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El parto por cesárea que pasa a través de una incisión en la pared abdominal y el útero en lugar de a través de la vagina. Ha habido un aumento gradual de los partos por cesárea en los últimos 30 años. En noviembre de 2005, los Centros para el Control y la Prevención de Enfermedades (CDC) informaron de la tasa de nacimientos por cesárea nacional a 29,1% , que fue la tasa más alta jamás registrado involucrando más de una cuarta parte de todos los nacimientos.
Esto significa que más que 1 en 4 mujeres son propensos a experimentar un parto por cesárea.
El procedimiento por cesárea normal promedia 45 minutos a una hora. El bebé se entrega generalmente en los primeros 5-15 minutos con el tiempo restante utilizado para cerrando la incisión.
Antes de la cirugía, se le dará una anestesia general, espinal o epidural) si ya no se le ha dado uno antes en su trabajo de parto. La anestesia general está normalmente sólo utilizado para las cesáreas de emergencia, ya que funciona de forma rápida y la madre está sedado.
La anestesia espinal y epidural adormecerá la área del abdomen a debajo de la cintura (a veces las piernas pueden ser entumecidas también), por lo que nada se puede sentir durante el procedimiento. En este procedimiento probablemente recibirá un catéter para recoger la orina, mientras que su parte inferior del cuerpo es entumecida.
El médico hará una incisión en la pared del abdomen primero. En una cesárea de emergencia esto más probable será una incisión vertical (desde el ombligo hasta el pubis) que permitirá el médico asistir con el parto del bebé más rápido.
La incisión más común se hace horizontalmente (a menudo llamado un corte bikini ), justo encima del hueso púbico. No se cortan los músculos de su estómago. Estarán separado para que el médico puede tener acceso al útero.
Una incisión estará hecho entonces el útero, horizontalmente o verticalmente. El mismo tipo de incisión no tiene que estar realizado en ambos el abdomen y el útero. La incisión clásica hecho verticalmente, usualmente está reservado por situaciones complicadas, como placenta previa, emergencias, o para los bebés con anormalidades.
Un parto vaginal después de una cesárea (PVDC) no se recomienda para las mujeres con la incisión clásica . Otro tipo de incisión que raramente se utiliza es la incisión vertical del segmento inferior. Esto sólo se utilizaría en aquellos casos donde los problemas con el útero no permitirían otro tipo de incisión estar hecho.
La incisión más común es la incisión transversal baja. Esta incisión tiene menos riesgos y complicaciones que los otros y permite la mayoría de las mujeres para intentar un parto vaginal en su siguiente embarazo con poco riesgo de ruptura uterina.
El médico luego succionará el líquido amniótico y pues asiste con el parto del bebé. La cabeza del bebé se entregará primero para que la boca y la nariz se pueden limpiar para que pueda respirar. Una vez que todo el cuerpo se entrega, el médico levantará y le mostrará su bebé.
La mayoría de los proveedores de atención médica luego pasará el bebé a la enfermera para su evaluación. Por último, la placenta se entregará (usted puede sentir algún tirón), después de que el equipo quirúrgico se iniciará el proceso de cerrar.
Después de la cirugía, usted puede comenzar a experimentar algunas náuseas y temblor. Esto puede estar provocado por la anestesia, por los efectos de la contracción del útero o de una adrenalina disminución. Estos síntomas por lo general pasan rápidamente y pueden estar seguido por somnolencia.
ISi su bebé está sano, esto es normalmente cuando el bebé pueda descansar en su pecho y se puede iniciar la lactancia materna y la vinculación. Usted y su bebé estará continuamente monitoreado para cualquier complicación potencial.
Cuando le den el alta del hospital, se le informará sobre el cuidado postoperatorio adecuado para la incisión y usted mismo.
Última actualización: 08/2015
Compilado utilizando la información de las siguientes fuentes:
William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 25.
Coalition for Improving Maternity Services (CIMS), www.motherfriendly.org
Centers for Disease Control and Prevention, www.cdc.gov
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Ultrasound
After any surgical intervention, there is a risk of infection, inflammation and other complications, so ultrasound of the uterus after cesarean section is always done.
The specialist diagnoses a few clots in the area being examined, which remain in the uterine cavity after a cesarean section and are clearly visible on ultrasound. Over time, clots descend to the bottom of the organ. The examination is carried out in the first few days after childbirth and during the entire recovery period.
Ultrasound of the uterus after childbirth, especially if there was a caesarean section, helps specialists monitor the condition of the internal organs of a woman. Having identified deviations from the normal course of recovery in time, the doctor can prescribe a course of treatment.
In addition, during surgery, a scar from the suture may remain on the inner surface of the uterus, which will affect subsequent births. Therefore, experts recommend that it is mandatory to do an ultrasound of the scar on the uterus after a cesarean section.
The uterus is large and has an injured inner surface. Over time, there is a process of healing and reduction. Ultrasound captures a decrease in the size and weight of the uterus, however, after a cesarean section, the process is slower and is accompanied by postpartum discharge.
