What are the main indications for a cesarean section? Caesarean section: from preparation for surgery to discharge from the hospital Does the traumatologist give indications for a cesarean section

All my patients (I'm now exclusively talking about expectant mothers) are divided into two types. The first are those who believe that a woman is simply obliged, even though she has all the indications for a caesarean section, to give birth herself.

And when the ladies from this category find out that surgical intervention cannot be avoided, they torture themselves with remorse until the baby is born: “How is it, why me, after all I tried so hard to make everything“ right ” ...

Another category includes women who, at the first consultation, categorically declare: “Doctor, whatever you want, but I will not give birth myself. Cut me up and better under general anesthesia. Otherwise, I simply will not survive all the torments that people write about on the forums and talk about sitting in line to see a doctor. "

The firstSecond

If you recognize yourself in one of the situations I have described, then it will be very useful and interesting for you to learn everything about absolute and relative indications indicating the need for surgical obstetrics. So, we understand when it is absolutely impossible to do without an operation, and when a doctor can agree to carry it out even without any prerequisites.

List of indications for caesarean section 2020

There are daily changes in the medical protocols related to the CS. For example, not so long ago, in vitro fertilization was the first item in the list of indications for a planned cesarean section. Today, this prescription is not so categorical, and when deciding on the advisability of surgical intervention in the labor process, the reasons why the patient underwent IVF are considered first of all. If, for example, assistance in assisted reproductive technologies arose due to the male factor, and the woman is quite healthy, then why cannot she give birth on her own?

Many heart diseases, vision pathologies, etc. were also excluded from the list of indications for cesarean section. Nevertheless, over the past period of 2020, more than 30% of children left the mother's womb precisely through an incision in the abdomen, and not naturally. Let us consider in more detail the reasons for this fact.

Absolute readings

The absolute indications for a cesarean section are clinical circumstances in which natural delivery is a threat to the patient's life.

A woman cannot avoid surgery if she has:

1. Narrow pelvis.
2. Neoplasms have been found in the ovaries, uterus, or bladder that block the birth canal and can prevent the baby from coming into the world.
3. Placental presentation.
4. The placenta began to flake off earlier than it caused bleeding.
5. The fruit is in an oblique or transverse position.
6. Previously, there was an operation on the uterus (for example, childbirth).
7. Eclampsia is a late toxicosis with a severe course.
8. Oncological diseases of the abdominal cavity, reproductive or genitourinary system.
9. There is a risk of uterine rupture.
10. The size of the pelvis does not correspond to the parameters of the fetal head.
11. Varicose veins of the external genital organs or vagina.

Almost all of these factors become known already during pregnancy, so the fact that a cesarean will be performed will not come as a surprise to a woman.

Relative indications

The list of relative (indirect) indications for cesarean section for each doctor may vary depending on his professional experience, accepted norms and protocols in a particular clinic.

1. A narrow pelvis in combination with a large fruit or his.
2. Asynclitic head insertions.
3. High straight or low transverse position of the swept seam.
4. Oxygen starvation of the fetus.
5. Weak or discoordinated labor that cannot be corrected.
6. The fetus is in breech presentation.
7. Pregnancy is already postponed, and the body does not give signals of readiness for childbirth.
8. Moderate or mild late toxicosis.
9. The first childbirth, while the age is 35+.
10. The fruit is too large.
11. Serious pathologies of the development of the uterus.
12. The umbilical cord loops fall out.

In addition to those listed above, there are also situations when there is an urgent need for an operation.

Indications for emergency caesarean section

As a rule, the need for urgent surgical intervention arises in situations where the patient cannot give birth on her own without risking her own life and the child's. That is, most often, indications for an emergency caesarean section are found during natural childbirth or almost at the last moment before such.

Here are the most common examples:

• The woman's labor activity is normal, the contractions are "on schedule", the uterus has opened, and the baby's head does not move along the birth canal.
• Drug stimulation does not work, labor is absent, but the amniotic fluid has already departed, which makes the fetus vulnerable to infections.
• The connection between the placenta and the walls of the uterus is broken.
• There was a rupture of the uterus.
• The placenta exfoliated and bleeding began.
• Acute fetal hypoxia developed.
• The baby is turned in such a way that the loops of the umbilical cord prevent it from coming out.
• Acute preeclampsia due to impaired renal function.
• The woman in labor had a sharp increase in blood pressure, and convulsions began.

