Some pathologies of mother and child can affect natural history childbirth or cause death of the mother and fetus. To avoid severe consequences, gynecologists have developed indications for caesarean section.

This list is divided into absolute and relative indications.

Absolute - these are those in which a woman cannot give birth without surgical intervention.

Relative - all reasons in which childbirth occurs with complications and threatens the death or injury of the child. Most often, Caesarean sections are performed when there are relative indications in favor of the baby.

Caesarean section is a surgical abdominal operation. The purpose of which is the birth of a child, preserving the life and health of mother and baby.

Absolute maternal and fetal indications

Mandatory indications identified in a woman in labor:

• anatomically;
• early with normal location;
• full ;
• bleeding with incomplete presentation;
• heavy and;
• scarring of the tissues of the pelvis, vagina, walls of the uterus, cervix, pelvic organs, fistulas of the genitals and intestines.

From the fetus:

• transverse, oblique, pelvic presentation;
• incorrect entry of the head into the birth canal;
• umbilical cord prolapse;
• acute oxygen starvation;
• near-death condition or death of a woman in labor.

Relative indications from mother and fetus

On the part of the pregnant woman:

• clinically narrowed pelvis;
• gestosis, which continues from the 20th week of pregnancy and is difficult to treat;
• extragenital diseases, which during natural delivery will lead to a significant deterioration in health;
• weak, pathological birth process;
• genitals;
• post-term pregnancy;
• , especially for those giving birth for the first time.

From the fetus:

• chronic between the fetus and placenta;
• early in the breech or the age of a primigravida over 30 years;
• weight more than 4 kg.

Indications for cesarean section according to vision relate to relative indications from mother's side:

• fundus dystrophy;
• eye injury;
• undergone surgery due to retinal detachment;
• myopia;
• severe myopia of minus seven diopters or more.

Indications for caesarean section by age are also relative. Depends on general condition women in labor and the course of pregnancy.

Indications for emergency surgery

Caesarean sections are usually planned in advance. But sometimes situations arise in which it is the only way to save the life of the mother and baby.

This is an operation for life-saving reasons:

• the head is too large for the pelvis, detection of pathology during childbirth;
• early effusion amniotic fluid in the absence of labor;
• weak birth uterus even after ;
• placental abruption during childbirth;
• the threat of uterine rupture or the beginning of a rupture - with such an injury severe bleeding occurs;
• loss of umbilical cord loops and blocking of their head;
• fetal hypoxia, threatening its death;
• gestosis of a pregnant woman, emerging renal failure.

Caesarean without indication

A caesarean section is an abdominal operation in which the peritoneum is opened. It is associated with many dangers during the postoperative period. During surgery, there are difficulties with selecting anesthesia, especially during emergency caesarean.

Complications also occur in the form of bleeding and injuries to internal organs located near the uterus.

TO surgical complications refers to the discrepancy between the baby’s head or body and the incision made.

The anesthesia administered to the mother somehow penetrates to the baby and has a toxic effect on him.

The postoperative period has its complications. At abdominal operations exists:

• high risk of infection in abdominal cavity and infection of internal organs;
• bleeding inside the peritoneum;
• rejection suture material, divergence of seams, and others.

The postoperative period is accompanied severe pain. Anesthesia harms the child, and more weak drugs don't help the mother.

Abdominal operations also have a postoperative complication in the form of adhesions - the appearance connective tissue merging internal organs with the walls of the peritoneum.

They interfere with traffic fallopian tubes and intestines. As a result, secondary infertility and diseases of the digestive system develop.

A baby born by Caesarean section is not burdened with the mother’s microflora and does not develop immunity immediately after birth. He does not experience a pressure difference during the passage of the birth canal, which is designed to launch his vital processes.

During natural delivery, the child passes through the narrow birth canal and at the same time is involved in the work:

• his lungs, kidneys;
• digestive and nervous systems;
• second circle of blood circulation;
• the opening between the atria closes.

Caesarean section is not alternative way birth of a baby, but an operation designed to save the life of mother and child. It is not carried out without evidence. The decision to undergo surgery natural process accepted by the doctor.

How is the operation performed?

Usually one week before the intended operation you are hospitalized. In a hospital setting, she is examined and the blood vessels of the pregnant woman, placenta, and fetus are examined.

At this stage, the woman will need help from her family.

