What is a Caesarean Section?

Cesarean section is an important operation in the field of obstetrics. Due to advances in anesthesia, blood transfusion, infusion, hydropower balance knowledge, and improvements in surgical methods, surgical suture materials, and control of infections, cesarean section has become an effective solution to dystocia and certain obstetric complications, saving the lives of women and perinatal infants means.

Zhao Yan	Deputy Chief Physician	Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University
Huangling	Attending physician	Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University
That all	Attending physician	Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University

Introduction to cesarean section

Cesarean section is an important operation in the field of obstetrics. The first live cesarean section occurred in 1610, when surgeons Trautmann and Gusth first performed a cesarean section on the woman, but the woman died 25 days after the operation.

Transvaginal delivery is a natural and physiological way to deliver. Maternal women can recover quickly after delivery, and newborns can better adapt to the external environment. Caesarean section is an operation to remove the fetus through an abdominal incision.

The cesarean section's intraoperative bleeding, postoperative thrombosis rate, and the risk of placenta previa and uterine rupture during pregnancy are much higher than those of vaginal delivery. At the same time, cesarean section newborns have abnormal respiratory function and amblyopia. Higher than vaginal delivery newborns, its resistance is much lower than vaginal delivery newborns. Cesarean section without medical indications can not only reduce the perinatal mortality, but also increase the morbidity and maternal mortality after cesarean section. Therefore, it is not advisable to perform cesarean section without medical indications ^[1] .

Cesarean section indications

Cesarean dystocia

(1) The pelvis is not called: it refers to the narrow plane of the pelvic entrance. In layman's terms, it means that the fetus is too large relative to the pelvic entrance of the mother.

Among them, "absolute pelvic pelvis" occurs when the pelvis of the pregnant woman is significantly narrowed or deformed, or the fetus is significantly too large. Full-term live births of this type of pregnant women cannot be "into the pelvis" and cannot be delivered via the vagina. A full-term pregnancy requires a cesarean section with clear evidence and easy decisions. However, there are fewer clinical "absolute pelvic disproportions" and more common are "relative pelvic disproportions". Pregnant women with "absolute cephalopelvic disproportion" are expected to have a small fetal weight, good fetal tolerability, and sufficient birth and fertility to try vaginal delivery.

However, because the current methods of measuring the internal diameter of the fetus and pelvis during pregnancy are mostly "estimated", and the delivery process is a multi-plane fetal body and multi-path lines through the birth canal (such as shoulder dystocia: after the fetal head is delivered, the fetal shoulder is stuck in the pelvis It is impossible to deliver at the exit), so before delivery, it is impossible to ensure whether these "relative pelvis" pregnant women can finally vaginal delivery, and it is impossible to accurately predict the delivery process.

(2) Abnormal birth canal or soft birth canal: Abnormal birth canal, such as pregnant women with fractured tailbone, may cause the tailbone to tip up, narrowing the effective birth canal. Abnormal soft birth canal, such as severe vaginal malformations, scar stenosis, etc., or pregnancy with rectal or pelvic benign and malignant tumor obstruction of the birth canal. In these cases, even if a perineal incision is performed, it is estimated that a full-term fetus cannot pass through the birth canal, and it is better to perform a cesarean section.

(3) Abnormal fetal or fetal position: for example, some buttocks, lateral positions, abnormal head positions (high upright position, forehead position, posterior condyle position, etc.) are not suitable for vaginal delivery. There are also some cases of twins and multiple births (the first twin of the twin is breech, horizontal, or conjoined twins, etc.), and it is not suitable for vaginal delivery. In addition, some correctable fetal abnormalities, the fetus cannot tolerate the delivery process, or some abnormalities of the fetus can not pass through the birth canal, cesarean section should be performed.

(4) Umbilical cord prolapse: In some pregnant women whose fetal membranes have been broken, the fetal umbilical cord protrudes out of the cervix and enters the vagina, even outside the vagina. At this time, the cervix, fetal exposed part, etc. squeeze the umbilical cord, the fetus may quickly develop intrauterine distress, or even stillbirth. Therefore, once umbilical cord prolapse is found, the fetal heart still exists, and the fetus should be delivered within a few minutes.

(5) Fetal distress: refers to hypoxia in the fetus, which causes fetal acidosis and damage to the nervous system. In severe cases, there can be sequelae and even fetal death, which is a common obstetric complication. In this case, if vaginal delivery is not possible in the short term, a cesarean section should be performed immediately.

(6) History of cesarean section: prone to uterine rupture or threatened uterine rupture,

Cesarean pregnancy complications

Such as severe preeclampsia, eclampsia, placenta previa, placental abruption and so on.

Cesarean pregnancy complications

For example, some uterine fibroids and ovarian tumors. Certain medical and surgical diseases, such as heart disease, diabetes, kidney disease, etc. Certain infectious diseases, such as pregnancy with genital warts or gonorrhea.

Precious children of cesarean section

This is a relative indication for cesarean section. Maternal older, many years of infertility, multiple pregnancy failures, precious fetus, etc. ^[2] .

Preparing for cesarean section

1. Prepare blood

2. Penicillin test

3. Indwelling catheterization

4. Preoperative psychological nursing

Treatment after cesarean section

1. Antibiotics prevent infection of conventional cephalosporins, and can be breast-fed for 24 hours after using the drug. For some special drugs, consult your doctor.

2.Protocol contraction treatment

3, as early as possible to prevent adhesions

Observe the postpartum bleeding and pay attention to the uterine restoration.