I have listed only the most common cases that occur in my practice, and are indications for an emergency caesarean section. But other situations may arise that no doctor, unfortunately, is able to foresee.

The main list of contraindications

In some situations, surgical intervention during childbirth is highly undesirable.

The operation is dangerous:

• if there is a risk of complications of a purulent-septic nature in the patient;
• the fetus has malformations or deformities that are incompatible with life;
• the fetus in the womb froze (died);
• the fetus is deeply premature and cannot survive outside the uterus.

When there is no longer any doubt that the fetus is not viable, we, doctors, direct all efforts to save the life of a woman. In such cases, even if there is a section, the operation is still done, but according to a special technique. Previously, the dead fetus had to be removed together with the uterus in order to prevent purulent-inflammatory complications. But today we have the opportunity to preserve the main genital organ for women, thanks to the extraperitoneal technique, which involves the temporary isolation of the abdominal cavity during surgery.

Caesarean section without indication

Perhaps you will find an obstetrician-gynecologist who will do a caesarean without indication. But I always refuse such requests to my patients, since I consider such a decision of a woman to be nothing more than a whim and a desire to get a result without efforts on her part.

I argue my refusal with the following facts:

1. Every healthy woman is able and should give birth on her own.
2. With CS, the risk of complications 12 times higher.
3. Anesthesia has a bad effect on the body of the mother and child.
4. it will take a long time, and having given birth on your own, you will be able to return to your usual way of life the very next day.
5. If you go for a cesarean section without indications, it is not a fact that you will be able to have children in the future, and if you can, then not earlier than in 3 years.
6. The postoperative suture will bother you for a long time.
7. It is not a fact that after the COP is normalized, the child may have to grow up on artificial mixtures, which will definitely not contribute to the strengthening of his immunity.

In addition, the "kesarenka" lacks the hormones necessary to adapt to the new environment. Therefore, before making such decisions, think about whether it is worth risking your health, if not your own, then that little man whom you will give birth to.

I try not to give a lot of advice to patients who are going to have surgery. After all, a woman during pregnancy is very impressionable, and can take my advice as a warning, rather than cause unnecessary worries. All that is required from the expectant mother for a successful cesarean section:

1. Observe the regime.
2. Eat right, especially in the last days before childbirth (exclude hard, fatty, salty, spicy foods and carbonated water).
3. Prepare in advance everything you need for yourself and the child (a detailed list of things and hygiene products is provided in the antenatal department).
4. Get enough sleep.
5. Walk more in the fresh air.
6. Follow all doctor's prescriptions.

If a woman does not have serious health problems, then the implementation of these six simple recommendations is quite enough for the CS and the recovery period to pass without any complications.

How is the operation going

If the indications for a cesarean section are established at the stage of pregnancy, and a planned operation is to be performed, the technique for performing it is as follows:

1. Anesthesia is introduced - local or (the doctor together with the patient decides on which anesthesia to use).
2. The operating field is treated with an antiseptic.
3. Step by step, layer by layer, the skin on the abdomen, muscles and abdominal wall are cut.
4. The uterine cavity is opened.
5. The child is removed.
6. The umbilical cord is cut
7. Manipulations are carried out to cleanse the mucus from the mouth and nose of the newborn.
8. The placenta is removed.
9. The cut layers are sewn up in reverse order.
10. The seam is treated with special preparations.

In terms of time, these 10 stages last a total of no more than an hour. After that, the mother is transferred to the intensive care unit for literally a day. If there are no complications, the woman goes to the general department the very next day, where she can fully enjoy the joy of motherhood.

What you need to be prepared for

Many of my patients, who during pregnancy find out that they have indications for cesarean, ask me the same question: "Doctor, what should I expect, what should I prepare for?" I answer almost everyone the same: "Get ready to become a happy mom!". Yes, the operation is difficult. Yes, you need to follow all the doctor's prescriptions for all 9 months, lead a healthy lifestyle, etc.

