Abdominal surgery The removal of the fetus from the mother's womb is called a caesarean section. It can be carried out if there are indications as planned or urgently if problems arose or were discovered during the process of delivery.

Timing of surgical delivery during the first pregnancy

If in case emergency surgery the question of when to start the operation is practically not worth it, then at what time the planned C-section, the question is quite natural. Pregnancy is considered full-term, starting from. Surgical fetal extraction is possible at these times, but the date of birth is determined individually, depending on the reasons that prompted the doctor to decide to perform a cesarean section:

• when carrying monoamniotic twins;
• 1-2 weeks before the date natural birth(on);
• when HIV infection is detected in the mother at 38 weeks.

If the course of a singleton first pregnancy is relatively normal, the woman is operated on at 39-40 weeks. In this case, it is better to attribute planned surgery Caesarean section during the first birth to the onset of contractions. When determining the time of surgery, the doctor takes into account:

• child's weight;
• degree of maturity of the placenta;
• general condition mothers;
• the general condition of the fetus and its readiness for birth (for example, the degree of maturity of the lungs);
• presence of entanglement and degree of fetal hypoxia;
• other factors that may influence the course of the postpartum period.

Rules for preparing for surgery, the course of the operation and possible consequences a woman can find out from her doctor. For modern medicine such an operation is not considered difficult, takes about 30 minutes, and in most cases ends without significant complications.

Planned surgery for repeated births

Quite often, surgical resolution of labor is recommended for women who gave birth to their first child this way. Because the presence of scar formations on the wall of the uterus can cause complications during natural birth process.

Timing of the operation during pregnancy II

If they try to set the date of the operation almost at the beginning labor activity during the first birth, this rule does not apply to planned caesarean section during the second birth. How many weeks is it done in this case? To minimize the risk to the mother and fetus, surgical delivery is scheduled 2 weeks before the planned date of birth, that is, 37-38 weeks.

Duration of operative delivery during third pregnancy

In most cases, if a woman has given birth to two children by cesarean section, experts do not recommend a third pregnancy. There are no strict restrictions for multiple pregnancies ending with surgery. It depends on the condition of the uterus and post-operative scars. If the scar is incompetent (not able to withstand stretching during pregnancy), then the course of the gestational process may be disrupted, for example, due to rupture of the uterine walls.

If a woman nevertheless takes the risk of a third and subsequent pregnancy, knowing about the danger, with proper management of labor and compliance with the recommendations of a specialist, she has a chance to bear healthy baby. In this case, a planned caesarean section is performed for the third birth and for all subsequent ones at 37-38 weeks. That is, as soon as the pregnancy becomes full-term.

Indications and contraindications for surgery

Indications for surgery to remove the fetus can be absolute and relative. Absolute (vital) indications relate to both the condition of the woman in labor and the condition of the fetus. Relative readings- these are factors that may not affect the process of delivery and the early postpartum period or lead to the development severe complications the mother or her baby. If the risk is high, doctors suggest minimizing the consequences through surgery.

Absolute readings

TO absolute indications include anatomical features buildings female body, discrepancy between the fetus and the size of the birth canal and some pathologies:

• narrowing of the pelvis II-IV degree;
• uterine rupture (threatened and in progress);
• death of the mother in the presence of a living fetus;
• eclampsia;
• placental abruption;
• neoplasms mechanically blocking the birth canal (fibroids, cysts, malignant formations cervix);
• pronounced varicose veins;
• severe renal or liver failure;
• deformation pelvic bones;
• placenta previa;
• transverse position of the fetus.

Doctors may recommend surgery for any abnormal position of the fetus in the womb (breech presentation, facing out). Children are born with breech diligence naturally, but this is traumatic for them, they get serious hematomas of the lower body (buttocks, genitals).

Relative readings

There is a list of accepted indications for which the doctor recommends surgery, but this list is not strict. This means that the doctor can suggest surgery if he considers it appropriate, even if the woman’s condition is not described by a pathology from the specified list. Surgical resolution of pregnancy may be recommended if:

• the fruit is large (4.5 kg or more);
• narrowing of the pelvis I-II degrees;
• pregnancy is over 42 weeks, the cervix is ​​immature, labor does not begin, stimulation does not have the desired effect;
• multiple births;
• the woman belongs to the group of late primigravidas (she is 30 years or more);
• there are pathologies of the organ of vision;
• pregnancy using IVF method;
• history of infertility;
• genital herpes in the acute stage (surgery prevents infection of the fetus):
• Some types of tachycardia have been diagnosed.

The doctor, having assessed the woman’s condition, decides on the need for surgery. Some women are afraid labor pains and they themselves ask to operate on them. This is not a decision worth making. Abdominal surgery is something that should be avoided at all costs. Surgery always has consequences.

