Many people think that giving birth by cesarean section is easier - no pushing, no pain, no tears, and the baby will see the world faster. It is worth understanding that such a procedure is an operation. All doctors say: “Cesarean section is not a panacea, any surgical intervention in the body does not pass without leaving a trace.”
If a woman has to give birth surgically, she must first visit a doctor and get permission.
When should a woman give birth “unnaturally”?
This happens in the following cases:
1. Placenta previa. If the placenta closes the entrance to the uterus, then the baby cannot “find a way out.” This phenomenon can occur as a result of past illnesses or abortions.
2. Transverse position of the fetus. If the fetus does not want to occupy the desired position, then the mother will not be able to give birth to it naturally.
3. Preeclampsia. When mom suffers high pressure, the appearance of convulsions and even fainting, feels unwell - not a single doctor can say how a woman in labor will behave at the time of contractions and further movement of the fetus. A cesarean section is definitely performed.
4. Placental abruption. The placenta should come out strictly after the baby cries for the first time. Otherwise, you cannot hesitate, but immediately send the pregnant woman to the table.
5. If a woman is expecting a child not for the first time and has already had a caesarean section, the second and subsequent births will be the same. There is no clear opinion on this matter. It is not forbidden to give birth in the “usual” way even after a cesarean section, but in this case there should be increased attention to the pregnant woman so that nothing happens to the suture.
6. Usually first-time mothers have caesareans for 30 years. Of course, age is not a hindrance; to be safe from unexpected surprises, doctors agree to the operation.
7. A woman with a scar on the uterus (previous operations, not necessarily abortions), a narrow pelvis, has a chance of giving birth without straining.
8. Poor pregnancy and weak labor activity– reasons for performing a cesarean section. There are situations when difficulties are observed during normal childbirth - then the mother will see the baby after examining him by doctors.
9. If the baby has pathologies in the mother’s womb or the baby is large, there is a 99% chance that he will be born through surgery.
The doctor prescribes surgery when he believes that this method of birth is more favorable for mother and baby. By the way, among the medical staff there are supporters of surgical birth of children. But as they say, everything is strictly according to indications.
Several arguments for caesarean section
Advantages of caesarean section:
1. After such a procedure, the likelihood of complications is reduced to zero.
2. The fetus receives the required amount of oxygen, and if it is also entwined with the umbilical cord, there is no threat to the health of the fetus.
3. Avoidance of unpleasant consequences: weakening of the pelvic muscles, incisions, pain.
4. An accomplished daddy can dress up the car and buy diapers - after all, parents know what date a new family member will be born.
The negative side of cesarean
Disadvantages of the operation:
1. Any surgical intervention in the body does not pass without leaving a trace.
2. In order for the child to experience “useful” stress, it is better if he is born in the usual way.
3. Scar from an abdominal incision. At times this brings grief to the ladies (women never stop wanting to be beautiful at any age).
4. Inability to experience sensations (to find out the whole seamy side of the process).
As doctors and almost 100% of men like to say: “Every woman is not the first to become pregnant, and not the last to give birth - she’s not going anywhere.” If the body was able to bear the fetus, then it could help it see the light. But if complications arise, the doctor will help. It doesn’t matter how the baby is born, the main thing is that mom and dad will soon be able to see the long-awaited miracle.
Due to a significant increase in the frequency of various surgical interventions on the uterus in women of fertile age, the number of women with a scar on the uterus is correspondingly increasing. The question of whether pregnancy is possible after such operations is quite relevant.
In addition, certain difficulties exist when choosing tactics for managing pregnant women with a uterine scar, determining optimal methods and timing of delivery. Of course, all these issues must be resolved in each specific case separately, depending on the type of surgical intervention, its timing, and the degree of complete healing of the scar. Let's consider whether pregnancy is possible after hysteroscopy, cesarean section, myomectomy, laparectomy.