Contraindications for surgery

With complete placenta previa and an anatomically narrow pelvis, refusal of a cesarean section means the death of the child and the woman in labor.

Refusal to undergo surgical intervention can only be justified high risk purulent complications and sepsis in the postoperative period.

Typically, such complications occur if the patient has an acute inflammatory disease— , endometritis, .

Also to relative contraindications Caesar's is considered:

• prolonged labor - longer than a day;
• departure amniotic fluid more than 12 hours ago;
• frequent vaginal examinations;
• failed attempts at delivery;
• death of a child in the womb, severe pathologies of the fetus.

Pregnancy after cesarean

The dissection of the peritoneum is carried out between the muscles of the peritoneum along the tendon plate. After healing, a scar remains.

During subsequent pregnancies and childbirth, there is a risk of rupture.

It is prohibited to have more than three pregnancies during a surgical delivery.

Each subsequent excision reduces the area of ​​the uterine body.

A new pregnancy is allowed after 2 years.

Video: indications for caesarean section list

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

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

However, it is worth considering that performing a planned or emergency caesarean section may cause complications and consequences in the distant future. But at the time of the operation, preserving the life of the child and mother plays an important role.

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

When is the operation performed?

Cesarean births can be elective, planned or emergency. At elective surgery appointed her exact date(often a week or two before the expected date of birth) and is carried out if there is normal readings in the mother and fetus, as well as at the first signs of the onset of labor.

A woman often learns about a planned caesarean section during pregnancy (sometimes in the very early stages). But even in this case, childbirth begins naturally and is completed abdominally.

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

• The fetus is alive and can continue to exist in the womb, but to preserve the life of the mother it is removed prematurely;
• The woman must give written consent to the operation;
• IN bladder patients have a catheter installed, since cesarean section is performed only in conditions of an empty bladder;
• The woman in labor has no signs of infection;
• Surgery should only be performed in the operating room with the participation of an experienced obstetric surgeon.

Main indications

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

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

In addition, there is a division of provoking factors into maternal and fetal. Can also be carried out emergency surgery during childbirth or in the last stages of pregnancy.

Absolute readings

Indications for which a cesarean section is mandatory include an extensive list of maternal and fetal factors. These include:

Anatomical narrow pelvis

There are two groups of pelvic narrowing. The first group includes a flat, transversely 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 conjugate is less than 9 centimeters), complications may arise before the labor process:

• Oxygen starvation of the fetus;
• Weak contractions;
• Child infection;
• Early rupture of the amniotic sac;
• Loss of the baby's umbilical cord or limbs.

An anatomical narrow pelvis also provokes the development of complications during the pushing period:

• Secondary weakness of pushing;
• Injuries to the pelvic joints and nerve endings;
• Oxygen starvation of a child;
• Birth injuries and uterine rupture;
• 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 transporting blood, oxygen and nutrients from mother to baby. Normally, the placenta is located on the fundus of the uterus or the posterior or anterior organ of the organ. However, there are cases when the placenta is formed in lower segment uterus and overlaps internal os, 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 covers only part of the internal os. However, even incomplete presentation can cause sudden bleeding. Bleeding especially often begins during childbirth, when the internal os expands, causing gradual bleeding. Caesarean section operation in in this case carried out only when severe loss blood.

Threat or presence of uterine rupture

There are many reasons that can cause uterine rupture: improper management of labor, poor coordination ancestral forces, too much big size fetus If the patient is not promptly provided medical assistance, the uterus may rupture, in which case both the woman and her child die.

Early placental abruption

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

Scars on the uterus (two or more)

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

Failed scar

Sutures on the uterus can appear not only after abdominal delivery, but also after any other surgical manipulations on the internal genital organs. A scar that arose during a complicated postoperative period is considered defective (the woman had heat, skin sutures took too long to heal or endometritis developed). The fullness of the scar can be determined only with the help of ultrasound.

Caesarean section is a surgical operation in which the fetus is removed through an incision in the anterior abdominal wall and uterus.

It is believed that the name of the operation is related to the name of Gaius Julius Caesar, who was removed through an incision in the abdomen. The first reliable report of a caesarean section on a living woman was in 1610. The operation was performed by J. Trautman from Wittenborg. In Russia, the first caesarean section was performed by I. Erasmus in Pernov (1756) and V. M. Richter (1842) in Moscow.

