Indications for cesarean section during pregnancy and childbirth. List of absolute and conditional indications for surgery

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 represent mortal danger for 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 issues emerging from the genital tract on latest dates pregnancy or directly during childbirth. As a rule, they are not accompanied painful sensations and most often happen at night. To clarify the location of the placenta in the uterus, ultrasonography. 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 with polyhydramnios at the time of rupture of amniotic fluid, when the baby's head for a long time not inserted into the pelvic inlet. The reason for this may be a large fetus, 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. The baby may be born naturally only if at the time of birth it is in a longitudinal position (parallel to the uterine axis), that is, with the head down, or in the pelvic position - with the 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 labor activity the child spontaneously turns into the correct position. But, if this does not happen, the waters have already broken, and external techniques used in obstetrics have not helped to turn the fetus into a normal longitudinal position, then the birth of the baby through the natural birth canal becomes impossible and one has 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 upper sections abdomen, and in some cases even cramps. Such symptoms require immediate delivery, since this complication Not only the mother suffers, but also the child.

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 starvation 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 caesarean section; the need to resort to surgery is determined by the fact that at this age it is often observed gynecological pathology, namely chronic gynecological diseases, which lead to long-term infertility and miscarriage. Often diseases not related to the genital organs accumulate, but provoke big number complications during pregnancy and childbirth: hypertension, obesity, diabetes, heart disease. Such conditions are associated with great risk for the baby and mother. Undoubtedly, in the late reproductive age indications for caesarean section are expanding in cases of breech presentation and chronic fetal hypoxia. This 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 scar on the uterus, ultrasound diagnostics, 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 performed in mandatory, as well as in the case of detection of gross deformations, 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 at 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: V 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 stimulating labor, but this does not always help the opening 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 stated, absolute contraindications There are no cesarean sections for surgery. 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 case of surgical intervention(inflammation of the uterus, appendages, development of peritonitis - purulent inflammation peritoneum), since the dead fetus becomes a source of infection.

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

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);
diseases of women internal organs and pregnancy complications that cause blood microcirculation disorders (in particular anemia, late gestosis, hypotonic and hypertension and others);
any immunodeficiency condition of a woman (HIV, decreased immunity as a result of exposure to toxic medicines And so on);
duration of labor over 12 hours;
the duration of the water-free period (after the water breaks) is more than 6 hours;
pathological and not timely compensated blood loss;
frequent vaginal instrumental and manual manipulations and examinations;
high risk infections due to the unfavorable epidemiological situation in the maternity hospital;
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 infectious process, doctors may perform an abdominal delivery. In this case, the fetus is removed along with the uterus to avoid development in abdominal cavity generalized purulent inflammation - 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:

Childbirth by caesarean section – current method the birth of a child today. Despite the fact that this practice has many disadvantages (for example, low adaptability of the newborn to external environment, heavy recovery period for the mother), in some cases it is irreplaceable. We are talking about situations where, without surgical intervention, the mother and (or) her baby will inevitably die. We'll talk about indications for caesarean section later.

Natural childbirth has always been and will be a priority: according to nature’s plan, only two people should participate in the birth of a new life - mother and child. But the doctors did not hesitate to intervene in the sacred sacrament, and figured out how to help the woman, if for some reason physiological reason she cannot give birth on her own. It is reliably known that the practice of dissecting the anterior wall of the abdomen for obstetrics began to be mastered in the distant past. From myths Ancient Greece it is known that artificially Asclepius and Dionysus were born when their mothers died during childbirth. Up to the 16th century. This method of delivery was called a Caesarean operation, and the term we are familiar with appeared only in 1598.

You can often hear this operation called a royal birth. Indeed, in Latin, “caesarea” translates as “royal”, and “sectio” means “cut”. Today the concept has been somewhat distorted: some believe that with the help of a surgical scalpel women give birth who imagine themselves to be queens - with complete anesthesia and without the slightest effort of your own. Despite the fact that surgery is resorted to mainly when it is not possible to give birth naturally, many women ask doctors whether it is possible to use a cesarean section without indications.