Pregnancy after hysteroscopy
Hysteroscopy is one of the effective methods diagnosis and treatment in gynecology. Modern techniques and hardware for hysteroscopy make this procedure relatively painless and safe. Hysteroscopy is performed for a variety of gynecological diseases, such as endometriosis, synechiae in the uterine cavity, tumor, incomplete abortion, myomatous node, bleeding, uterine malformation, infertility.
Is pregnancy possible after hysteroscopy? Yes, definitely. Moreover, this procedure is carried out in many cases to determine the causes of infertility. It is during hysteroscopy that the causes that prevent pregnancy from occurring (polyps, endometrial hyperplasia, uterine tumors, adhesions) are identified.
In many cases, pregnancy occurs after hysteroscopy, since during this manipulation the mechanical factors that prevent a woman from becoming pregnant are removed.
Many patients are interested in the question of when pregnancy will occur after hysteroscopy. Unfortunately, there is no clear answer to this question, since much depends not on the procedure itself, but specifically on the type of pathology that is detected during hysteroscopy and the effectiveness of its subsequent treatment. However, it is recommended to plan pregnancy after surgical hysteroscopy no earlier than six months later.
Pregnancy after caesarean section
The first pregnancy for a number of reasons (maternal health, fetal condition, problems during childbirth and pregnancy) can end in a cesarean section. Most couples dream of having more children, but pregnancy after a cesarean section is very scary for many women.
Of course, the success of a subsequent pregnancy after a cesarean section is determined by specific conditions, namely, the degree of complete healing of the uterine wall dissected during the operation, and depends largely on the type of incision on the uterus and, accordingly, the scar.
In a set of measures to prepare for the upcoming pregnancy after a cesarean section, it is the condition of the uterine scar that is the most important factor determining its course and favorable outcome. The most reliable diagnostic methods for determining the condition of a scar on the uterus are hysterography and hysteroscopy, which complement each other.
Pregnancy after cesarean section has a number of clinical features. These women are more likely to experience low presentation or the location of the placenta, as well as abnormal position of the fetus. Almost 30% of women with a uterine scar show signs of a threatened miscarriage.
Scar failure is one of the common complications in women after cesarean section. Scar tissue, compared to muscle tissue, has significantly less strength and elasticity and does not stretch, which is why uterine rupture is possible at the border of muscle and scar tissue. Unfavorable factors for scar formation include uterine curettage, since abortions performed in the period after a cesarean section and before the next pregnancy worsen its prognosis, since additional trauma to the uterine wall occurs. In this case, the risk of scar failure increases by 1.5 times.
In this regard, during pregnancy, pain in the lower back, lower abdomen, in the area of the scar on the abdominal wall, and pain of unclear localization should be taken seriously, since this may be one of the signs of scar failure. Therefore, all pregnant women with a uterine scar are subject to thorough examination to determine further obstetric tactics.
Pregnant women with a uterine scar should carefully and regularly conduct a comprehensive assessment of the condition of the fetus (Dopplerography, ultrasound, CTG 3-4 times during pregnancy). When signs are detected intrauterine hypoxia appropriate treatment should be started promptly for the fetus.
Regarding the type of obstetric care, after a previous caesarean section, the best option is a natural birth, in the absence, of course, of absolute indications for this operation.
Subsequent pregnancy after cesarean section must be planned, and its occurrence is undesirable after the first two years after the operation. This is exactly the period required for the formation of a full-fledged scar on the uterus, allowing you to bear a child again. When planning a pregnancy, it is also necessary to take into account a number of factors: the age of the woman giving birth, general state health, psychological readiness for childbirth. A pregnant woman with a scar on the uterus is hospitalized as planned in maternity hospital at 35-36 weeks.
Pregnancy after myomectomy
Myomectomy is an operation to remove single or multiple fibroids while preserving the uterus. As a rule, this operation is performed on women reproductive age who still want to be pregnant and have no contraindications. In most cases, patients had uterine fibroids and only 3% had nodular endometriosis.
