NORMALLY POSITIONED PLACENTA : Normally, the placenta separates from the wall of the uterus only after the birth of the baby. If the placenta or a significant part of it is separated before the baby is born, sharp pain occurs in the abdomen, which is often accompanied by severe bleeding, and the development of painful shock is possible. In this case, the oxygen supply to the fetus is sharply disrupted, and emergency measures are required to save the lives of mother and baby.

Breech presentation of the fetus refers to relative indications and does not necessarily require surgical intervention . However, breech birth is considered pathological, since during natural childbirth there is a high probability of injury and oxygen deprivation of the fetus. The risk of these complications especially increases when breech presentation is combined with large fetal sizes (more than 3600 g), excessive extension of the fetal head, distortion, and also in the case of anatomical narrowing of the pelvis.

THE AGE OF THE PRIMIPAROUS MOTHER IS MORE THAN 30 YEARS OLD: in fact, age itself is not an indication for a cesarean section; the need to resort to surgery is determined by the fact that gynecological pathology is often observed at this age, namely chronic gynecological diseases that lead to long-term infertility and miscarriage. Diseases not related to the genital organs often accumulate, but provoke a large number of complications in pregnancy and childbirth: hypertension, obesity, diabetes, heart disease. Such conditions are associated with great risk for the baby and mother. Undoubtedly, in late reproductive age, the indications for cesarean section expand in cases of breech presentation and chronic fetal hypoxia. That is why women who give birth for the first time at the age of over 30 often require constant medical supervision throughout their pregnancy.

SCAR ON THE UTERUSmay become another relative indication for surgical intervention during childbirth. It may remain as a result of removal of myomatous nodes or after suturing the uterine wall due to its perforation during an induced abortion, as well as after a previous cesarean section. This indication was previously considered absolute, but now the condition of the scar is taken into account. A cesarean section is prescribed in cases of defective scars (in particular, those with a risk of splitting), in the presence of several scars after a cesarean section, as well as after reconstructive surgeries that correct uterine defects and in some other cases.

To clarify the condition of the uterine scar, ultrasound diagnostics are performed; this study is mandatory from 36-37 weeks of pregnancy. Modern medicine allows operations to be performed more efficiently, using high-quality suture material, which results in the formation of a healthy scar on the uterus and a chance for the woman to subsequently give birth to a baby through the natural birth canal.

CLINICALLY NARROW PELVIS: this complication occurs directly during childbirth, due to the excess size of the baby’s head in comparison with the internal size of the mother’s pelvis. As a result of this, there is no forward movement of the head along the birth canal, despite the full dilatation of the cervix and vigorous labor. This can threaten uterine rupture, acute fetal hypoxia (lack of oxygen) and even its death.

The complication occurs both when the mother’s pelvis is anatomically narrow and when it is of normal size, when the fetus is large, especially when the baby’s head is inserted incorrectly or when it is twisted. Additional research methods, in particular: ultrasound and x-ray pelvimetry (x-ray of the pelvic bones), which allow you to predict the outcome of childbirth, allow you to assess in advance the correct proportionality of the mother’s pelvis and the fetal head.

If the pelvis is significantly narrowed, a cesarean section is mandatory, as well as in the case of gross deformations or bone tumors in the pelvis of the woman in labor, which are an obstacle to the passage of the fetus. In addition, the absolute indication for cesarean section is incorrect insertion of the baby's head (frontal, facial) diagnosed during childbirth by vaginal examination. In these cases, childbirth cannot occur naturally, since the fetal head is inserted into the pelvis with its largest size, significantly exceeding the size of the mother’s pelvis.

ACUTE FETAL HYPOXIA (OXYGEN LACK, OXYGEN STARVATION): Insufficient oxygen reaches the fetus through the placenta and umbilical cord vessels. The reasons for this are different, for example, prolapse of the umbilical cord, placental abruption, prolonged labor, excessively active labor, etc. To diagnose this condition that threatens the child, use: auscultation (listening) using an obstetric stethoscope, cardiotocography (registration of fetal heartbeats, carried out with using a special device), amnioscopy (examination of amniotic fluid using a special optical device, which, with the amniotic sac intact, is inserted into the cervical canal), ultrasound with Doppler (study of blood movement through the vessels of the fetus, placenta, uterus). If signs of threatening hypoxia are detected and there is no effect from the treatment, surgical intervention is urgently required to bring the child into the world as soon as possible.