In some European countries, a woman independently decides how she will give birth. In Russia, doctors insist on the need to perform a caesarean section only when indicated, but official law, which would prohibit the “abuse” of the operational procedure in the absence good reasons, No. This may be why some expectant mothers choose this particular method of delivery.

List of indications for caesarean section

The grounds for carrying out an operation are absolute and relative:

they talk about absolute indications if the life of a woman in labor and her child is at stake. In this case, doctors have no choice and there is only one way out - surgical intervention;
about relative indications we're talking about, when a woman can give birth to a baby herself, but the risk of developing certain complications still exists. Then doctors weigh the pros and cons, after which they make a final decision on the method of delivery.

It also happens emergency situations for fetal or maternal reasons, when doctors promptly change the course natural birth to operational.

Absolute indications for caesarean section

Many factors can be identified as indications for elective caesarean.

Too narrow pelvic bone.

With such anatomical feature the course of labor depends on how much the bone is narrowed. So, a degree exceeding 3 – 4 is dangerous negative consequences for the mother in labor and the baby. Narrow pelvis associated with the following complications during childbirth:

fading of contractions;
premature rupture of amniotic fluid;
intrauterine infection of the fetus;
development of endometritis and chorioamnionitis;
oxygen starvation of the child in the womb.

As a result of pushing, a woman in labor with a narrow pelvis may experience:

uterine rupture;
injury to the baby during childbirth;
damage to the pelvic joints;
the appearance of fistulas in the genitourinary and intestinal tract;
severe bleeding after childbirth.

Covering the internal os with the placenta.

Usually, when the placenta is located in the uterus, in its back or front wall, no problems arise. When the child's seat is attached too low, it completely covers internal os and, accordingly, excludes the child from leaving in a natural way. The same difficulties arise if there is incomplete overlap, lateral or edge. In this case, bleeding may begin during contractions, the intensity of which doctors cannot predict.

Premature detachment normally located placenta.

If the placenta detaches prematurely, bleeding begins, which can take various shapes. With closed bleeding, blood accumulates between the wall of the uterus and the placenta without visible signs, when open, blood is released from the genital tract. Mixed bleeding is a combination of open and closed forms. The problem life threatening mother and child are resolved through an emergency caesarean section.

Uterine rupture.

In this dangerous situation the answer to the question of why a cesarean section is performed becomes obvious. Without surgical intervention, both mother and child will die. The cause of uterine rupture can be a large fetus, the actions of an inexperienced obstetrician, or improper distribution of the force with which the expectant mother pushes.

Incorrect suturing.

When after any surgical operation An irregular scar remains on the uterus, and a caesarean section is performed for delivery. The characteristics of the scar are learned during an ultrasound.

Two or more scars on the uterus.

Two or more operations on the uterus are a serious obstacle to having a child naturally. During normal delivery, ruptures may appear in place postoperative scars. By the way, the number of surgical deliveries is also limited. Answering the question of how many times a caesarean section can be performed, doctors are unanimous - without significant risk to health, women have two caesarean sections in their entire lives. IN isolated cases, if there are serious reasons, a third operation may be performed.

Unsuccessful treatment of seizures.

With late toxicosis, in some cases convulsions occur, which drive the woman into coma. If therapy for this condition is unsuccessful, an emergency caesarean section is performed within two hours, otherwise the woman in labor will die along with the child.

Serious illnesses during pregnancy.

We list in which cases a caesarean section is performed:

heart disease;
illnesses nervous system in an acute stage;
diseases thyroid gland with severe course;
diseases associated with blood pressure disorders;
diabetes;
eye surgery or high degree myopia.

Anomalies in the development of the uterus and birth canal.

Due to the weak contractile activity of the uterus and obstruction of the birth canal, the child is deprived of the opportunity to move forward, and therefore needs outside help. This situation is most often caused by the presence of tumors in the pelvic organs blocking the birth canal.

Late pregnancy.

With age, the vaginal muscles become less elastic, which can lead to serious internal ruptures during spontaneous childbirth. This is one of those cases when you can do a cesarean section, even if all the health indicators of the woman in labor are normal.

Relative indications for caesarean section

Narrow pelvis.