Statistics show that almost 37% of women with uterine fibroids experience infertility, that is, pregnancy does not always occur after a myomectomy and a course of rehabilitation measures. This is due to the fact that pregnancy most often occurs in the first year after myomectomy, when the recovery period has not yet ended and its interruption often occurs. Reproductive losses largely depend on the duration of development of uterine fibroids and the size of the tumor.
A feature of the course of pregnancy after myomectomy is the presence of scars on the uterus, and the volume and nature of the operation performed are of key importance. Thus, after conservative myomectomy, scar failure is up to 21%, that is, the main factors in pregnancy after myomectomy are the functional and morphological state of the scar.
It is recommended to plan pregnancy after myomectomy no earlier than one year later. Therefore, women with a history of myomectomy require constant monitoring of the condition of the scar, early prenatal hospitalization and right choice method of delivery. After any type of myomectomy (without opening or with opening of the uterine cavity) with a burdened obstetric history: breech presentation of the fetus, post-term pregnancy, full-term pregnancy, age over 30 years for a primigravida, a cesarean section is indicated.
Pregnancy after laparoscopy
Laparoscopy is one of the most modern and common diagnostic and therapeutic procedures. Laparoscopy is a surgical method that is carried out by making several incisions in the abdominal cavity through which a laparoscope is inserted.
This technique makes it possible to almost painlessly and quickly identify the presence of physiological disorders that complicate pregnancy, as well as eliminate them (obstruction of the fallopian tubes, ectopic pregnancy). Laparoscopy is also performed for ovarian cysts, endometriosis, uterine fibroids and other inflammatory diseases of the internal genital organs.
Many women are concerned about how quickly pregnancy can occur after lapara, since some women believe that pregnancy after lapara can only occur after a long time. This is not entirely true, since in many cases it is carried out directly to eliminate the causes of infertility.
Since the healing process of the wound surface proceeds quickly and is restored in the shortest possible time menstrual cycle, then the possibility of getting pregnant is 55-70%. Therefore, a long-awaited pregnancy can occur in the coming months after surgery. However, in case of major surgical interventions using laparoscopy, subsequent pregnancies should be planned. It should be noted that during pregnancy after lapara, women should be under close supervision of specialists; if necessary, hospitalization is indicated for more careful monitoring. In addition, after laparoscopy it is often prescribed drug treatment for the purpose of maintaining or restoring hormonal levels.
Thus, the possibility of pregnancy after surgical interventions on the uterus depends on many factors - specific features of the disease, the woman’s health status.
We talked a lot about after any medications, contraceptives or IUDs. In this matter, it became clear that the approach to planning a child will be individual, and there cannot be a universal period for all women; each time it is necessary to proceed from what drugs were needed and for what indications. But what to do if there were operations in the reproductive sphere - after all, this is not appendicitis or a boil, the intervention is carried out directly on those organs that in the future should take part in conception?
How long should you wait after genital surgery?
One of the persistent myths in matters of reproduction is the possibility of pregnancy after surgery on the gynecological organs no earlier than four to five years after it was performed. This myth has its roots in the past of medicine, but it can still be heard quite often from modern women. The thing is that such a myth was formed at a time when gynecological and obstetric operations were carried out using “old technologies”. These were precisely the waiting periods that were recommended by doctors after uterine surgery, and especially during caesarean section, several decades ago. Such an impressive period of time was required between the surgical intervention and pregnancy planning for the reasons that a long time was necessary for the complete resorption of the suture materials used at that time, as well as for the formation of substantial scars at the incision sites. It was also necessary to have a long-term recovery of the woman’s body from the moment of a rather severe and traumatic operation.
But now is the twenty-first century, and technology in medicine has stepped far forward compared to the last century. Today, both medicine itself and the techniques of surgical interventions on the uterus and genitals have changed for the better. They have become much less traumatic; for example, today a cesarean section with vertical incisions along the entire abdominal line is used extremely rarely. In addition, modern suture materials can dissolve within several weeks, and postoperative scars have become much thinner and more elastic because of this. This significantly reduces the risk of developing uterine rupture along the scar during subsequent pregnancies and during childbirth. Therefore, today it is believed that the formation of a completely stable scar after surgery on the uterus occurs completely approximately one year after the operation.
