Indications for cesarean delivery
Absolute indications of cesarean section
Absolute indications are the complications of pregnancy and childbirth, in which another method of delivery (even taking into account the fruit-destroying operation) poses a mortal danger for the mother:
- complete placenta previa;
- severe and moderately severe forms of premature detachment of the normally located placenta in unprepared birth canals;
- threatening rupture of the uterus;
- absolutely narrow pelvis;
- Tumors and scarring, which prevent the birth of the fetus.
In those cases when there are absolute indications for cesarean section, all other conditions and contraindications are not taken into account.
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Relative indications of cesarean section
Relative (from the mother and fetal) indications arise if the possibility of delivery through the natural birth can not be ruled out, but with a high risk of perinatal mortality and a threat to the health or life of the mother. At the heart of this group of indications is the principle of preserving the health and life of the mother and fetus, therefore the cesarean section is performed with the obligatory consideration of the conditions and contraindications that determine the timing and method of the operation.
Indications for caesarean section during pregnancy
- Full placenta previa.
- Incomplete presentation of the placenta with marked bleeding.
- Premature detachment of a normally located placenta with marked bleeding or intrauterine hypoxia.
- The inconsistency of the scar on the uterus after cesarean section or other operations on the uterus.
- Two or more scars on the uterus after cesarean section.
- Anatomically narrow pelvis of II-IV degree of narrowing, tumor or deformity of pelvic bones.
- Condition after operations on hip joints and pelvic bones, spine.
- Malformations of the uterus and vagina.
- Tumors of the pelvic organs blocking the birth canal.
- Multiple uterine fibroids of large size, degeneration of myoma nodes, low node location.
- Severe forms of gestosis in the absence of the effect of therapy and unprepared birth canal.
- Severe extragenital diseases.
- Cicatricial narrowing of the cervix and vagina after plastic surgeries of urogenital and intestinal vaginal fistulas.
- Condition after rupture of the third degree perineum with the preceding birth.
- Pronounced varicose veins in the vagina and vulva.
- The transverse position of the fetus.
- Fused twins.
- Pelvic presentation of the fetus with fetal mass over 3600 g and less than 1500 g or with anatomical changes of the pelvis.
- Pelvic presentation or transverse position of one fetus in multiple pregnancies.
- Three or more fetuses in multiple pregnancies.
- Chronic intrauterine fetal hypoxia, fetal hypotrophy, not amenable to drug therapy.
- Hemolytic disease of the fetus with unprepared birthmarks.
- Prolonged infertility in the history in combination with other aggravating factors.
- Pregnancy resulting from the use of assistive technologies (in vitro fertilization, artificial insemination of sperm) with a complicated obstetric-gynecological anamnesis.
- Migrated pregnancy in combination with a burdened obstetric-gynecological anamnesis, unpreparedness of the birth canal and lack of the effect of induction.
- Extragenital cancer and cervical cancer.
- Exacerbation of herpetic infection of the genital tract.
Indications for cesarean delivery during labor
- Clinically narrow pelvis.
- Premature discharge of amniotic fluid and lack of effect on births.
- Anomalies of labor, not amenable to drug therapy.
- Acute fetal intrauterine hypoxia.
- Premature detachment of a normal or low-lying placenta.
- A threatening or beginning rupture of the uterus.
- Presentation or prolapse of the umbilical cord.
- Incorrect insertion or presentation of the fetal head (frontal, front view of the facial, posterior view of the high direct standing of the sagittal seam).
- The state of agony or the sudden death of a woman in labor with a live fetus.
Indications for consultation of other specialists
- Anesthesiologist: the need for abdominal delivery.
- Neonatologist resuscitator: the need for resuscitation at birth of a newborn with a moderate and severe asphyxia.
What is the cesarean section for?
Effective delivery with a favorable prognosis for the mother and newborn.
Indications for hospitalization
Presence of indications for cesarean section.
Conditions for cesarean section
- A living and viable fetus (not always feasible with absolute indications).
- Absence of symptoms of the infectious process in childbirth.
- Empty bladder.
- The choice of the optimal operation time (do not do it too hastily or as an "operation of desperation").
- The presence of a doctor who owns the operation technique, an anesthesiologist.
- The consent of the pregnant woman (the mother in childbirth) to the operation.
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Anesthesia: general multi-component anesthesia, regional anesthesia.
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