This reason for performing a cesarean section is discovered during natural childbirth, when the doctor sees that the circumference of the fetal head does not correspond to the size of the pelvic inlet. This happens if the baby is very large or labor is too weak.

Divergence of the pelvic bones.

Every expectant mother faces this phenomenon. The discrepancy of the pelvic bones is expressed by pain in the pubic region, swelling, changes in gait and clicking sounds while walking. But if the pelvic bones do not diverge enough, and in addition to this, the woman has a physiologically narrow pelvis and a large fetus, a cesarean section is inevitable.

Weak labor.

When ancestral forces the woman in labor has little, her amniotic sac is artificially punctured to stimulate the process. However, if even such a measure is not enough to activate natural delivery, a decision is made to perform a cesarean section. This is the only way out, otherwise the baby will suffocate or be seriously injured during childbirth.

Post-term pregnancy.

The operation is indicated for unsuccessful stimulation of labor, weak contractions, and the presence of gynecological problems and diseases in the acute stage in a pregnant woman.

Pregnancy after artificial insemination or long-term infertility.

If a woman, after numerous unsuccessful attempts, manages to become pregnant and carry a child to term, she passes full diagnostics indications so that doctors can make a verdict on the method of delivery. If the woman has a history of abortion, stillbirth, or miscarriage, she will have a caesarean section.

Hypoxia or intrauterine growth retardation.

In this case, the expectant mother will also have to undergo surgery. The question of how long a planned cesarean section is performed for such indications depends on how long the child did not receive sufficient oxygen and whether this problem was solved with the help of drug treatment.

In addition, a woman in labor will certainly have to have an artificial birth if at least one of the following factors is present:

pubic varicose veins;
large fruit;
immature cervix;
multiple pregnancy.

Reasons for caesarean section dictated by the interests of the child

If the mother herself has no reason to surgical intervention, but the fetus has them, delivery will be prompt. Indications may be:

incorrect position of the baby. If the baby is positioned head down towards pelvic bones moms - everything is fine. Any other position of the fetus is considered a deviation from the norm. This is especially dangerous for male babies: being in the wrong position and moving along the mother’s birth canal that is not yet dilated, boys can crush the testicles, which will lead to infertility. The baby's head will also suffer from excessive pressure;
hypoxia. If oxygen deficiency is diagnosed, immediate surgery is indicated, otherwise contractions will only worsen the baby’s well-being, and he may suffocate;
umbilical cord prolapse. With this pathology, the loops of the umbilical cord often wrap around the baby so tightly that he dies from suffocation. Only an emergency caesarean section will correct the situation, but, unfortunately, it is not always possible to save the child;
life of the fetus after the death of the mother. When the mother dies, the child’s vital activity continues for some time, then an operation is performed to save the baby.

Restrictions on performing a caesarean section

Doctors, of course, always try to save both lives, but in some cases circumstances do not work out as we would like, so doctors are forced to save a woman or child. There are several situations in which you have to make difficult choices:

severe prematurity;
intrauterine fetal death;
serious infection of the baby;
chorioamnionitis in combination with high fever during childbirth;
prolonged labor (more than one day).

How to do a caesarean section

The most optimal time to begin the operation - intensification of labor. In this case contractile activity The uterus will facilitate the manipulations of specialists and will help the baby adapt to external irritating factors. At what stage a planned caesarean section is performed depends mainly on the doctor’s decision, but this does not occur earlier than 37 weeks of pregnancy. Ideally, the expectant mother is admitted to the hospital at 38 weeks of an “interesting” position.

Almost all artificial birth operations are accompanied by epidural anesthesia. In this case, the analgesic effect extends to bottom part body so that the mother can attach the baby to the breast immediately after his birth. An emergency caesarean section is performed under general anesthesia.

At the moment when the baby is about to be born, the doctor cuts abdominal wall and the womb of the woman in labor to help him be born. After the baby is removed, the incisions are sutured using continuous seam and staples are placed on top for security. They are removed 6–7 days after the operation, before sending the happy parents and heir home.