There is a risk of complications as a result of prolonged anesthesia and surgery - this is also a fact. As well as the fact that the recovery period in this case is longer and not the easiest. But all this can and should be experienced in order to give life to another person and subsequently enjoy all the joys of motherhood.

Conclusion

If you have an indication for a cesarean, whether direct or indirect, it is definitely not worth the risk. Moreover, your life and your child's are at stake. Despite all the difficulties of the operation, if there are even the slightest risks, it is better to completely eliminate them.

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There is no consensus regarding caesarean section. Some believe that this is a great way to avoid pain that is natural during independent childbirth, while others are panicky afraid of such a surgical intervention. However, it is worth clarifying that this is, first of all, an operation performed under special anesthesia, which means that there are certain medical indications for a cesarean section, according to which the attending physician prescribes this method of obstetrics to the future mother.

2. Indications for cesarean section and from the fetus

2.1. Incorrect presentation
2.2. Polyhydramnios or very little water
2.3. Hypoxia
2.4. Multiple pregnancies
2.5. Placenta previa
2.6. Insufficient incision in the uterus

3.Cesarean section at the request of the woman. Is it possible?
4. Video

These include both the testimony from the mother and from the fetus.

Maternal indications

The most common reasons for a caesarean section are the mother's age and the presence of various diseases.

Age

Today, women who decide to give birth after the age of 27 automatically fall into the risk group (they are sometimes also called “primiparous” or even “old-giving birth.”) Age itself, of course, is not a fundamental factor in caesarean section.

Low vision

But if you add to it, for example, vision problems, then - yes, the issue with the operation is resolved. And if until recently it was believed that a woman whose vision has reached the mark - 5 (myopia) or below, needs to be prepared for surgery, now a number of other indicators related to vision are needed: deterioration of the retina (its deformation or detachment) as well as increased eye pressure. With such indicators, even a strenuous period is prohibited, since in the process of contractions a woman can lose her eyesight for a certain period of time.

A woman learns about how she is to give birth in the region of 18-20 weeks (if the issue of caesarean section was not discussed earlier), when she fills in the "slider". The doctor must give an opinion, which will indicate the method of delivery: natural or through surgery. During the entire pregnancy, the data obtained changes, so it is so important to carry out examinations as often as possible.

However, there are a number of other indicators related to the health of the mother and leading to surgical intervention:

Narrow pelvis

Due to the anatomical features of the structure, the child will not be able to pass through the birth canal; or in the process of childbirth, he may receive injuries incompatible with life;

various kinds of "obstacles" - tumors, fibroids, scars from previous operations.

Caesarean section at first birth

By the way, a woman who has previously undergone a cesarean section is prescribed a second operation regardless of other indicators. In very rare cases, doctors recommend that mommy try to give birth on her own (of course, under the close supervision of doctors), but only if the reason for which the caesarean was carried out during the previous pregnancy was eliminated. More terrible and even fatal is the situation when the uterus can rupture - then the operation is inevitable.

Placental abruption

In this case, an emergency caesarean section is always prescribed, which helps to save the mother and child from coma (or death);

prolapse of the umbilical cord into the cervix - fetal hypoxia may occur - the operation is performed on an emergency basis.

if the mother has acute chronic diseases: oncology, neurology, kidney, liver and heart diseases and especially diabetes mellitus;

Large baby weight

Varicose veins

It can also become a reason for a caesarean section, but this disease is considered only in conjunction with other ailments that arise during pregnancy.

Late gestosis

Severe swelling, protein in the urine, high blood pressure, the appearance of black or white flies before the eyes, headache, and sometimes cramps.

Termination of labor

When the child does not move well or does not move at all, and some genital diseases, for example, genital herpes, in this case, the operation is prescribed to reduce the risk of infection of the newborn (and the treatment is already carried out after childbirth).

Indications for cesarean section and from the fetus

Incorrect presentation

As a rule, the most likely cause for a cesarean is a breech presentation of the fetus, as in the process of natural childbirth, it can suffocate or get injured

Polyhydramnios or very little water

Not so much an obvious reason, but it is taken into account in conjunction with other conditions for the operation;

Hypoxia

Oxygen starvation is very dangerous for the development of the child, therefore, if it does not respond to treatment, then a decision is made to carry out an emergency operation;

various kinds of delays in the development of the child - are detected during the ultrasound scan.