Caesarean section is performed when delivery through the birth canal is impossible or dangerous for the life of the mother and fetus. In Moscow, caesarean sections account for about 15% of all births.
Like any surgical operation, a caesarean section is performed strictly according to indications. They can be on the mother’s side, when childbirth poses a threat to her health, and on the fetus’ side, when the birth process is a burden for him, which can lead to birth trauma and fetal hypoxia. Indications for cesarean section may occur during pregnancy and childbirth.

Indications for caesarean section during pregnancy:

• Placenta previa. The placenta (baby place) is located in the lower part of the uterus and covers the internal os (the entrance to the uterus from the vagina). This threatens 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 occurs.
• Premature detachment normally located placenta. Normally, the placenta separates from the wall of the uterus after the baby is born. Sometimes this happens during pregnancy, then it starts heavy bleeding, which threatens the life of the mother and fetus and requires immediate surgery.
• Inconsistency of the uterine scar after cesarean section or other uterine surgeries. A uterine scar is considered invalid if, according to ultrasound, its thickness is less than 3 mm, its contours are uneven and there are inclusions of connective tissue. Complicated course of the postoperative period after the first operation (fever, inflammation of the uterus, prolonged healing of the suture on the skin) also indicates the failure of the uterine scar
• Two or more scars on the uterus after cesarean sections. It is believed that two or more caesarean sections increase the risk of uterine rupture due to the scar during childbirth. Therefore, a caesarean section is performed before labor begins.
• Anatomically narrow pelvis II - IV degree of narrowing. Every woman has her pelvic size measured during pregnancy. Obstetricians have clear criteria normal sizes pelvis and narrow pelvis according to the degree of narrowing.
• Tumors and deformations of the pelvic bones. They can serve as 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, closing the birth canal.
• Large fruit in combination with other pathology. A fruit is considered large when its weight is 4 kg or more
• Severe symphysitis. Symphysitis or symphysiopathy - discrepancy pubic bones. In this case, severe difficulties and pain appear when walking.
• Multiple fibroids uterus large sizes, nutritional disorders of myomatous nodes.
• Severe forms gestosis and lack of effect from treatment. Preeclampsia is a complication of pregnancy in which vital function is disrupted. important organs, especially vascular system and blood flow. Severe manifestations gestosis - preeclampsia and eclampsia. In this case, microcirculation in the central nervous system is disrupted, which can lead to serious complications for both the mother and the fetus.
• Serious illnesses Diseases of cardio-vascular system with symptoms of decompensation, disease nervous system, diabetes mellitus, myopia high degree with changes in the fundus, etc.)
• Severe cicatricial narrowing of the cervix and vagina. May occur after previous operations or childbirth. This creates insurmountable obstacles to the opening 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 genitourinary and enterogenital fistulas. A fistula is an unnatural connection between two adjacent hollow organs.
• Perineal rupture III in previous births. If during childbirth, in addition to the skin and muscles of the perineum, the sphincter (muscle that locks anus) and/or rectal mucosa, then this is a perineal rupture III degree, a poorly sutured rupture can lead to gas and fecal incontinence.
• Pronounced dilatation of veins in the vaginal area. At spontaneous birth bleeding from such veins can become life-threatening
• Transverse position of the fetus.
• Conjoined twins.
• Breech presentation of the fetus in combination with a fetal weight of more than 3600 g and less than 1500 g, as well as with a narrowing of the pelvis. With a breech presentation, the risk of birth injury during birth of the fetal head increases.
• In vitro fertilization, artificial insemination in the presence of other complications from the mother and fetus.
• Chronic hypoxia fetus, fetal hypotrophy, refractory to drug therapy. In this case, the fetus receives an insufficient amount of oxygen and for it the process of childbirth is a burden that can lead to birth trauma.
• Primiparas over 30 years of age in combination with another pathology.
• Long-term infertility in combination with another pathology.
• Hemolytic disease of the fetus due to unprepared birth canal. When rhesus (less often - group) incompatibility of the blood of mother and fetus develops hemolytic disease fetus - destruction of red blood cells (erythrocytes). The fetus begins to suffer from lack of oxygen and harmful influence erythrocyte breakdown products. If the fetal condition worsens, a caesarean section is performed.
• Diabetes if early delivery is necessary and the birth canal is unprepared.
• Post-term pregnancy with unpreparedness birth canal and in combination with other pathology. The process of childbirth is also a stress that can lead to birth injury to the fetus.
• Cancer of any location.
• Exacerbation of genital herpes. For genital herpes, the indication for cesarean section is the presence of vesicles. herpetic rashes on the external genitalia.

