Caesarean section 3 times. Next surgical delivery. "Caesarean section" with breech presentation

Catherine

Question

Good afternoon

I am 33 years old. This is my third pregnancy at 36-37 weeks. Pregnancy proceeds without complications, tests are normal. There will be PCS.

Previous births were also CS:

1 - weakness of labor activity, EX.
2 - PKC 1 g 8 months after the first CS.

7 years have passed since the second CS.

I have a question:

At what obstetric period do they issue a referral for hospitalization to the maternity department of the RD?

At what obstetric period is PCS done, given that there have already been two CSs, will this be the third?

Thank you very much in advance…

Answer

Hello Ekaterina!

Antenatal hospitalization for 38-39 weeks' gestation.

You can find out the exact date from your doctor, as it depends on:

the state of the fetus;
woman's condition;
the course of pregnancy;
the date of the previous birth.

You can be hospitalized ahead of schedule according to indications if you suspect a scar failure or problems with the fetus.

A planned operative delivery is carried out after the woman enters the hospital for 1-3 days, if there are no additional indications for delivery.

A planned CS implies the passage of all necessary studies in the antenatal clinic. Each analysis has its own expiration date, which determines the speed of the operation.

For admission to the maternity ward, you need to have a referral with the results of the following studies:

blood type and Rh factor;
general blood analysis;
general urine analysis;
blood chemistry;
blood glucose;
coagulogram;
blood tests for syphilis, hepatitis and HIV;
smear on flora;
therapist consultation.

The blood type and Rh factor are determined when a woman is registered.

Blood for syphilis, hepatitis and HIV is given before the issuance of maternity leave at 30 weeks of pregnancy.

The rest of the blood and urine tests have a shelf life of 10 days. The same terms regarding the ECG.

In a smear on the flora, there should be no inflammatory reaction. Often, in the period of 36-37 weeks of gestation, the obstetrician-gynecologist recommends putting vaginal suppositories to sanitize the vagina.

Which involves doing it on an empty stomach.

Additionally, in the hospital on the eve of the operation, you will have:

- fetal monitoring;
consultation with an anesthesiologist who will select an effective and gentle method of anesthesia.

Already after the second dissection of the uterus during childbirth, a woman is often offered to undergo sterilization, since the third caesarean section will cause irreparable harm to maternal and child health.

Why is the third caesarean dangerous?

Conducting a triple dissection of the uterus and abdominal cavity is fraught with such complications as:

inflicting wounds to the intestines;
damage to the bladder and ureters;
violation of the natural placement of the pelvic organs;
adhesions in the area of the scar;
persistent hypotonic bleeding;
uterus removal;
intoxication and fetal hypoxia.

The risks of a third caesarean are extremely serious, medically justified and require the woman to be familiarized with their likelihood in advance.

Is a third pregnancy possible after a second caesarean?

When planning a third child, it is necessary to observe the time interval during which the seam will become complete and the entire body will recover. The process of the third gestation will be under careful medical supervision, and will proceed with the same pathologies as the previous ones. A third pregnancy after a caesarean section has a small chance of ending naturally, but the risk is not recommended.

Third caesarean in a year

The ideal option for a subsequent pregnancy is its onset at least 2-3 years after the previous dissection. The onset of unwanted fertilization must be prevented by taking contraceptives. Additional trauma to the uterus by abortions, curettage or forced births in the early stages is not allowed.

Is a third caesarean dangerous?

There is no doubt, since each surgical intervention in the work of the body causes some harm. Especially if it is intended for the same body. Constantly superimposed scar, chronic endometritis, anemia - the minimum "set" of a constantly cesarean woman. Therefore, after the third caesarean, doctors will insist on sterilization in order to avoid lethal outcome.