WEAK LABOR ACTIVITY: in this case, the frequency, duration and intensity of contractions are not sufficient to complete the birth naturally and then a caesarean section may be required. To begin with, of course, doctors use medications to stimulate labor, but this does not always help the dilation of the cervix and the advancement of the fetus along the birth canal. Weak labor delays labor, provokes the risk of fetal infection and hypoxia, and the longer the baby stays without water in the womb, the higher the threat to life and health.

· Caesarean section: contraindications. When should a caesarean section not be performed?

As already mentioned, there are no absolute contraindications to a cesarean section. The reasons why they resort to it are quite serious and often ignoring them is too dangerous. Possible contraindications to cesarean section may be associated with a high risk of developing purulent-septic complications in the mother in the postoperative period. It happens that a contraindication for a cesarean section is intrauterine fetal death, extreme prematurity (non-viability of the fetus), deformity, prolonged and severe fetal hypoxia, when the death of the newborn or stillbirth can no longer be excluded. In such cases, the choice of method is entirely aimed at preserving the woman’s health and reducing the risks of infectious and septic complications in the event of surgical intervention (inflammation of the uterus, appendages, development of peritonitis - purulent inflammation of the peritoneum), since the dead fetus becomes a source of infection.

The following are considered high risk factors for the development of purulent inflammatory complications:

  1. the presence of a chronic or acute source of infection in the pregnant woman’s body (inflammation of the appendages, chronic pyelonephritis, carious teeth, cholecystitis, respiratory tract diseases and others);
  2. diseases of female internal organs and complications of pregnancy that cause disturbances in blood microcirculation (in particular anemia, late gestosis, hypotensive and hypertensive diseases and others);
  3. any immunodeficiency conditions of a woman (HIV, decreased immunity as a result of exposure to toxic drugs, etc.);
  4. duration of labor over 12 hours;
  5. the duration of the water-free period (after the water breaks) is more than 6 hours;
  6. pathological and not timely compensated blood loss;
  7. frequent vaginal instrumental and manual manipulations and examinations;
  8. high risk of infection due to the unfavorable epidemiological situation in the maternity hospital;
  9. the presence of a corporal incision in the uterus (across the uterine muscle fibers).

If there are absolute indications for cesarean section on the part of the mother, which cannot be ignored, despite the presence of an infectious process, doctors can perform an abdominal delivery. In this case, the fetus is removed along with the uterus to avoid the development of generalized purulent inflammation in the abdominal cavity - peritonitis. Also, modern medicine allows the use of other surgical techniques - extraperitoneal cesarean section or cesarean section, with the so-called temporary isolation of the abdominal cavity. The risk of developing purulent-inflammatory, life- and health-threatening complications in this case is much lower.

Yana Lagidna, especially for MyMom . ru

And a little more about what indications and contraindications a cesarean section has, video:

Many expectant mothers are wondering whether to give birth on their own or have a cesarean section - an operation in which the baby is removed through an incision made in the abdominal cavity. However, there are those who are not given this choice based on indications.

Such indications can be like absolute- when childbirth through natural means is physically impossible, if available, an order for a planned cesarean section is issued, and relative– when a woman can physically give birth on her own, but this will involve a risk to the health of the expectant mother or baby. If the risk is justified, you will have an emergency caesarean section. Now let's look in more detail at what the indications for caesarean section may be.

Absolute indications for caesarean section

In case of absolute indications, the doctor must carry out the birth in the only possible way - through a caesarean section. Only this way and no other way. Such indications include the anatomical feature of the woman in labor - narrow pelvis.