Indications for cesarean section during childbirth:

• Clinically narrow pelvis. This is a discrepancy between the fetal head and the mother's pelvis.
• Premature rupture of amniotic fluid and lack of effect from induction of labor. When water breaks out before contractions begin, they try to induce them with the help of medications (prostaglandins, oxytocin), but this does not always lead to success.
• Anomalies of labor that are not amenable to drug therapy. If weakness or incoordination develops, labor is carried out drug therapy, which also does not always lead to success.
• Acute fetal hypoxia. A sign of acute fetal hypoxia is, first of all, a sharp decrease in the fetal heartbeat, which does not recover.
• Abruption of a normal or low-lying placenta. Normally, the placenta separates from the wall of the uterus after the baby is born. Sometimes this happens during labor, then severe bleeding begins, which threatens the life of the mother and fetus and requires immediate surgery.
• Threatening or incipient uterine rupture. It must be promptly recognized by a doctor, since a delayed operation can lead to fetal death and removal of the uterus.
• Presentation or prolapse of umbilical cord loops. If the umbilical cord prolapses and the fetus is in cephalic presentation, if a caesarean section is not performed within the next few minutes, 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, straight position of the head.

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 a caesarean section, but together they create real threat for the life of the fetus.

For many women, surgery with an incision becomes an inevitable ordeal, for which giving birth through the birth canal is impossible or dangerous for her and her baby. Like any other surgery, caesarean section is performed only for medical reasons.

Indications for surgery can be from the mother, when childbirth poses a threat to her health, and from the fetus, when the birth process is a burden for him, which can lead to birth trauma and fetal hypoxia. They can occur both during pregnancy and 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 place) is located in the lower part of the uterus and covers the internal os (the entrance to the uterus from the vagina). This threatens 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 occurs.
• Premature abruption of a normally located placenta. Normally, the placenta separates from the wall of the uterus after the baby is born. Sometimes this happens during pregnancy, then severe bleeding begins, which threatens the life of the mother and fetus and requires immediate surgery.
• Inconsistency of the uterine scar after an incision in a previous birth or other operations on the uterus.

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

• Two or more scars on the uterus after incision surgery. It is believed that two or more cesareans increase the risk of uterine rupture along the scar during childbirth due to the weakness of the scar tissue. Therefore, the incision is made before labor begins.
• Anatomically narrow pelvis (the so-called anatomical limitation in the size of a woman’s pelvic ring, which makes it difficult for the fetal head to pass through this ring) II-IV degree of narrowing. Every woman has her pelvic size measured during pregnancy. Obstetricians have clear criteria for normal pelvic sizes and a narrow pelvis based on the degree of narrowing. Tumors and deformations of the pelvic bones. They can serve as 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, closing the birth canal.
• Large fetus in combination with another pathology. A fruit is considered large when its weight is 4 kg or more.
• Severe symphysitis. Symphysitis or symphysiopathy is the separation of the pubic bones. In this case, severe difficulties and pain appear when walking.
• Multiple large uterine fibroids, malnutrition of myomatous nodes.
• Severe forms of gestosis and lack of effect from treatment. Preeclampsia is a complication of pregnancy in which the function of vital organs, especially the vascular system and blood flow, is disrupted. Severe manifestations of gestosis are preeclampsia and eclampsia. In this case, microcirculation in the central nervous system is disrupted, 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.
• Severe cicatricial narrowing of the cervix and vagina. May occur after previous operations or childbirth. This creates insurmountable obstacles to the opening 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 genitourinary and enterogenital fistulas. A fistula is an unnatural connection between two adjacent hollow organs.
• III degree perineal rupture in previous births. If during childbirth, in addition to the skin and muscles of the perineum, the sphincter (the muscle that locks the anus) and/or the rectal mucosa is torn, then this is a third-degree perineal rupture; a poorly sutured rupture can lead to incontinence of gases and feces.
• Pronounced dilatation of veins in the vaginal area. During spontaneous childbirth, bleeding from such veins can become life-threatening.
• Transverse position of the fetus.
• Conjoined 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 with a narrowing of the pelvis. With a breech presentation, the risk of birth injury during birth of the fetal head increases.
• In vitro fertilization, artificial insemination in the presence of other complications from the mother and fetus.
• Chronic fetal hypoxia, fetal hypotrophy, refractory to drug therapy. In this case, the fetus receives an insufficient amount of oxygen and for it the process of childbirth is a burden that can lead to birth trauma.
• Primiparas over 30 years of age in combination with another pathology.
• Long-term infertility in combination with another pathology.
• Hemolytic disease of the fetus due to unprepared birth canal. When Rh (less often - group) incompatibility of the blood of mother and fetus develops, 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 red blood cell breakdown products.
• Diabetes mellitus in case of need for early delivery and unprepared birth canal.
• Post-term pregnancy with unprepared birth canal and in combination with other pathology. The process of childbirth is also a stress that can lead to birth injury to the fetus.
• Cancer of any location.
• Exacerbation of genital herpes. For genital herpes, the indication is the presence of blistering herpetic eruptions on the external genitalia. If by the time of childbirth it is not possible to cure a woman of this disease, there is a risk of infection of the fetus (in case of rupture membranes or the passage of the fetus through the birth canal).