Third caesarean at 40

Sometimes women "ripe" for a third child when the number of years begins to exceed the mark of 40. And there may be an unplanned pregnancy after 40 years. It is not age itself that is important here, but the time interval from previous births to pregnancy and the state of health of the intended mother. In any state of affairs, it is necessary to undergo a thorough examination by specialists who will assess the situation and offer a suitable method of delivery. And not everyone will be able to decide on a caesarean section for the third time.

womanadvice.ru

If the doctor hears that this will be the third caesarean, then his eyebrows will fly up to the ceiling. Few agree to undergo this operation for the third time, usually two are enough through the roof. And doctors already during childbirth suggest sterilization to avoid the next pregnancy, because the risk of a third cesarean section is simply huge, and the pregnancy itself after two operations will already be unhealthy. This, of course, does not stop some, and they will go to the third cesarean and the fourth for the sake of the children. But is it worth it?

Third caesarean section - risk and complications

A third caesarean section is a risk, and a huge one at that. And any doctor will definitely warn that you can voluntarily agree to this only if your health and your own life are not expensive. And even the best obstetricians are unable to prevent most of the consequences of the third caesarean section, because the body after two operations will be completely unpredictable.

Complications in the third caesarean may be the following: injury to the intestinal region and bladder, deformity of the pelvic organs, displacement or perforation of nearby organs. The formation of adhesions in the area of scarring, uncontrolled and unstoppable bleeding, the need for amputation of the uterus, fetal hypoxia, due to the fact that anesthesia will have to be made longer.

Should I have a planned caesarean section?

In recent decades, more and more babies are born by caesarean section (CS). In some maternity hospitals in the CIS countries, CS rates reach 50% of all births. In 2005, WHO conducted studies showing that with an increase in the frequency of CS, the frequency of prescribing antibiotics in the postpartum period increases, and the level of maternal morbidity and mortality increases. On average, caesarean section occurs in 15 births out of 100, while a further increase in the frequency of CS does not lead to a decrease in perinatal morbidity and mortality in children.

Given the relatively high frequency of CS, any opportunity to reduce the risks associated with operative delivery will have significant benefits both for individual women in labor and in terms of economic costs.

Compared with vaginal delivery, maternal mortality rates for CS (40 per 10,000 cases) are 4 times higher than for all types of vaginal births, and 8 times higher than for normal vaginal births (5 out of 10,000 cases).

Planned caesarean section

A caesarean section can be performed as planned, when the doctor, together with the woman in labor, decides in advance on operative delivery, as the safest method of delivery, or urgently, when there are indications for urgent operative delivery. Even when registering, an obstetrician-gynecologist collects an anamnesis of a pregnant woman. Based on this information, he decides on the type of delivery recommended for this woman. Indications for a planned caesarean section can be both on the part of the mother and on the part of the fetus.

These include the following states:

From the mother's side:

Placenta previa, which is confirmed by ultrasound after the 36th week of pregnancy (the edge of the placenta is less than 2 cm from the internal os);

A scar on the uterus in the presence of contraindications to subsequent vaginal delivery:

The presence of any contraindications to vaginal delivery;
Previous corporal CS;
Previous T and J-shaped incision on the uterus;
History of uterine rupture;
Any previous reconstructive operations on the uterus, resection of the uterine angle, hysterotomy, myomectomy with a history of penetration into the uterine cavity, laparoscopic myomectomy in the absence of uterine suturing with modern suture materials;
More than one CS in history. As an exception, vaginal delivery is allowed in women who have undergone 2 CSs, if there is at least one vaginal delivery in history;
A woman's refusal to attempt vaginal delivery;

HIV-infected women:

women taking three antiretroviral drugs and having a viral load of more than 50 copies per 1 ml;
women taking zadovudine monotherapy;
Women infected with HIV and hepatitis C at the same time.

in such cases, the CS is indicated for a period of 38 obstetric weeks, before the rupture of the membranes;

The appearance of genital herpes for the first time 6 or less weeks before delivery;

The presence of extragenital pathologies (the diagnosis must be established or confirmed by a specialized doctor):

on the part of the cardiovascular system - arterial hypertension of the III degree, coarctation of the aorta (without surgical correction of the defect), aneurysm of the aorta or other large artery, systolic dysfunction of the left ventricle with ejection fraction
ophthalmic - hemorrhagic form of retinopathy, perforated corneal ulcer, wound of the eyeball with penetration, "fresh" burn. Other pathologies of the organs of vision are not an indication for CS;
pulmonological, gastroenterological, neurological pathologies in which the attending physician recommends childbirth by CS;
Tumors of the pelvic organs or the consequences of a pelvic injury that prevent the birth of a child;
Cervical cancer;
Conditions after rupture of the perineum III degree or plastic surgery on the perineum;
Conditions after surgical treatment of urogenital and enterogenital fistulas;