Also today, many urological or gynecological operations are performed in a special way - endoscopically, through the uterine cavity, or through the vagina; intravascular operations (endovascular) or laparoscopic operations, through micro-incisions (punctures), can also be performed. Such techniques make it possible to minimize traumatic damage to the body, which significantly reduces the time required to fully restore health before planning conception. Therefore, today, on the issue of possible timing of pregnancy planning after a cesarean section, doctors talk about a period of approximately two years. After she has undergone some special operations on the female or male genitals, which are carried out in order to increase the chance of successful conception– sometimes it takes a couple of months, or even the cycle following discharge.
Such operations may include treating areas of varicose veins or hydrocele in men, or blowing out the fallopian tubes or removing endometrioid areas in women (foci of endometrial growth not inside the uterus). Naturally, it is worth remembering that each case of surgery will be unique and recommendations for the couple will be given very individually. The specific type of intervention and indications for it, the scope of the operation and the characteristics of its course, and the recovery period after the operation will all play a role. Also, everything will largely depend on the age and general condition of the parents who underwent surgery.
If you have undergone laparoscopic surgery
Today, laparoscopic operations are quite widely used in emergency or planned surgery, including for diseases and pathological conditions in the pelvic organs. But how can they influence further fertility and the further course of pregnancy? Can such operations cause complications and problems with conception? Laparoscopic operations are types of modern surgical treatment that have a number of important differences from conventional operations. First of all, access to the abdominal cavity or pelvic organs is made through two or three very small incisions. Usually, a special optic is inserted into one of the incisions near the navel so that the doctor can see the cavity from the inside, and a special micromanipulator is inserted into the other incision in the suprapubic area, which replaces the surgeon’s hands. Sometimes it is possible to insert a manipulator through the vagina, then only one thin scar will remain on the abdomen. During surgery, the doctor sees the surgical field on a monitor screen, and carbon dioxide is injected into the cavity to improve visibility and reduce damage to neighboring organs. After such an operation, the time for the body to recover is significantly reduced.
The effect of laparoscopy on conception
For whatever purpose doctors perform surgery on a woman’s pelvic organs, one of its primary goals is to preserve or completely restore the ability to bear children. Due to its low trauma and rapid tightening of sutures, minimal deformation of organs and the formation of adhesions during its implementation, this technique has become leading in the treatment of infertility. In addition, such operations are often directly indicated for eliminating infertility and restoring the ability to become pregnant. The doctor can dissect adhesions even from past operations and performs various types of operations to treat infertility - removing foci of endometriosis inside the abdominal cavity, removing fibroid nodes, puncturing or removing cysts on the ovaries, checking the patency of the fallopian tubes. Also, with the help of laparoscopy, an ectopic pregnancy in the abdominal cavity or in the tube is accurately confirmed and it is terminated in the most minimally traumatic manner. There is no need to be afraid of such operations - this is the most gentle of all surgical treatment methods, helping you to delay the conception of a baby as little as possible.
Typically, the period for abstinence from pregnancy is from three months to one year, and this will be decided by the doctor, based on the reasons that led to the laparoscopic operation. Thus, when diagnosing the patency of the fallopian tubes, when removing an ovarian cyst or eliminating foci of endometriosis, the period of abstinence from pregnancy is three months, when removing appendicitis or fibroids - about six months, when dissecting massive adhesions up to a year. Sometimes after some operations it takes less time for the sutures to heal and the cycle to restore. And in the future, the course of pregnancy after laparoscopic surgery will not affect the course of pregnancy in any way. If you follow all the recommendations given by the doctor after the operation and meet the deadlines for conception, no unpleasant consequences of the operation will affect you.