How is a caesarean section performed? Video

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 it starts heavy bleeding, 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 normal sizes pelvis and narrow pelvis according to 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 vital function is disrupted. important organs, especially the vascular system and blood flow.

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 in no other way, 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 region, 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. Clinically narrow maternal pelvis, that is, a situation when the size of the woman’s pelvis does not correspond to the size of the presenting part of the child - this is also relative reading to a caesarean 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. It occurs more often when premature birth or during childbirth in a leg presentation.

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, sudden sharp pain in a stomach. 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.

The absolute indications for a 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.

The most serious achievement of modern obstetric art is a caesarean section - an operation that allows even in the most difficult cases to save the life of the child and mother.

Historical facts confirm that similar operations were carried out in ancient times, but now a caesarean section is very often a way to save the woman in labor. IN Lately the number of indications for cesarean section has increased significantly, since for many women natural vaginal birth is risky.

However, it is worth considering that performing a planned or emergency caesarean section may cause complications and consequences in the distant future. But at the time of the operation, preserving the life of the child and mother plays an important role.

The name of the operation comes from the legend about the birth of the Roman Emperor Gaius Julius Caesar. During the birth process, the mother of the future emperor died, and then his father, wanting to save the child’s life, cut open the stomach and pulled out the baby.

When is the operation performed?

Cesarean births can be elective, planned or emergency. In case of a planned operation, it is prescribed exact date(often a week or two before the expected date of birth) and is carried out if there is normal readings in the mother and fetus, as well as at the first signs of the onset of labor.

A woman often learns about a planned caesarean section during pregnancy (sometimes in the very early stages). But even in this case, childbirth begins naturally and is completed abdominally.

There are a number of factors that are necessary indications for a cesarean section:

The fetus is alive and can continue to exist in the womb, but to preserve the life of the mother it is removed prematurely;
The woman must give written consent to the operation;
IN bladder patients have a catheter installed, since cesarean section is performed only in conditions of an empty bladder;
The woman in labor has no signs of infection;
Surgery should only be performed in the operating room with the participation of an experienced obstetric surgeon.

Main indications

There are two large groups of factors that can lead to termination of pregnancy by cesarean section:

Absolute indications for which there is no other way to manage labor;
Relative indications under which a woman can give birth to a child naturally, and the decision to perform the operation is decided at a consultation.

In addition, there is a division of provoking factors into maternal and fetal. Can also be carried out emergency surgery during childbirth or in the last stages of pregnancy.

Absolute readings

Indications for which a cesarean section is mandatory include an extensive list of maternal and fetal factors. These include:

Anatomical narrow pelvis

There are two groups of pelvic narrowing. The first group includes a flat, transversely narrowed, flat-rachitic and generally uniformly narrowed pelvis. The second includes an oblique and oblique pelvis, as well as a pelvis deformed under the influence of tumors, fractures or other external factors.

If a woman has a narrow pelvis of 3 or 4 degrees (the size of the conjugate is less than 9 centimeters), complications may arise before the labor process:

Oxygen starvation of the fetus;
Weak contractions;
Child infection;
Early rupture of the amniotic sac;
Loss of umbilical cord loops or limbs of the child.

An anatomical narrow pelvis also provokes the development of complications during the pushing period:

Secondary weakness of pushing;
Injuries to the pelvic joints and nerve endings;
Oxygen starvation of a child;
Birth injuries and uterine rupture;
Necrosis of internal tissues with subsequent formation of fistulas;
With an anatomically narrow pelvis, childbirth in the third period can provoke bleeding.

Complete placenta previa

The placenta is formed in a woman’s body only during pregnancy and is necessary for transporting blood, oxygen and nutrients from mother to baby. Normally, the placenta is located on the fundus of the uterus or the posterior or anterior organ of the organ. However, there are cases when the placenta forms in the lower segment of the uterus and blocks the internal os, making natural delivery impossible. In addition, such a pathology can cause complications during pregnancy in the form of bleeding, the intensity and duration of which cannot be determined.

Incomplete placenta previa

This pathology can be lateral or marginal, that is, the placenta covers only part of the internal os. However, even partial presentation can cause sudden bleeding. Bleeding especially often begins during childbirth, when the internal os expands, causing gradual bleeding. In this case, a caesarean section is performed only when severe loss blood.