The fetal head will physically not be able to pass through the pelvic ring. This feature is identified by a doctor even at the stage of pregnancy based on an analysis of ultrasound results, data from routine examinations and pelvic measurements. The pelvis of the second to fourth degree of narrowing is considered absolutely narrow.

Also, an absolute indication for a cesarean section is any mechanical obstacles that will prevent the fetus from passing through the natural birth canal. Such obstacles can be an ovarian tumor, in some cases uterine fibroids or deformation of the pelvic bones.

Another serious absolute indication is a reasonable threat of uterine rupture. Typically this situation occurs in two cases. The first case: repeated birth, provided that the previous birth was carried out by caesarean section.

The second case: any abdominal surgery performed on the uterus, as a result of which an incompetent, that is, poorly healed, scar was left on it.

The doctor can easily determine the failure of the scar by performing an ultrasound, which is done more than once during the entire pregnancy, so if there is a threat of uterine rupture, you will definitely be prescribed a planned cesarean section.

Absolute indications for surgical delivery may be not only due to problems in the expectant mother, but also in the fetus. These include placenta previa and her unexpected premature detachment.

Placenta previa means that it is not positioned correctly. Usually the placenta should be attached to the back wall.

In case of presentation, the placenta is attached to the uterus directly above the cervix and blocks the fetus from exiting through the birth canal. If the placenta is not positioned correctly, the mother may experience heavy bleeding, which poses a serious threat to her life and the life of the baby. Therefore, placenta previa is a clear reason for a cesarean section.

The premature onset of placental abruption, that is, when the placenta begins to separate from the wall of the uterus even before the onset of labor itself, also serves as a serious reason for a cesarean section.

In this case, the operation is performed at 38 weeks and even earlier if the woman in labor begins to experience bleeding, signaling placental abruption.

The urgency of the operation is due to the fact that when placental abruption occurs, oxygen ceases to flow to the fetus and, if a caesarean section is not performed urgently, the baby may suffocate and the mother may die from blood loss.

Relative indications for caesarean section

In addition to absolute indications for caesarean section, there are also those in the presence of which a normal birth is possible, but with a probability of risk to the health of the mother and baby. They are called relative indications.

In case of relative indications, the issue of operative delivery is considered individually. Carefully pay attention to all circumstances and contraindications.

During a natural birth, if the doctor notices a threat, you may be immediately prescribed an emergency caesarean section, so as not to risk your health and the health of the unborn baby.

The most common relative indication for cesarean section in some cases is poor vision - myopia with a high degree of fundus changes.

Since during natural childbirth, when the expectant mother pushes out the baby, there is a lot of strain on the eyes, women with poor vision are at risk of going blind. Therefore, a woman in labor may be offered surgical delivery.

Relative indications also include diseases that are not associated with pregnancy at all, but if present, natural childbirth can threaten the health of the expectant mother.

These diseases include:

  • kidney diseases;
  • cardiovascular pathology;
  • diseases of the nervous system;
  • diabetes mellitus and other diseases.

It may also be an exacerbation of chronic diseases of the genital organs, for example, genital herpes. This is dangerous because the infection can be transmitted to the baby during natural childbirth.

Complications during pregnancy are a fairly serious relative indication for surgical delivery.

First of all, such an indication is gestosis. This is a complication that occurs in late pregnancy, resulting in a disorder of the vital functions of the vascular system and blood flow.

Doctors at our center are confident that conditions and contraindications for cesarean section are taken into account only in the absence of absolute indications for cesarean section. In this case, a cesarean section is performed at 38 weeks of pregnancy or even earlier if bleeding appears, indicating placental abruption. A history of anal sphincter rupture is also a relative indication for cesarean section.

The first reliable report of a caesarean section on a living woman was in 1610. The operation was performed by J. Trautman from Wittenborg. In Russia, the first caesarean section was performed by I. Erasmus in Pernov (1756) and V. M. Richter (1842) in Moscow. Sometimes this happens during pregnancy, then severe bleeding begins, which threatens the life of the mother and fetus and requires immediate surgery.

