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Everything about childbirth >> Cesarean delivery >> Indications for cesarean section. When cesarean inevitable.

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Indications for cesarean section. When cesarean inevitable.

Caesarean section - an operation which consists in extracting the fetus from the uterus after the surgical incision.

Indications for cesarean section are of two types: absolute and relative. Absolute. Mean threat to the mother's life at birth vaginally and leave doctors no choice, no time to think. However, by themselves, these states are not necessarily a disaster, so do not be sensitive to this phrase - "the absolute indications for cesarean section in the vital interests of the mother" - it means just what it says, but does, for example, is not a contraindication to pregnancy or reading interrupt when his detected during pregnancy.
Relative. This is a situation in which it is possible to take into account the circumstances, conditions and contraindications; when you can decide not only in favor of cesarean section; situations in which the birth vaginally physically possible, but endangered the life and health of the mother or child. The percentage of Caesarean sections has increased in the modern world precisely because of the relative indications, when in theory it would be possible to try to start a birth vaginally, the risk. But the possibilities of modern technology, the quality of the suture and anesthesia, qualified surgeons is increasing and elective caesarean section at a relative indication becomes safer yield than the risk and the possibility of bringing the situation to an emergency.

Absolute indications for cesarean section.

1. Absolutely narrow pelvis - a condition in which the presenting part of the child can not pass through the mother's pelvic ring. Taz is anatomically narrowed (objective reduction in size) or clinically - that discrepancy size of the pelvis and the presenting part. The features of labor management at the narrowed pelvis absolutely narrow pelvis is considered to be a situation in which these features will not help, and the only solution is a cesarean section. Traditional survey size of the pelvis of pregnant women, and ultrasound of the fetus allows to translate this situation of emergency in the planned indications for cesarean section.

2. Mechanical obstacles to birth vaginally. For example, uterine fibroids, located in the Isthmus. This is not a contraindication to pregnancy, it's just an absolute indication for cesarean section. Of course, most of all - planned because fibroids rarely grow out of nothing for 9 months to the appropriate dimensions and ultrasound before and during pregnancy - a standard part of the survey, allowing to identify the localization of myoma node, and to estimate the rate of growth.

3. Placenta previa - the location of the placenta over the cervix, overlapping her way out to the child. This is clearly a planned situation, visible on ultrasound during pregnancy. Diagnosis, deciding the method of delivery, this phrase becomes only in the last few weeks, "presentation", revealed earlier, can pass by itself, the placenta is normally rises in the higher areas to the bottom of the uterus.

4. Premature detachment of the placenta. Normally, the placenta should be separated after birth and began to breath air. Before the baby is receiving oxygen through the blood flowing through the placenta from the mother to the umbilical cord. Placental abruption makes it impossible to breath the fetus and require emergency cesarean section in its vital interests. Maternal placental abruption is also a life-threatening situation due smertelnoopasnogo bleeding.

5. Threatened uterine rupture. Mortal danger emergency. Contributing factors are numerous generations in history, led to the thinning of the uterine wall, and the failure of the uterine scar from previous caesarean sections. Regular ultrasound allows you to set the uterine scar before and during pregnancy. Cesarean section is not a contraindication to any next pregnancy or to its natural delivery. In normal healing muscle tissue of the uterus uterine rupture is not threatened. Status of the scar should be checked periodically by ultrasound, and then this emergency situation is unlikely to happen.

6. Prolapse of the umbilical cord. When the umbilical cord descends into the cervix before the baby, the baby's body can pinch the cord, dramatically reducing the supply of oxygen and requires immediate cesarean section.

7. The disease of the fetus. Specific changes in fetal heart rate, detected by listening to or using electronic monitoring devices, may indicate a problem with the baby. These changes indicate that the child saves oxygen when providing them with limited (for example, by displacement of the umbilical cord or decreased blood flow to the placenta. Subsequent tests - stimulation of the head or blood test - will show whether well compensated child or began to suffer from lack of oxygen. If the child no longer able to cope with the lack of oxygen, you need a cesarean section.

All of the above indications for cesarean section require that surgery. In this case, doctors and midwives no choice and hope for the normal passage of birth.

Relative indications for cesarean section.

1. Uterine inertia

2. Clinically narrow pelvis

3. Diseases and conditions not related to pregnancy, in which the load of natural childbirth threatens the lives and health of the mother. If you have diabetes, kidney infection, asthma, hypertension, pre-eclampsia (toxemia), cardiac or other serious illness, you or the child can not survive the stress of labor and delivery through the natural way. The presence of virus in the vagina or around it is also an indication for cesarean section because the baby can be infected during passage through the birth canal. It is also an indication for surgery is often blizoukost mother more than 5 diopters, and the risk of detachment of the retina, leading to blindness. In this case, attempts to eliminate the use Cesarean section.

4. Pregnancy complications that threaten the life of a natural birth (severe preeclampsia).

5. Age older than 35 years, is often seen as a relative indication dangerous course not the number of calendar years, namely health. Young healthy 35-year-old body is not an indication for surgery, severe heart disease, or progressive myopia with the threat of retinal detachment may occur in 18 years. Therefore, a personal approach, rather than the template created an inferiority complex in modern working and building a career women who do not want too early to give birth, but who are afraid famous myths: "elderly primipara", "at that age she does not get pregnant, only IVF," "older 35 - only to Caesar. "

6. Lack of oxygen in the child (hypoxia). Chronic hypoxia leads to delayed development of the child, which can be seen on ultrasound. Acute hypoxia can be detected in the study of the baby's heartbeat - ideally by CTG - registration heartbeats and perturbations and their computer processing.

7. Breech presentation.

8. Lateral position of the fetus. The baby is in the womb fails to give birth by natural ways. Examples would be the lateral position of the fetus (baby is lying horizontally), some types of breech presentation (full or foot), facial and frontal presentation, presentation or sustainable zadnezatylochnoe asynclitism (the baby's head is turned, so that does not fall into the entrance of the pelvis).

9. Multiple pregnancy. The probability of cesarean birth of twins (twins or more) higher because of possible complications - such as toxemia, prematurity, breech presentation and cord prolapse.

In all the above regarding the indications for cesarean section before obstetrician gets a choice - to do or not to do a caesarean section. In many ways, the passage of delivery will depend on the experience of the obstetrician and his willingness to take responsibility.


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