Very thin scars after surgery will be able to fully heal without the formation of adhesions, and there will be no pain. Organs and tissues have time to recover after surgery and hormonal balance is completely restored. If pregnancy occurs earlier than three months after laparoscopic surgery, the likelihood of a threat of early termination of pregnancy due to dysfunction of the ovaries (during ovarian surgery) or the formation of placental insufficiency during surgery on the uterus or tubes may significantly increase. Also, conceiving earlier can reduce the mother’s immunity and increases the risk of inflammatory processes in the pelvic area, which can lead to disturbances in the development of the fetus and septic processes in the mother.
After laparoscopic operations, childbirth proceeds quite naturally, and the operation does not affect the recovery period after it. Often, problems during childbirth can be caused by those diagnoses against which laparoscopic surgery was directed. Therefore, if the patient has any operations, she is observed under a special regime during pregnancy.
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The beginning of the scientific development of modern extraperitoneal cesarean section with an incision of the uterus in the lower segment was laid at the beginning of the last century by the works of Frank (1906, 1907), Latzko (1909). These methods were further developed in the studies of J. Norton (1946), E.N. Morozova (1974), V.I. Krasnopolsky et al. (1997), V.I. Kulakova et al. (1998).
Indications for the use of extraperitoneal access during cesarean section are (Strizhakov A.N. et al., 1998):
- chorioamnionitis and endometritis with a long anhydrous interval;
- acute infectious diseases of the genital organs and urinary tract;
- purulent-septic diseases of any localization;
- history of peritonitis;
- genitourinary and enterogenital fistulas;
- polyvalent allergy.
IN AND. Kulakov et al. (1998) also highlight an increase in body temperature during labor above 37.6°C; condition after surgery on the cervix for isthmic-cervical insufficiency during this pregnancy (possibility of developing chorioamnionitis); exacerbation of herpetic infection of the genital organs; suspected intrauterine infection
Considering the technical features of extraperitoneal access, an important condition To perform this operation, it is necessary to have a highly qualified doctor who knows the technique of this operation, as well as the satisfactory condition of the fetus and the consent of the mother.
Contraindications to the use of extraperitoneal access:
- failure of the uterine scar;
- threatening uterine rupture;
- placenta previa or premature abruption of the placenta;
- developmental anomalies, tumors of the uterus or its appendages;
- pronounced varicose veins of the lower segment of the uterus.
Ch.S. Field (1988) also lists as contraindications an estimated fetal weight of 4000 g or more (if the operation is performed during labor) or more than 3800 g (during pregnancy), abnormal positions or presentation of a fetus weighing more than 3500 g, and fetal distress.
In addition, with extraperitoneal access during a cesarean section, it is impossible to perform tubal ligation.
The main stages of extraperitoneal cesarean section should be performed with a full bladder. To create adequate access during an extraperitoneal approach to the lower segment of the uterus during laparotomy, it is necessary to sufficiently separate the aponeurosis from the underlying rectus abdominis muscles down to the pubis and up to the umbilicus, which is carried out partially by blunt or sharp means. Then, after dividing the rectus and pyramidal muscles, the right rectus muscle is bluntly peeled off from the preperitoneal tissue and retracted to the right with a mirror.
At this stage, it is necessary to carry out a thorough topographical orientation, in which a triangle is identified, formed from above by the fold of the parietal peritoneum, on the medial side by the lateral surface of the apex of the bladder (lig. vesicoumbilicalis lateralis), on the lateral side by the right rib of the uterus.
To ensure sufficient displacement of the bladder, it is recommended to mobilize it by carefully cutting with thin scissors (or separating with tweezers) the transverse fascia (fascia endopelvina) along the entire surface of its connection with the bladder. After this, the vesicouterine fold is peeled off bluntly and retracted together with the bladder to the left rib of the uterus with a speculum, exposing its lower segment.
Before opening the uterus by palpation, you should make sure that the planned incision falls on the anterior surface of the lower segment, without moving to the rib of the uterus, which will avoid accidental injury to its vascular bundle or ureter. Next, during the operation, a transverse incision is made in the lower segment of the uterus 2 cm below the fold of the peritoneum, it is increased bluntly or according to Derfler to 10-12 cm, the fetus and placenta are removed, as when using the traditional technique.