Contraindications

Absolute contraindications there is no need for operative delivery if the fetus is alive and its life or the life of the mother is threatened unfavorable factors, the operation is performed in mandatory. But in some cases, doctors prefer to refrain from cesarean section:

• infectious diseases sexual labor that developed 2 weeks before birth;
• viral pathologies of the respiratory and digestive organs;
• inflammatory processes in the mother's body;
• massive pustular skin lesions;
• fetal death fetus;
• entry of the fetal head into the birth canal;
• fetal developmental anomalies incompatible with life;
• failed attempts at obstetrics (vacuum extraction, obstetric forceps, etc.);
• after carrying out fruit preparation operations (metreiriz, applying incisions to the cervical canal, etc.);
• some diseases of the cardiovascular system.

An operation performed in the presence of contraindications is fraught with complications for both the mother and the fetus. But if there is no way out, surgeons operate on the woman in the hope of saving the life of the mother and her child.

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A planned caesarean section is a type of operative delivery that is announced by the doctor in advance.

A planned caesarean section is carried out based on the testimony of the attending physician; the doctor can make a decision about such births long before the end of the pregnancy. Mothers in labor are very often worried about such an operation, and this is not surprising, since its timing often becomes known at the last moment. Therefore, it is not possible to find out the specific date or at what time doctors will perform a planned caesarean section.

Previously, it was customary not to wait for labor and to operate at 40 weeks. Now doctors have moved away from this approach and allow the baby to independently determine the time of appearance. After all, the most important thing is to preserve the health of the child and his mother. Experts say that the first contractions are the ideal moment for a cesarean section, so it is important not to miss it. This approach promotes natural lactation, the one that occurs after normal childbirth. Also, a cesarean section at this stage allows the baby to quickly adapt to life outside the placenta.

In some cases, surgery is prescribed earlier, without waiting for the first contractions, in order to avoid undesirable consequences. Also, the day of a planned cesarean section may be scheduled depending on the work of the maternity hospital. Some hospitals carry out such operations, for example, on Tuesday and Thursday. The workload of doctors or anesthesiologists can also delay the timing of the operation; there are also force majeure situations when there are no places in the intensive care unit. In such cases, if there is no danger to the mother and fetus, it is better to keep the woman in labor for a couple of days in the ward. Sorry to say exact date Caesarean is impossible, one can only guess here. The recommended cesarean delivery is 40 weeks, but it can be a week earlier or later; an exclusively individual approach is required here.

But, still, the question arises, in what week do maternity hospital doctors perform a planned cesarean section? If we consider exclusively planned surgery, then it can be scheduled no earlier than 38 weeks. This is due to the fact that before the 38th week the fetus is too small and quite weak, so early appearance may have a negative impact. As already described above, doctors try to prescribe a cesarean section at 40 weeks, since there is a possibility that precise definition gestational age.

Today, caesarean section is not a rare procedure and, according to experts, it is not more difficult to remove appendix, so no need to worry.

A second caesarean section, if planned, will also be performed at around 38 weeks. If the first birth was carried out via cesarean section, then the second one will also be carried out in this way. Therefore, in this situation it will be known long ago at what time the second caesarean section will occur.

Recommendations for planned implementation caesarean section can be different: from physiological state baby up various pathologies at mom's. Most often, this type of birth is carried out in the presence of placenta previa. This means that the placenta completely or partially blocks the fetus from leaving the uterus, therefore, natural childbirth is impossible and even dangerous. Sometimes prescribed for multiple pregnancies.

Important points during caesarean section. Planned caesarean

If the doctor has established an approximate date for the planned cesarean section, then the following points must be observed:

• A woman in labor should not shave her abdomen and pubic area. Shaving may cause irritation and inflammation, which can be quite dangerous during surgery. Pimples or pustules that arise can cause infection. Shaving or epilation is necessary before the operation itself by the medical staff.
• Don't forget to prepare purified water for drinking. In the first 24 hours you cannot eat, but you need to drink about 1.5 liters of water.
• Also, after a cesarean section, a bandage will be useful; it is also advisable to prepare it in advance;
• Additionally, you will need hygiene products: pads, diapers, diapers, some medications and other materials. The list should be compiled directly by your attending physician.

There are a number of cases when, while preparing for a natural birth, there is a need for an emergency cesarean section. There could be many reasons for this. There is no point in talking about what week an emergency caesarean section will be required. This may be 38 weeks or earlier if any pathologies were discovered that threaten the life of the mother and child. Note that a second caesarean section can also be an emergency and at what time it will have to be done is not always known.

This operation is performed with the consent of the woman, with the exception of the incapacity of the woman in labor. Then the consent of her close relatives will be required.