From the side of the fetus:

Breech presentation of the fetus after the 36th week;
Breech presentation or incorrect position of the fetus in multiple pregnancies;
Transverse presentation of the fetus;
Monoamniotic twins;
Syndrome of growth retardation of one of the fetuses in multiple pregnancies;
Gastroschisis, diaphragmatic hernia, spina bifida, teratoma in the fetus, fusion of twins - subject to the possibility of providing prompt assistance to a newborn child;

COP at the request of a woman in the absence of the above indications is not carried out. There are discussions about this in medicine. On the one hand, women want to decide on their own how to give birth to a child, and on the other hand, a caesarean section is an operation and is associated with many risks for the mother and fetus. If a woman refuses the indicated operation, she must sign an informed refusal with her own hand.

Scheduled caesarean section

Elective CS is performed after the full obstetric 39 weeks of pregnancy. This is due to the minimization of respiratory distress syndrome (RDS) in the newborn.

In the case of multiple pregnancies, elective CS is performed after 38 weeks.

In order to prevent vertical transmission of the disease in case of HIV infection of the mother - at 38 weeks of pregnancy, before the discharge of amniotic fluid or before the onset of labor.

In case of monoamniotic twins, the operation of the CS should be performed at a period of 32 weeks after the prevention of fetal RDS (special injections are made to help open the lungs).

www.babyplan.ru

When is a planned caesarean?

As you know, a caesarean section is nothing more than a surgical intervention, during which the fetus is removed from the mother's womb using an incision in the anterior abdominal wall and uterus. The decision to conduct such a planned operation is made depending on the presence of indications that do not allow natural childbirth.

At what gestational age is a planned caesarean section performed and what are its advantages?

With this kind of surgery, the likelihood of uterine rupture is sharply reduced. Besides? various kinds of complications observed during vaginal delivery during cesarean are less common. The operation also reduces the risk of uterine prolapse, which prevents heavy, uterine bleeding during childbirth.

If we talk about how long a planned cesarean is done, then this is most often 39 weeks. The thing is that it is by this time that a substance such as a surfactant begins to be produced in the body of the fetus, which contributes to the opening of the lungs at the first breath of the baby. If the operation is performed earlier than the specified period, the baby needs artificial ventilation of the lungs.

Who is scheduled for a planned caesarean?

This kind of surgery is not always prescribed. The main indications for its implementation are:

features of the anatomical structure (narrow pelvis);
the presence of mechanical obstacles to childbirth in a natural way (myoma, bone deformities, tumor);
having had a caesarean section in the past.

As for the last point, earlier, if a woman had already had a birth by caesarean section, then the subsequent ones were also carried out. Today, if there is a dense scar on the uterus, childbirth can also be carried out through natural routes. However, a repeated caesarean section is mandatory in the presence of such complications as a vertical incision of the uterus, uterine rupture, violation of placenta or fetus previa.

If we talk about how long the second planned cesarean is done, then usually it is the same as with the first - 39 weeks. However, if there is a risk of complications, it can be carried out earlier.

Why is a caesarean section dangerous?

Like any surgical intervention, caesarean section is associated with the development of certain risks of complications. These primarily include:

the development of adhesions and scars, which subsequently fasten together the organs located in the small pelvis and the muscles of the abdominal wall. This is accompanied by unpleasant sensations, discomfort;
violation of placenta previa in subsequent births.
accreted placenta. This complication occurs when the placenta cannot detach itself from the uterine wall. Therefore, manual separation is required, which is accompanied by severe bleeding. This kind of violation is observed in cases where a woman has already had 3 or more cesarean deliveries in the past.

How is the recovery period after a caesarean section?

The first day after the operation, the woman is under the supervision of doctors in the postpartum ward. Pain medications are prescribed for several days after the operation. At the same time, special attention is paid to the condition of the uterus, observing its contractility.