In any case, doctors initially try to solve the problem using conservative (i.e. non-surgical) methods. And they resort to surgical intervention only when their attempts did not lead to the desired result.

In addition to the above cases, there are also acute situations that require surgical delivery.

Indications for cesarean section during childbirth:

• Clinically narrow pelvis. This is a discrepancy between the fetal head and the mother's pelvis.
• Premature rupture of amniotic fluid and lack of effect from induction of labor. When water breaks out before contractions begin, they try to induce them with the help of medications (prostaglandins, oxytocin), but this does not always lead to success.
• Anomalies of labor that are not amenable to drug therapy. With the development of weakness or incoordination and labor, drug therapy is carried out, which also does not always lead to success.
• Acute fetal hypoxia. When the heartbeat suddenly becomes rare and does not recover.
• Abruption of a normal or low-lying placenta. Normally, the placenta separates from the wall of the uterus after the baby is born. Sometimes this happens during labor, then severe bleeding begins, which threatens the life of the mother and fetus and requires immediate surgery.
• Threatening or incipient uterine rupture. It must be promptly recognized by a doctor, since a delayed operation can lead to fetal death and removal of the uterus.
• Presentation or prolapse of umbilical cord loops. If the umbilical cord prolapses and the fetus is in cephalic presentation, if an incision is not made within the next few minutes, 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, straight position of the head.

Sometimes a cesarean 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 create a real threat to the life of the fetus. And a caesarean section is always a last resort when all attempts to help a woman give birth on her own are futile.

It should be noted that a caesarean section is considered elective when it is planned to be carried out directly during pregnancy. In this case, the woman in labor goes to the pathology department in advance in order to prepare for operative delivery, which includes detailed examination pregnant woman, as well as assessing the condition of the fetus. In addition, a meeting with an anesthesiologist will be required to discuss the type of anesthesia that will be used during the operation.

What are the indications for a caesarean section?

There are indications in the presence of which childbirth is carried out by caesarean section.

Chronic fetal hypoxia and growth retardation; malformations of the baby, such as coccyx teratoma, gastroschisis, omphalocele; death of an infant directly related to complications during a previous delivery.

Holding in the past in vitro fertilization– especially repeated with the presence of additional complications.

What are the consequences of a caesarean section?

The most common complications that arise in the postoperative period include: endometritis, characterized by inflammation of the uterus; education adhesive process between intestinal loops due to a violation of the integrity of the peritoneum; subinvolution of the uterus, which includes a disruption in the process of its contraction and reduction in size after childbirth, which contributes to retention in the uterine cavity blood clots. In addition, the prescribed postoperative bed rest may cause hospital-acquired pneumonia.

There is also a risk of developing anemia and thromboembolism pulmonary artery. These complications are quite dangerous for the health and life of the mother. In addition, after a cesarean section, a scar forms on the uterus, which reduces its strength and elasticity, making it functionally inferior. Therefore, when pregnant next pregnancy such a seam represents serious threat due to possible uterine rupture.