Every woman has her pelvic size measured during pregnancy. Obstetricians have clear criteria for normal pelvic sizes and a narrow pelvis based on the degree of narrowing. Large fetus in combination with another pathology. In this case, severe difficulties and pain appear when walking. Preeclampsia is a complication of pregnancy in which the function of vital organs, especially the vascular system and blood flow, is disrupted.

Indications for caesarean section

In this case, the fetus receives an insufficient amount of oxygen and for it the process of childbirth is a burden that can lead to birth trauma. If the fetal condition worsens, a caesarean section is performed. Post-term pregnancy with unprepared birth canal and in combination with other pathology.

Normally, the placenta separates from the wall of the uterus after the baby is born. If the umbilical cord prolapses and the fetus is in cephalic presentation, if a caesarean section is not performed within the next few minutes, the child may die.

In these cases, the doctor is obliged to carry out the birth through cesarean section and nothing else, regardless of all other conditions and possible contraindications. It is clear that a doctor can determine an absolutely narrow pelvis in a woman with the help of examinations and ultrasound even during pregnancy.

A mechanical obstacle can be, for example, uterine fibroids located in the isthmus area, ovarian tumors, etc. Most often, this obstacle is determined by ultrasound, and on its basis the doctor prescribes a planned cesarean section. Of course, in each case, the condition of the scar is checked by ultrasound individually and repeatedly during pregnancy.

Absolute indications for cesarean section are also possible from the fetus. These include placenta previa and premature placental abruption. This is definitely a planned situation, visible on ultrasound throughout pregnancy. Premature placental abruption, that is, a situation when the placenta separates from the wall of the uterus not after, but before childbirth, is also an absolute indication for cesarean section.

Placental abruption makes fetal breathing impossible and requires an emergency cesarean section in its vital interests. On the mother’s side, these are, first of all, her diseases not related to pregnancy, in which the burden of natural childbirth threatens the life and health of the mother.

Severe manifestations of gestosis are preeclampsia and eclampsia. A clinically narrow maternal pelvis, that is, a situation where the size of the woman’s pelvis does not correspond to the size of the presenting part of the child, is also a relative indication for cesarean section. A relative indication can be considered age over 35 years in combination with pathology.

A thousand and one indications for caesarean section

An indication for cesarean section is also fetal hypoxia - that is, lack of oxygen. In this case, cesarean section is the safest method of delivery for the child. There are other relative indications for cesarean section, most of which appear already during labor and serve as a reason for emergency cesarean section. Like any operation, a caesarean section can only be performed under certain conditions. In turn, intrauterine fetal death, fetal malformations and conditions incompatible with life, and the presence of infections in a woman in labor are contraindications for surgery.

Relative ones most often depend on the doctors delivering the baby and the current situation in obstetrics. Many women whose babies are about to be born will be offered a caesarean section. We will try to separate absolute and relative indications for surgery. This group of indications includes umbilical cord prolapse. At the same time, it can be compressed, and then blood stops flowing to the child. More often it occurs during premature birth or during breech birth.

In the case of complete placenta previa, it is located in the cervix and prevents the delivery of the baby. The most striking symptoms of this condition are the discharge of scarlet blood from the genital tract, which is not accompanied by pain and most often occurs at night at the end of pregnancy.

Placental abruption can occur both before and during childbirth. This means that the placenta, or a significant part of it, separates from the wall of the uterus before the baby is born. In typical and obvious cases, sharp pain in the abdomen suddenly occurs. In general, if the doctor suggests a cesarean section due to placental abruption, it is better not to discuss this indication.

This is why caesarean section rates vary so much from obstetrician to obstetrician, clinic to clinic, and country to country. Lack of progress during labor" is often cited as a reason for a first cesarean section.

Absolute indications for caesarean section are those situations in which natural childbirth is simply physically impossible. This is an undeniable indication for a cesarean section, except in cases where labor is already at the stage when the baby is about to be born. You can often hear that for a primigravida woman, age over 35 is also an indication for a caesarean section.