The sutures placed on the anterior abdominal wall are treated daily with antiseptic solutions, and then removed for 7-10 days. In the absence of complications in the mother, and if the baby does not have any disorders and was born completely healthy, discharge home occurs a week after the caesarean section.

Thus, doctors determine the choice of the period at which it is better to do a planned cesarean, based on the condition of the fetus and the pregnant woman. In the absence of any risks, such an operation can be performed with the onset of the first contractions in a pregnant woman.

womanadvice.ru

How is a cesarean section performed? - Sharmani.ru

How is the operation

An anesthetic is applied before a caesarean section is performed. As a rule, this is local anesthesia by epidural or spinal blockade. At the same time, the woman in labor remains completely conscious, local anesthesia affects only the lower part of the body, causing a feeling of numbness and blocking pain.

After anesthesia, the surgeon makes two incisions - an incision in the abdominal wall and an incision in the uterus. In most cases, these incisions are transverse (horizontal). With such incisions, there is minimal blood loss and a lower risk of postpartum infection, scars from transverse incisions heal well and leave strong scars. A longitudinal incision (from the womb to the navel) is made extremely rarely. The abdominal muscles during a "caesarean section" are not cut, but only pushed apart.

After that, the doctor sucks amniotic fluid from the uterus, removes the baby, separates and removes the placenta, and begins to sew up the incisions. The uterus and abdominal cavity are sutured with dissolvable surgical suture. The skin is also connected with a thread or metal brackets, which are removed before discharge from the hospital.

How long does a caesarean section take?

The date of "caesarean section" is set individually, after examination of the woman in labor. When setting deadlines, pay attention to:

child's weight;
the condition of the lungs, the child's ability to breathe independently;
the degree of aging of the placenta;
is there an entanglement of the fetus with the umbilical cord;
the state of health of the woman in labor - the presence of high blood pressure, kidney function.

At what time is a planned "caesarean section" done?

A planned cesarean section operation, if there is no threat to the child and mother, is usually done in late pregnancy. Most often this happens at the 39-40th week.

"Caesarean section" with breech presentation

Breech presentation of the fetus is one of the most common indications for a caesarean section.

Natural birth of a fetus in a breech presentation is classified as pathological. At the same time, approximately 40% of them are successful - with proper attention to the woman in labor.

Without fail, a "caesarean section" is prescribed for posterior breech presentation, foot presentation, or a tilted fetal head. With this arrangement of the child, the woman in labor is usually prescribed prenatal hospitalization, approximately at the 37th week of pregnancy. This is done in order to conduct a comprehensive examination and decide on the correct delivery.

How to behave after a "caesarean section"?

Getting out of bed after a "caesarean section" occurs, the woman in labor can be six hours later. Active movement is allowed after you are discharged from the intensive care unit. After the operation, wear a special bandage for several days to facilitate movement.

For some time you will feel dizzy, weak, get tired quickly. This is a completely normal condition, it will pass as soon as the body recovers. They are usually discharged from the hospital a week after the "caesarean section".

At home, there are also some restrictions. For example, you can take a bath only one and a half months after the operation, before that you will have to limit yourself to a shower. Sexual intercourse can be resumed after six weeks, but only after consulting a doctor. Try to rest more, avoid serious loads.

charmani.ru

Cesarean section | Growing family - pregnancy, childbirth, household

If there is only one relative indication, then in many cases natural childbirth is possible, and a caesarean section is performed, as a rule, if there are several relative indications.

Contraindications for caesarean section

After Kasarev section, inflammatory processes may occur, therefore, factors contributing to the development of inflammation may be a relative contraindication to surgery:

acute bacterial and viral diseases, a long anhydrous period, the duration of labor for more than 14 hours, immunodeficiency states.

An absolute contraindication to caesarean section may be a violation of blood clotting and intrauterine fetal death.