Threat or presence of uterine rupture

There are many reasons that can cause uterine rupture: improper management of labor, poor coordination of labor forces, too big size fetus If the patient is not promptly provided medical assistance, the uterus may rupture, in which case both the woman and her child die.

Early placental abruption

Even if the placenta is attached right place, during pregnancy or during childbirth, it may begin to peel off. This process is accompanied by bleeding, the intensity of which depends on the degree of detachment. In moderate to severe cases, emergency abdominal delivery is performed to save the mother and child.

Scars on the uterus (two or more)

If a woman has previously given birth at least twice by caesarean section, natural childbirth is no longer possible in the future, since in this case the risk of uterine rupture along the scar increases significantly.

Failed scar

Sutures on the uterus can appear not only after abdominal delivery, but also after any other surgical manipulations on the internal genital organs. A scar that occurs as a result of a complicated postoperative period(the woman had heat, skin sutures took too long to heal or endometritis developed). The fullness of the scar can be determined only with the help of ultrasound.

The article lists all the absolute and relative indications for cesarean section, and also discusses the most common reasons for surgical delivery.

If for any reason a vaginal birth is not recommended, doctors suggest a cesarean section, however expectant mother in some cases, she 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 cesarean section may be:

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

IMPORTANT: A caesarean section, like any other operation, can be performed with the consent of the woman in labor and her relatives. Besides mandatory conditions are the absence of infections in the mother, a living fetus, the presence of a doctor who practices this type of delivery and a prepared operating room.

Absolute medical indications for caesarean section: list

With absolute readings standard birth not carried out due to physiological characteristics.

These include:

narrow pelvis (2-4 degrees)
defects and injuries of the musculoskeletal system
mechanical obstacles that will prevent the baby from being born (tumors or deformities)
the likelihood of uterine rupture in the presence of an incompetent scar of less than 3 mm with uneven contours from recent operations on the uterus
two or more previous births by cesarean section
thinning of the uterus due to repeated births in the past
placenta previa, dangerous high probability emergence
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 is repeated entanglement of the baby with the umbilical cord.

Medical indications for caesarean section: list

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

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

Relative medical indications are:

diseases and pathologies of cardio-vascular system at the mother's
kidney disease
myopia
diabetes
malignant tumors
exacerbation of any chronic diseases
damage to the nervous system
gestosis
mother's age from 30 years
malpresentation
large fruit
entanglement

IMPORTANT: The 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

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

This situation could be:

cervical dilatation has stopped
the baby stopped moving down
stimulation of contractions does not bring results
the child is experiencing a lack of oxygen
fetal heart rate is significantly higher (lower) than normal
baby gets tangled in the umbilical cord
there was bleeding
threat of uterine rupture

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

Indications for cesarean section based on vision due to myopia

Myopia, in other words myopia, one of the most common reasons doctors recommend that pregnant women deliver by cesarean section.

For myopia eyeballs They 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 as the situation worsens. Then there is a noticeable deterioration in vision, and in critical situations- blindness.

The higher the degree of myopia, the greater the risk of retinal tears during childbirth. Therefore, pregnant women of average and high degree myopia, doctors do not recommend giving birth naturally.

In this case, the indications for cesarean section are:

stable vision impairment
myopia of 6 or more diopters
serious pathological changes in the fundus
retinal tear
surgery performed due to retinal detachment in the past
diabetes
retinal dystrophy

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

Myopia is an indication for cesarean section

Conditions in which a pregnant woman can give birth on her own, regardless of the presence of myopia:

no abnormalities in the fundus
improvement of retinal condition
healing of the gap

IMPORTANT: Women with myopia during natural childbirth must undergo episiotomy.

Indications for cesarean section by age

However, if the health of the expectant mother allows her to give birth on her own, this chance is worth taking advantage of.

IMPORTANT: Age in itself is not an indication for cesarean section. A planned operation should be carried out if there are accompanying circumstances that could interfere with the normal course of labor: a narrow pelvis, an immature cervix after 40 weeks, etc.