Before removing the fetus, the side speculum is removed and urine is released through the catheter. IN AND. Kulakov et al. (1998) recommend leaving the speculum that holds the vesicouterine fold for better access to the lower segment and to prevent bladder trauma.
After the birth of the fetus and placenta, the uterine wound is sutured as in a traditional operation. Then hemostasis and integrity of the peritoneum and bladder are monitored. If the peritoneum is damaged, its integrity is restored. To assess the condition of the bladder, it is refilled with saline (possibly with methylene blue dye). The vesicouterine fold is straightened into place and the anterior abdominal wall is restored layer by layer.
Some authors recommend, before suturing the abdominal wall, installing drainage tubes into the paravesical tissue on both sides, which are then brought out through the wound to the abdominal wall (Field Ch.S., 1988). Other authors use only one drainage, from the side of the surgical approach, which is installed in the presence of increased bleeding (Kulakov V.I. et al., 1998).
The advantages of extraperitoneal cesarean section include:
- reducing the risk of developing peritonitis and intestinal injuries;
- less blood loss and a slight reduction in the duration of the operation;
- prevention of the development of adhesions in the abdominal cavity;
- less pain in the postoperative period and the incidence of intestinal dysfunction.
However, it should be emphasized that the operation of an extraperitoneal cesarean section is more complex than a transperitoneal one, and also has a number of disadvantages. According to L.T. Hibbard (1985) with extraperitoneal access, the time before extraction of the fetus increases to 9-11 minutes from the skin incision, the risk of bleeding from varicose veins of the broad ligaments of the uterus and trauma to the bladder and ureters increases, in 10-25% rupture of the peritoneum occurs, which eliminates the main the advantage of this operation is to prevent the penetration of contents from the uterus into the abdominal cavity.
Some obstetricians use obstetric forceps to facilitate the birth of the fetus during extraperitoneal cesarean section, others consider this approach traumatic for the mother and fetus (Kulakov V.I. et al., 1998). So, according to V.I. Krasnopolsky et al. (2000) when removing a child with obstetric forceps, the frequency of newborn asphyxia decreases from 52% to 37%, hypoxic-ischemic damage to the central nervous system moderate severity from 16.7% to 12.2%. At the same time, he draws attention to the fact that even with the use of obstetric forceps, every third child is born in a state of asphyxia, and the frequency severe violations increases (10.5% at birth without the use of obstetric forceps, 12.2% when extracted with forceps).
N.S. Haesslein and R.C. Goodlin (1980), when analyzing 186 observations of cesarean section in women with a high risk of infectious complications, noted that indications for the use of extraperitoneal access more often arose in obstetric situations when there was no technical possibility of its use. On the contrary, in observations where extraperitoneal cesarean section could be used, the situation was successfully resolved by transperitoneal access.
With the exception of severe infection, in all other cases the prescription of antibiotics is an effective measure to prevent complications. Also Ch.S. Field (1988) notes that when performing extraperitoneal cesarean section according to developed indications, 57% of pathology localized in the pelvis cannot be detected in a timely manner. R.L. Wallace et al. (1984) based on the results of studying the outcomes of 91 extraperitoneal cesarean sections in labor with an anhydrous interval of more than 4 hours, they concluded that this approach does not have a significant effect on the incidence of endometritis and sepsis in the postpartum period.
IN last years The technique of extraperitoneal access has undergone virtually no significant changes; the existing improvements are not fundamental and do not significantly affect its outcomes (Koprivica Z. et al., 1997). In connection with the above, at present, extraperitoneal cesarean section is used relatively rarely (0.15-1.2%) (Komissarova L.M. et al., 2000), in severe septic conditions (Lebedev A.S., 2000). The decline in interest in cesarean section via extraperitoneal access is due to the widespread introduction of antibacterial prophylaxis (Cunningham F.G. et al., 1997; Hankins G.D.V. et al., 1995).