The progress of the caesarean section

A caesarean section is done through a corporal incision or through an incision in the lower uterine segment. The corporal incision runs vertically from the umbilicus to the womb along the midline of the abdomen. The incision on the uterus passes through the entire body, also vertically. With this method, the muscle fibers of the uterus are irreversibly injured, and significant blood loss occurs, however, this method allows you to get better access to the fetus during the operation. Therefore, a corporal caesarean section is used in emergency cases when childbirth needs to be completed as quickly as possible. This method is also used for delivery up to twenty-eight weeks of pregnancy. In all other cases, an incision is made in the lower uterine segment. With this type of operation, the incision passes along the growth line of the pubic hair, and the incision is also made transverse on the uterus. In this case, blood loss is less, and the uterine fibers are better restored.

Both with a corporal incision and with an incision in the lower uterine segment, the course of the caesarean section is the same: first, the abdominal wall is opened in layers, then the muscle fibers of the uterus are dissected and the fetus is removed. After that, the fetal membranes and the placenta are removed. The entire operation takes about forty minutes. Extraction of the fetus occurs in the first five minutes of the operation, the rest of the time is occupied by suturing the incision on the uterus and layer-by-layer restoration of the integrity of the abdominal wall.

Postoperative period

The first 12-24 hours after a caesarean section, a woman spends under supervision in the intensive care unit. It is desirable to get out of bed on the first day to improve the blood supply to the uterus. From the first days, it is recommended to wear a postpartum bandage, although in maternity hospitals, the stomach is often pulled in with a diaper instead. This reduces pain. In addition, the first days the woman is given painkillers. If the sutures were applied with non-absorbable threads, then they are removed on the sixth - seventh day. Discharged on the eighth - tenth day, provided that the postoperative period was uneventful.

Caesarea

Several factors affect the baby during a caesarean section:

general anesthesia drugs enter the bloodstream of the fetus,
fluid is not squeezed out of the lungs, since there is no compression of the chest in the birth canal,
with a planned caesarean section, the child leaves the womb when the doctors decide, and not himself.

Children born by caesarean section are more likely to have problems with the respiratory system, and muscle hypertonicity is often observed. Therefore, in the first year of life, such cesareans need to be monitored by a neuropathologist, swimming and massage are desirable. Although, recently, almost all adverse factors of the effect of caesarean section on the fetus have been taken into account by doctors and neutralized during childbirth: anesthesia is often done epidural rather than general, so drugs do not get to the fetus, fluid is squeezed out of the lungs, and the operation is performed with generic naal activities. Subject to all these conditions, children after caesarean section do not differ from babies born through the natural birth canal.

Pregnancy after caesarean section

How the next pregnancy will proceed after a caesarean section largely depends on how the scar on the uterus was formed. If there was inflammation in the postoperative period, then the scar may be insolvent, that is, unable to withstand stretching during the next pregnancy.

It is recommended to take a break between caesarean and subsequent pregnancy at two years. But if you have become pregnant before, you should not worry too much. There are many examples of women giving birth normally, becoming pregnant 3-4 months after a caesarean section. An abortion after a caesarean section can be much more dangerous than a second pregnancy, since there is a direct rough mechanical effect in the area of the scar.

After a caesarean section, vaginal delivery is possible in the absence of indications for a second operation, a full-fledged scar on the uterus and the obligatory desire of a woman to give birth on her own.

Sterilization after caesarean section

A woman is not recommended to have more than three caesarean sections, but some have had eight or ten such operations! Therefore, the doctor, before the third caesarean section, or even before the second or first, if there are any contraindications to subsequent pregnancies, may suggest sterilization along with the operation - the creation of artificial obstruction of the fallopian tubes. However, the decision is made only by the woman, and sterilization without her consent cannot be carried out.

Caesarean section at the request of the woman

Now many women, not wanting to "suffer in childbirth," ask for a caesarean section if they wish. This is not a good idea, since a caesarean is an abdominal operation. This operation can have negative consequences for both the mother and the fetus, although they happen extremely rarely, so it should be carried out strictly according to indications and only in cases where natural childbirth is impossible or too dangerous.

www.2007ya.ru

At what time is the second (third) planned caesarean usually done? Pregnancy and childbirth. Conferences on 7ya.ru

But I don’t know))))) usually at 38, but I don’t know))))) usually they put me at 38, but a lot depends on the seam ... my second one herself asked to be released before the hospitalization period - it was again EXA with this B has not yet gone to the RD .... 02/22/2012 23:16:13, GerberA