Multiple pregnancies

a cesarean section is done if a pregnant woman is carrying 3 or more children.

As a rule, these factors are clarified in advance - during routine examinations and ultrasound. By the way, the identified anomalies can serve as an indication not only for a planned caesarean section, but also for an emergency one.

Placenta previa

For example, placenta previa accompanied by bleeding can be a serious reason for an unscheduled operation.

Insufficient incision in the uterus

Another possible cause of injury in both a premature and a post-term fetus (even damage to the spinal cord and brain is possible).

Caesarean section is also performed for mixed indications. In other words, if several conditions specified above are taken, each of which is not individually considered the basis for a caesarean section, but in their totality they will pose a real threat to the life of the mother and child, then the operation is inevitable.

Caesarean section at the request of the woman. Is it possible?

Caesarean section, although it is not the most difficult abdominal operation, but like any surgical intervention is performed only if there is evidence, but not at the request of the woman.

And yet, today, more and more often, expectant mothers have a question: is it possible to have a cesarean section at will. There is no definite answer to this question. Doctors try to protect the mother's body from stress and potential risks associated with abdominal surgery.

anesthesia (unpleasant, but you can endure it), when you have to get up and wash for the first time after the operation, walk along the corridor and pick up the baby. In addition, there is a likelihood of seam divergence or suppuration, and no one is yet insured against the consequences of anesthesia.

Therefore, before the operation with the woman in labor, the time of the planned operation is discussed and all possible complications recorded in writing are discussed. In this document, the patients also express their consent to the operation. In the event that the life of a pregnant woman is in danger, for example, she is unconscious, a caesarean section will be performed with the consent of relatives, or for medical reasons.

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

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

However, it should be borne in mind that a planned or emergency caesarean section can cause complications and consequences in the distant future. But at the time of the operation, the preservation of the life of the child and the mother plays an important role.

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

When is the operation performed?

Caesarean births can be planned, planned and emergency. With a planned operation, its exact date is assigned (often a week or two before the expected date of birth) and is carried out in the presence of normal indications in the mother and fetus, as well as at the first signs of the onset of labor.

A woman often learns about a planned cesarean section even during pregnancy (sometimes at the very beginning). But in this case, childbirth begins to be carried out in a natural way, and ends abdominal.

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

• The fetus is alive, and can continue to exist in the womb, but to preserve the life of the mother, it is removed ahead of time;
• The woman must give written consent to the operation;
• A catheter is inserted into the patient's bladder, since the cesarean procedure is performed only when the bladder is empty;
• The woman in labor has no signs of infection;
• Surgery should only be performed in the operating room with the participation of an experienced obstetrician-surgeon.

Basic indications

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

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

In addition, there is a division of provoking factors into maternal and fetal. Emergency surgery may also be performed during childbirth or late pregnancy.

Absolute readings

Indications for which a cesarean section is mandatory include an extensive list of factors on the part of the mother and the fetus. These include:

Anatomical narrow pelvis

There are two groups of narrowing of the pelvis. The first includes a flat, cross-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 conjugates is less than 9 centimeters), complications may arise before the process of labor:

• Oxygen starvation of the fetus;
• Weak contractions;
• Infection of the child;
• Early breakthrough of the amniotic fluid;
• Loops of the umbilical cord or limbs of the child.

The anatomical narrow pelvis also provokes the development of complications of the persistent period:

• Secondary weakness of pushing;
• Injuries to the joints of the pelvis and nerve endings;
• Oxygen starvation of the child;
• Birth trauma and rupture of the uterus;
• 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 the transport of blood, oxygen and nutrients from mother to baby. Normally, the placenta is located at the fundus of the uterus or the posterior or anterior loom of the organ. However, there are cases when the placenta forms in the lower segment of the uterus and overlaps the internal pharynx, 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 overlaps only part of the internal pharynx. However, even an incomplete presentation can cause sudden bleeding. Especially often, bleeding begins already during childbirth, when the internal pharynx expands, provoking a gradual one. In this case, a caesarean section is performed only with severe blood loss.