In case of potential infection during labor (long anhydrous period, a large number of vaginal were examined) and the presence of foci of extragenital infection (acute pyelonephritis with nephrostomy, etc.), we perform transperitoneal cesarean section using prolonged postoperative laparoscopic sanitation of the abdominal cavity (Strizhakov A.N. et al., 1998).
At the Department of Obstetrics and Gynecology No. 2, Faculty of Medicine, Moscow Medical Academy. THEM. Sechenov, a “Device for Laparoscopy” was developed and introduced into clinical practice (author’s certificate No. 1653744).
The device (cannula) consists of a special trocar (1), a sleeve with a latch hinged at the end, having an L-shape in the longitudinal section (2), a support sleeve, an o-ring, and a plug. At the working end of the sleeve there is a thread for a fixing nut (3). The trocar, sleeve and support sleeve are made of titanium, the fixing nut and plug are made of fluoroplastic.
The sequence of working with the device: the assembled cannula is used to pierce the anterior abdominal wall, loosen the fixing nut, rotate the trocar and remove it; After attaching the cannula to the anterior abdominal wall, a plug is installed in it. In the postoperative period, after removing the plug, a laparoscope is inserted into the abdominal cavity through a cannula.
As a rule, dynamic laparoscopy is performed in the operating room; in case of severe condition of the patient, it can be performed in an intensive care unit. For pain relief, short-term intravenous anesthesia is used.
During laparoscopic sanitation (usually on the 1st and 2nd days of the postoperative period), the uterus, suture line were examined, the condition of the uterine appendages and adjacent organs was assessed ( bladder, intestines), determined the amount and nature of effusion in the abdominal cavity. On the first day, a small amount (up to 70-100 ml) of hemorrhagic exudate was found in the abdominal cavity of the examined women at risk of infectious complications, which was evacuated in the abdominal cavity. A bacteriological study of the exudate revealed a growth of opportunistic flora in 75% of cases; in every fourth woman there was no growth of flora.
The peritoneal cover of the uterus and adjacent organs was Pink colour, brilliant; Small fibrin clots were sometimes found in the suture area of the uterus. If necessary, the abdominal cavity was washed with saline solution with the addition of an antibiotic. On the second day of the postoperative period, the amount of effusion in the abdominal cavity decreased sharply, and there were no signs of the development of an infectious process. Positive dynamics clinical symptoms(the general condition of the woman, indicators of temperature, hemodynamics, bowel function, peripheral blood, etc.) and a favorable laparoscopic picture on the second day of the postoperative period in all observations allowed us to complete endoscopic control and remove the cannula.
The course of the postoperative period in all examined women was uncomplicated. The data obtained indicate the advisability of prolonged postoperative laparoscopic sanitation in women at high risk of developing infectious complications.
In our opinion, a further reduction in the frequency of extraperitoneal cesarean section and other techniques performed in the presence of infection should be facilitated by rational tactics of pregnancy and childbirth, based on modern detection and prevention of the development of inflammatory diseases, disorders of the vaginal microcenosis, and a body-based approach to the choice of method of delivery for women at risk. with timely expansion of indications for transperitoneal caesarean section.
A.N. Strizhakov, O.R. Baev
All over the world there is a clear trend towards gentle childbirth, which helps preserve the health of both mother and child. The tool that helps achieve this is the cesarean section (CS). A significant achievement was wide application modern techniques pain relief.
The main disadvantage of this intervention is considered to be an increase in the frequency of postpartum infectious complications by 5-20 times. However, adequate antibacterial therapy significantly reduces the likelihood of their occurrence. However, there is still debate about in which cases a caesarean section is performed and when a physiological birth is acceptable.
When is surgical delivery indicated?
C-section– a serious surgical intervention, which increases the risk of complications compared to normal natural childbirth. It is carried out only according to strict indications. At the request of the patient, a CS can be performed in a private clinic, but not all obstetricians-gynecologists will undertake such an operation unless necessary.