It is important for a specialist to monitor the state of internal organs after surgery and stimulate the speed of their recovery with the help of medications, if necessary. Therefore, regular ultrasound of the uterus is especially important after a caesarean section.
Ultrasound of the uterus, even after a cesarean section, does not require special preparation. It is enough for the patient to take a horizontal position, the specialist does the rest. The procedure lasts no more than 15 minutes and does not cause discomfort.
Most often, the examination is carried out on the first day after childbirth by the transabdominal method , that is, through the abdominal wall. Ultrasound of the uterus in a transvaginal way is performed after a caesarean section, when a specialist needs to determine the condition of the cervix. Then the sensor is inserted into the vagina. The question of when to conduct an ultrasound of the uterus after a cesarean section and how to do an examination, the specialist decides based on an analysis of the patient’s condition.
The recovery period can last up to 6 weeks after delivery. In a month and a half, the organs of the reproductive system involute – they return to the state before childbirth. The process can be complicated, so the size of the uterus, shape and other important changes after a caesarean section should be monitored by an ultrasound specialist.
By the end of the 3rd day, the shape of the uterus should become round. In the future, changes in the contours on ultrasound of the uterus will be more and more noticeable, by the 5th day after cesarean section, it should become oval. In a normal postpartum recovery, the uterus will be pear-shaped after a week.
Another important indicator of normal involution is the position of the uterus. On the 4th day, she occupies a position between the navel and the pubis. On the ultrasound of the uterus, made on the 9th day after the caesarean section, it will be higher than the womb.
Normally, a decrease in the ultrasound of the uterus is more and more noticeable every day after a cesarean section. On the 2nd day, its normal length and width will be 13.6-14.4 cm and 13.3-13.9 cm, respectively. On ultrasound of the uterus on the 4th day after cesarean section, it should normally be 11.5-12.5 cm long and 11.1-11.9 cm wide. On the 8th day, it should not exceed 10.6 cm in length and 10.5 cm in width.
On ultrasound, it is possible to determine the weight of the uterus, every day after a cesarean section, it should decrease. On the 7th day, the organ should weigh 500-600 g, after two weeks – 350 g. On the 3rd week, the normal weight for the uterus is 200 g, and after six weeks – 60 g.
Clots on ultrasound of the uterus immediately after cesarean section are concentrated in the upper sections. With normal recovery, after seven days, the clots should become smaller, they should shift down.
If clots on ultrasound of the uterus continue to appear for a long time after a cesarean section, an inflammatory process has most likely begun. Then the uterus will contract more slowly than it should, and its internal cavity will be deformed and expanded.
Immediately after surgery, constant monitoring is required. Specialists look after the patient’s standing and carefully monitor the amount and nature of discharge from the uterus. In the first 5-7 days, they resemble discharge during menstruation, but are more abundant (up to 500 ml). Usually the discharge is red and contains clots.
Over time, the number of lochia decreases, their color becomes darker. By 4-5 weeks they become very small. The color of the discharge is dark. The process of restoration of the uterine mucosa ends by 6-8 weeks. By this time, the discharge should not differ from the discharge before pregnancy.
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With the help of an emergency caesarean section, a baby is born in a situation where childbirth cannot be quickly resolved through the natural birth canal without harm to mother and child. On the part of the mother, indications for surgery are cases when, due to a particular disease, childbirth poses a threat to her health, and with indications from the fetus, cases when the birth act is a burden for him, which can lead to birth trauma, birth in asphyxia ( state of acute oxygen deficiency).
This occurs in the following situations.
Clinically narrow pelvis. In this case, with normal dimensions of the pelvis, which were determined during pregnancy, at the time of delivery, it turns out that the internal dimensions of the pelvis do not correspond to the dimensions of the fetal head. This is found out when the contractions are already in full swing, the cervix has dilated, but the head, despite good labor activity and attempts that have already begun, does not move along the birth canal. This is possible in cases where the size of the fetal head is large relative to the size of the bone pelvis:
If a clinically narrow pelvis is suspected, the woman is observed for an hour: if the head does not advance, a caesarean section is performed.
Premature rupture of amniotic fluid and lack of effect from labor induction. Normally, amniotic fluid is poured out at the end of the first stage of labor, i.e., when the cervix is already open. In the case when the waters poured out before the onset of contractions, they speak of premature rupture of amniotic fluid. Further events can develop according to different scenarios. Along with the outpouring of water, regular labor activity can begin, but it also happens that contractions do not begin. Then the methods of artificial labor induction are used, for this purpose PROSTAGLANDINS AND OXYTOCIN are administered intravenously – drugs that contribute to the onset of labor. This is necessary because after the opening of the fetal bladder, the fetus is no longer protected from the penetration of infection by the membranes and cannot be in the uterine cavity for more than 24 hours after the outflow of amniotic fluid, as this is fraught with the development of infectious and inflammatory complications, both in the mother and in fetus. If, under the influence of drugs, labor activity does not begin, then a caesarean section is performed.