Threat or presence of uterine rupture

There are many reasons that can cause a ruptured uterus: improper management of labor, poor coordination of labor forces, too large a fetus. If the patient is not provided with medical assistance in a timely manner, the uterus may rupture, and in this case both the woman and her child die.

Early placental abruption

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

Scars on the uterus (two or more)

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

Inconsistent scar

Sutures on the uterus can appear not only after abdominal delivery, but also any other surgical manipulations on the internal genital organs. A scar is considered to be inadequate if it has arisen during a complicated postoperative period (the woman had a high temperature, the skin sutures healed for too long, or endometritis developed). It is possible to determine the usefulness of the scar only with the help of ultrasound.

For many women, incision surgery becomes an inevitable challenge, for which it is impossible or dangerous for her and her baby to give birth through the birth canal. Like any other surgical procedure, a caesarean section is performed only for medical reasons.

Indications for surgery can be on the part of the mother, when childbirth poses a threat to her health, and on the part of the fetus, when the process of childbirth is a burden for him, which can lead to birth trauma and fetal hypoxia. They can occur both during pregnancy and during childbirth.

First, let us dwell on certain points, the presence of which presupposes such an operation in pregnant women.

Indications for caesarean section during pregnancy:

• Placenta previa. When the placenta (baby's place) is located in the lower part of the uterus and overlaps the internal pharynx (the entrance to the uterus from the side of the vagina). This threatens with severe bleeding, dangerous for both the life of the mother and the fetus. The operation is performed at 38 weeks of pregnancy or earlier if bleeding appears.
• Premature detachment of a normally located placenta. Normally, the placenta is separated from the wall of the uterus after the baby is born. Sometimes this happens during pregnancy, then heavy bleeding begins, which threatens the life of the mother and the fetus and requires immediate surgery.
• Inconsistency of the scar on the uterus after an incision in a previous birth or other operations on the uterus.

  A scar on the uterus is considered insolvent if, according to ultrasound, its thickness is less than 3 mm, the contours are uneven and there are inclusions of connective tissue. If the postoperative period after the first operation was difficult (increased body temperature, inflammation of the uterus, prolonged healing of the suture on the skin), this also indicates the inconsistency of the scar on the uterus.