The operation is performed in the following situations:
1. Complete placenta previa is a condition in which the placenta is located in the lower part of the uterus and closes the internal os, preventing the baby from being born. Incomplete presentation is an indication for surgery when bleeding occurs. The placenta is abundantly supplied with blood vessels, and even slight damage to it can cause blood loss, lack of oxygen and fetal death.
2. Occurred prematurely from the uterine wall - a condition that threatens the life of a woman and child. The placenta detached from the uterus is a source of blood loss for the mother. The fetus stops receiving oxygen and may die.
3. Previous surgical interventions on the uterus, namely:
- at least two caesarean sections;
- combination of one CS operation and at least one of the relative indications;
- removal of intermuscular or on a solid basis;
- correction of a defect in the structure of the uterus.
4. Transverse and oblique position of the child in the uterine cavity, breech presentation (“butt down”) in combination with an expected fetal weight of over 3.6 kg or with any relative indication for surgical delivery: a situation where the child is located at the internal os in the non-parietal region , but the forehead (frontal) or face (facial presentation), and other location features that contribute to birth trauma in the child.
Pregnancy can occur even during the first weeks of the postpartum period. The calendar method of contraception is not applicable in conditions of an irregular cycle. The most commonly used condoms, mini-pills (gestagen contraceptives that do not affect the child during feeding) or regular ones (in the absence of lactation). Use must be excluded.
One of the most popular methods is. Installation of an IUD after a cesarean section can be performed in the first two days after it, however, this increases the risk of infection and is also quite painful. Most often, the IUD is installed after about a month and a half, immediately after the start of menstruation or on any day convenient for the woman.
If a woman is over 35 years old and has at least two children, at her request, during the operation, the surgeon can perform surgical sterilization, in other words, tubal ligation. This is an irreversible method, after which conception almost never occurs.
Subsequent pregnancy
Natural childbirth after a cesarean section is allowed if the formed connective tissue on the uterus is strong, that is, strong, smooth, and able to withstand muscle tension during childbirth. This issue should be discussed with your attending physician during your next pregnancy.
The likelihood of subsequent births normally increases with following cases:
- the woman gave birth to at least one child vaginally;
- if the CS was performed due to incorrect fetal position.
On the other hand, if the patient is over 35 years old at the time of subsequent births, she has excess weight, concomitant diseases, discrepant sizes of the fetus and pelvis, it is likely that she will undergo surgery again.
How many times can you have a caesarean section?
The number of such interventions is theoretically unlimited, but to maintain health it is recommended to do them no more than twice.
Typically, the tactics for repeated pregnancy are as follows: the woman is regularly observed by an obstetrician-gynecologist, and at the end of the gestation period a choice is made - surgery or natural childbirth. During a normal birth, doctors are ready to perform emergency surgery at any time.
Pregnancy after cesarean section is best planned at intervals of three years or more. In this case, the risk of suture failure on the uterus is reduced, pregnancy and childbirth proceed without complications.
How soon can I give birth after surgery?
This depends on the condition of the scar, the woman’s age, and concomitant diseases. Abortion after CS has a negative impact on reproductive health. Therefore, if a woman does become pregnant almost immediately after a CS, then with a normal course of pregnancy and constant medical supervision, she can carry a child, but delivery will most likely be operative.
The main danger early pregnancy after CS there is a failure of the suture. It is manifested by increasing intense pain in the abdomen, the appearance of bloody discharge from the vagina, then signs of internal bleeding may appear: dizziness, pallor, falling blood pressure, loss of consciousness. In this case, it is necessary to urgently call " Ambulance».
What is important to know when having a second caesarean section?
Elective surgery is usually performed at 37-39 weeks. The incision is made along the old scar, which somewhat lengthens the operation time and requires stronger anesthesia. Recovery after a CS may also be slower as scar tissue and abdominal adhesions prevent the uterus from contracting well. However, when positive attitude women and her family, with the help of relatives, these temporary difficulties are completely surmountable.