If complications arise during vaginal birth, 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 cesarean section due to hemorrhoids, varicose veins

Natural childbirth with hemorrhoids dangerous due to the risk of rupture of external components. This can happen when pushing, when blood overflows the cones and ruptures them under strong pressure. Heavy bleeding occurs internal cones fall out.

If the obstetrician does not have time to straighten the internal nodes before the anus contracts, they will become pinched, which can lead to the disease becoming acute. At the same time, the woman experiences severe pain.

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

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

Hemorrhoids are one of the indications for cesarean section

A similar situation with the choice of method of childbirth for varicose veins. If during pregnancy a woman took measures to prevent thrombosis, and the doctor did not note any deterioration, a natural birth is likely.

Immediately before giving birth, a woman's feet are bandaged elastic bandage. This helps to avoid blood reflux at moments highest pressure- when pushing.

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

IMPORTANT: Varicose veins themselves are not an absolute indication for cesarean section. However, in women suffering 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 mother and child. Taking into account these factors and the woman’s condition, the doctor makes a decision and chooses the method of childbirth.

Indications for cesarean section due to a large fetus

"Large Fruit"- the concept is individual for each pregnant woman. If the expectant mother is petite and thin short stature a woman with a narrow pelvis, even a 3 kg child can be large for her. The doctor will then recommend that she give birth by caesarean section.

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

Development macrosomia possible for the following reasons:

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

IMPORTANT: If the doctor detects signs of the development of macrosomia at any stage, first of all he tries to find out the causes of this phenomenon and normalize the situation. If this is successful and the fetal weight returns to normal before birth, a cesarean section is not prescribed.

To normalize the weight of a pregnant fetus, you need to:

undergo recommended examinations
consult an endocrinologist
donate blood for glucose
exercise every day
stop eating sweets, flour, fatty and fried foods

Large fetus - indication for caesarean section

Indications for caesarean section due to a narrow pelvis

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

When prescribing a caesarean section due to a narrow pelvis, doctors focus not only on standard tabular indicators, but also on such an important factor as the size of the child’s head.

If the baby has a large skull, he will not be able to pass through the birth canal naturally, even if the cervix is well prepared for childbirth, and the contractions will intensify. At the same time, if the woman’s pelvis 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 a pregnant woman is registered, pelvic measurements will be taken. The data obtained will allow us to predict the likelihood of complications.

IMPORTANT: Even a slight narrowing of the pelvis often leads to the child taking an incorrect position - oblique or transverse. This position of the child in itself is an indication for a cesarean section.

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

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

Narrow pelvis - indication for caesarean section

Indications for cesarean section due to gestosis

Early and late gestosis 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 severe consequences and even the death of the mother.

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

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

kidney dysfunction
blurred vision
cerebral hemorrhage
deterioration of blood clotting
ekplamsia

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

Preeclampsia in pregnant women - indication for cesarean section

Indications for breech caesarean section

Breech presentation- a position taken by the child in the womb that is unfavorable for natural childbirth. On ultrasound images you can see that the child seems to be sitting with his legs raised or tucked in, instead of lying head down.

Up to 33 weeks all turnings of the fetus inside the mother’s belly are quite natural and do not cause concern. However after 33 weeks the baby should roll over. If this does not happen and the child sits on his bottom even before birth, the doctor may decide to deliver by caesarean section.

Several factors influence how childbirth will be carried out in this situation:

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

Breech presentation and multiple pregnancy - indications for cesarean section

Is it possible to request a caesarean section without an indication?

Caesarean section is performed for medical reasons. But if the expectant mother has no desire to give birth on her own, she is only inclined to have an operation, the maternity hospital will most likely accommodate her.

Psychological readiness is one of important factors, determining the method of childbirth. Having had 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 cesarean section will be the safest delivery option for mother and baby.

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

Expectant mothers undergoing a caesarean section should not be afraid.

Modern technologies make it possible not to put the woman in labor to sleep, but to apply spinal anesthesia and carry out childbirth in her presence, and a good postpartum care and painkillers will help you get through the first few difficult days after surgery.