• Two or more scars on the uterus after incision surgery. It is believed that two or more caesareans increase the risk of rupture of the uterus along the scar during labor due to the weakness of the scar tissue. Therefore, the incision is made before the onset of labor.
• Anatomically narrow pelvis (the so-called anatomical limitation of the size of the pelvic ring of a woman, making it difficult for the fetal head to pass through this ring) II-IV degree of narrowing. Every woman has her pelvis measured during pregnancy. Doctors-obstetricians have clear criteria for the normal size of the pelvis and a narrow pelvis in terms of the degree of narrowing. Tumors and deformities of the pelvic bones. They can be an obstacle to the birth of a child.
• Malformations of the uterus and vagina. Tumors of the uterus, ovaries and other organs of the pelvic cavity that close the birth canal.
• Large fetus in combination with another pathology. A fruit is considered large when its weight is 4 kg or more.
• Pronounced symphysitis. Symphysitis or symphysiopathy is the divergence of the pubic bones. In this case, there are pronounced difficulties and pains when walking.
• Multiple uterine fibroids of large sizes, malnutrition of myomatous nodes.
• Severe forms of preeclampsia and lack of effect of treatment. Gestosis is a complication of pregnancy in which there is a disorder in the function of vital organs, especially the vascular system and blood flow. Severe manifestations of gestosis are pre-eclampsia and eclampsia. This disrupts microcirculation in the central nervous system, which can lead to serious complications for both the mother and the fetus.
• Serious illnesses. Diseases of the cardiovascular system with symptoms of decompensation, diseases of the nervous system, diabetes mellitus, high myopia with changes in the fundus, etc.
• Pronounced cicatricial narrowing of the cervix and vagina. May occur after previous surgery or childbirth. This creates insurmountable obstacles to the dilatation of the cervix and the stretching of the vaginal walls necessary for the passage of the fetus.
• Condition after plastic surgery on the cervix and vagina, after suturing urogenital and genital fistulas. A fistula is an unnatural communication between two adjacent hollow organs.
• Perineal rupture of the III degree in previous childbirth. If in childbirth, in addition to the skin and muscles of the perineum, the sphincter (the muscle that blocks the anus) and / or the rectal mucosa are torn, then this is a grade III perineal rupture, a poorly sutured rupture can lead to gas and fecal incontinence.
• Severe varicose veins in the vaginal area. Bleeding from these veins can be life-threatening if you give birth spontaneously.
• The transverse position of the fetus.
• Fused twins.
• Breech presentation of the fetus (especially a boy) in combination with a fetal weight of more than 3600 g and less than 1500 g, as well as a narrowing of the pelvis. With a breech presentation, the risk of birth trauma increases at the birth of the fetal head.
• In vitro fertilization, artificial insemination in the presence of other complications from the mother and the fetus.
• Chronic fetal hypoxia, fetal malnutrition, refractory to drug therapy. In this case, the fetus receives an insufficient amount of oxygen and for him the process of childbirth is a load that can lead to birth trauma.
• The age of primiparas is over 30 years old in combination with another pathology.
• Long-term infertility in combination with other pathology.
• Hemolytic disease of the fetus with the unpreparedness of the birth canal. With Rh (less often - group) incompatibility of the blood of the mother and the fetus, hemolytic disease of the fetus develops - the destruction of red blood cells (erythrocytes). The fetus begins to suffer from a lack of oxygen and the harmful effects of the breakdown products of red blood cells.
• Diabetes mellitus in the need for early delivery and unpreparedness of the birth canal.
• Postterm pregnancy with an unprepared birth canal and in combination with other pathology. The process of childbirth is also a stress that can lead to birth trauma to the fetus.
• Cancer of any location.
• Exacerbation of genital herpes. With genital herpes, the indication is the presence of vesicular herpetic eruptions on the external genitalia. If by the time of childbirth it is not possible to cure a woman from this disease, there is a risk of infection of the fetus (with rupture of the membranes or the passage of the fetus through the birth canal).

In any case, doctors first try to solve the problem with conservative (i.e., non-surgical) methods. And they resort to surgical intervention only when their attempts have not led to the desired result.

In addition to the above cases, there are acute situations requiring surgical delivery.

Indications for a caesarean section during labor:

• Clinically narrow pelvis. This is the discrepancy between the fetal head and the mother's pelvis.
• Premature rupture of amniotic fluid and lack of effect from labor induction. When water is poured out before the onset of contractions, they are tried to be called with the help of medications (prostaglandins, oxytocin), but this does not always lead to success.
• Abnormalities of labor, refractory to drug therapy. With the development of weakness or discoordination and labor, drug therapy is carried out, which also does not always lead to success.
• Acute fetal hypoxia. When the heartbeat suddenly becomes infrequent and does not recover.
• Abruption of a normal or low-lying placenta. Normally, the placenta is separated from the wall of the uterus after the baby is born. Sometimes this happens during labor, then heavy bleeding begins, which threatens the life of the mother and fetus and requires immediate surgery.
• Threatening or incipient rupture of the uterus. Should be recognized in a timely manner by the doctor, since a delayed operation can lead to the death of the fetus and removal of the uterus.
• Presentation or loss of umbilical cord loops. If an incision is not made within the next few minutes during the prolapse of the umbilical cord and the cephalic presentation of the fetus, the child may die.
• Incorrect insertion of the fetal head. When the head is in an extended state (frontal, facial presentation), as well as a high erect head position.

Sometimes a caesarean section is performed for combined indications, which are a combination of several complications of pregnancy and childbirth, each of which individually does not serve as an indication for surgery, but together they pose a real threat to the life of the fetus. And always a caesarean section is an extreme measure, when all attempts to help a woman give birth on her own are futile.

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

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

Absolute indications for caesarean section

Absolute indications for a cesarean section today are called situations when delivery in another way is impossible or endangers the life of a woman. Among them:

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

Relative indications for caesarean section

The relative indications for cesarean section include situations that do not exclude the possibility of spontaneous delivery, but the likelihood of complications for the woman and / or the fetus is greater than in the case of surgical delivery. This includes:

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