Anomalies in the development of labor, not amenable to drug therapy. These most often include the weakness of labor activity. At the same time, the strength of the contractions is insufficient, the contractions are not long. The main reasons leading to weakness of labor activity are as follows:
For the treatment of weakness in labor, drugs are used that are administered intravenously using a dropper. When using these drugs, the doctor examines the woman in labor at certain intervals, observes the speed at which the cervix opens. If the uterus does not respond to the administered drugs, then they say that rhodostimulation is ineffective. In this case, you also have to resort to operative delivery.
Acute fetal hypoxia. During childbirth, the condition of the fetus is monitored as carefully as the health of the mother. How the baby feels can be judged by several indicators. The first is the fetal heart rate. Normally, the baby’s heart beats at a frequency of 140 – 160 beats per minute, during a contraction, the heartbeat quickens to 180 beats per minute. The heartbeat of the fetus during childbirth is recorded using a special device – a heart monitor and recorded on tape. The doctor can also determine the fetal heart rate with a stethoscope. A deviation in the fetal heartbeat may indicate that the baby does not have enough oxygen. Another indicator of the baby’s condition is the nature of the amniotic fluid. Normally the water is clear. When the color of the water changes during childbirth from light green to dark brown, one can also talk about the occurrence of acute oxygen deficiency. The change in the nature of the amniotic fluid is due to the appearance of the original feces – meconium.
In case of acute fetal hypoxia, when the condition of the baby deteriorates sharply during childbirth, the immediate completion of labor is required, since in conditions of oxygen deficiency the fetus will die inside the uterus.
Placental abruption. Violation of the connection between the placenta and the uterine wall is accompanied by bleeding, which adversely affects both the condition of the woman and the condition of the fetus. The root cause of premature abruption of the placenta is not always possible to establish. This can be caused by both mechanical trauma during a blow and a fall, as well as diseases of various organs and systems (hypertension, kidney disease, etc. ), anomalies in the development of the uterus, polyhydramnios, multiple pregnancies, and a short umbilical cord. Other reasons are possible.
Placental abruption causes bleeding. Depending on how the placenta exfoliates – from the edge or in the center, blood may leak out or accumulate between the placenta and the wall of the uterus. In any case, due to blood loss, the condition of both the mother and the baby quickly and progressively worsens. To avoid negative consequences, it is necessary to immediately end the birth by surgery.
Threatening or incipient uterine rupture. Uterine rupture is an extremely rare injury. This condition can be caused by a discrepancy between the size of the fetus and the mother’s pelvis (clinically narrow pelvis), as well as previous operations (caesarean section, operations to remove myomatous nodes). The contractions become frequent, very painful, the pain in the lower abdomen becomes permanent, the uterus does not relax between contractions. With the completed rupture in the mother and fetus, signs of acute blood loss are determined. In this case, only a timely operation can save the life of the mother and fetus.
Presentation and prolapse of the umbilical cord. There are cases where the umbilical cord loops are in front of the head or pelvic end of the fetus, that is, they will be born first, or the umbilical cord loops fall out before the birth of the head. This can occur with polyhydramnios. This leads to the fact that the loops of the umbilical cord are pressed against the walls of the pelvis by the head of the fetus, blood circulation between the placenta and the fetus stops. This situation also requires immediate surgical intervention.
Severe preeclampsia. Preeclampsia is a pathology of the second half of pregnancy, which is characterized by an increase in blood pressure, a violation of the kidneys, which is expressed in the appearance of protein in the urine, as well as the presence of edema. The operation is performed with a persistent increase in blood pressure during childbirth to high numbers, which is not regulated by medication, as well as with the progression of the disease, which is expressed by the appearance of seizures. In this case, there is a spasm of the vessels of the pregnant woman, including the vessels that feed the placenta.
Emergency surgery requires minimal preparation. First, hygienic treatment is performed. If the pregnant woman ate a few hours before the operation, then the stomach is washed and the probe is left in the stomach to avoid bronchospasm from getting vomit into the respiratory tract. The patient is administered sedative drugs intravenously, which has a positive effect on her psychological state, and also accelerates and deepens the action of the anesthetic that will be administered during anesthesia. Empty the bladder. To perform a caesarean section, the consent of the mother to the operation is required, which is reflected in the history of childbirth even in emergency situations.
Pain relief during an emergency caesarean section . Since the current situation requires a speedy resolution, methods of anesthesia are used that can be implemented as soon as possible. That is why for pain relief during emergency caesarean section operations, the so-called GENERAL ANESTHESIA is used more often than during planned operations. At the same time, the woman is in an unconscious state, an apparatus for artificial respiration is used.
Since epidural anesthesia takes 15 to 30 minutes to relieve pain, in emergency operations this method of anesthesia is used only when the catheter has been inserted into the space above the dura mater, even during childbirth. In this case, the woman remains conscious.
SPINAL ANESTHESIA may be used during emergency surgery. With this method, as with epidural anesthesia, an injection is made in the back in the lumbar region, the anesthetic is injected into the spinal space. Anesthesia begins to work within the first 5 minutes, which allows you to quickly start the operation.