A planned cesarean section differs from an emergency one in the type of anesthesia used. Emergency caesarean section requires quick action, so general anesthesia is used. This type of anesthesia allows you to be completely unconscious.

However, in lately, spinal anesthesia is increasingly being used.

It is carried out using anesthesia between the lumbar vertebrae into the spinal canal, the effect of the drug begins within 5 minutes. This allows you to proceed to an emergency caesarean section as soon as possible. This anesthesia only relieves pain bottom part body, so the woman is conscious and can observe the progress of the operation. Note that in this case the incision will be made from the navel area to the pubic part, i.e. longitudinal. In case of emergency cesarean section, such an incision best provides access to the pelvic organs.

The danger of an emergency cesarean section is the risk of infection. Therefore, during the operation and after it, the woman in labor must take antibiotics, which will be prescribed by the attending physician.

It should also be noted psychological side emergency Caesarean section After all, what is planned is discussed in advance, thereby the woman is ready for it and does not consider it as a disaster. When an emergency caesarean section causes anxiety and fear, since the woman in labor was ready for a natural birth. For many, such childbirth is a shock, which requires additional attention to the woman from medical personnel.

Doctors advise that someone close to you be in this situation: husband, sister, mother, perhaps even a psychologist. A woman, being in a state of anxiety and fear, cannot always adequately assess situations. That's why close person it is simply necessary nearby, in particular, to remind you that this operation is important for the baby’s health, and worries here are unnecessary.

Indications for caesarean section

Note that a caesarean section can be performed at any stage, depending on the condition of the mother and fetus. But, nevertheless, there are a number of indications that cannot be ignored. These include the following:

• too narrow pelvis women in labor, which makes it impossible for the fetus to pass through;
• previous cesarean section with a vertical incision;
• multiple pregnancy, more than 3 babies;
• severe maternal pathologies, in particular diabetes of any type;
• the fruit is too large;
• the presence of injuries of varying severity in the hip area;
• placental presentation (placental enlargement, obstruction of the outlet);
• when diagnosing HIV infection, AIDS, hepatitis;
• incorrect placement of the fetus.

Often during pregnancy, during the next examination, the gynecologist reveals any abnormalities in the expectant mother or her fetus that may threaten their health or even life. In this case, he may decide on the need for surgical delivery so that everything goes well with minimal losses.

A pre-planned caesarean section will allow the woman to get used to the idea and prepare for the operation. What are its advantages and disadvantages?

A planned caesarean section is not the norm. Therefore, you need to know in what cases it is carried out this operation. There are a number medical indications for surgical intervention during childbirth. There are quite a lot of them and they are caused by a variety of factors.

Are you planning to conceive or has it already happened? In this case, study this list to know for sure whether your baby will be born naturally or whether doctors will insist on surgery.

Maternal health:

• abnormal placenta previa;
• scar on the uterus;
• if the previous caesarean section was corporal, the next one should be planned;
• T and J-shaped incision on the uterus;
• any uterine operations: resection, hysterotomy, myomectomy, etc.;
• more than two caesarean sections;
• HIV infection;
• genital herpes that manifested itself less than 6 weeks before the birth of the child;
• cardiovascular diseases: arterial hypertension, coarctation of the aorta, its aneurysm, dysfunction cardiac ventricle, pericarditis;
• vision problems: retinopathy, perforated corneal ulcer, burn of the mucous membrane of the eye;
• pulmonary, neurological, gastroenterological pathologies;
• injuries or tumors of the pelvic organs;
• cervical cancer;
• severe form of late toxicosis;
• plastic surgery on the perineum;
• genitourinary, enterogenital fistulas.

Fetal condition:

• breech presentation after the 36th week;
• pelvic or any incorrect position during multiple pregnancy;
• transverse presentation;
• monoamniotic twins;
• growth retardation of one of the babies during multiple pregnancy;
• gastroschisis, teratoma, diaphragmatic hernia, fusion of twins.

These are the cases in which a planned caesarean section is traditionally prescribed. True, there are cases when the operation is prescribed at the request of the woman herself. This happens if she is afraid of pain or complications after vaginal birth. However, doctors oppose such weakness (read our study:) and discourage CS if there are no medical indications for it. Otherwise, you will have to carefully prepare for surgery.

Preparation

As soon as you learn about the upcoming operation, ask your doctor in detail about the preparation for a planned cesarean section, which will minimize negative consequences and unwanted risks after childbirth. It includes several stages. Firstly, you will need to put your body in order throughout your pregnancy. Secondly, a number of appropriate measures will need to be taken immediately a few days before the operation.

During pregnancy

1. Be sure to ask the gynecologist observing you all the questions and exciting questions: at what time will you be operated on, when will you go to the hospital, are all your tests in order, etc. This will calm you down, give you confidence, and relieve you of unnecessary worries.
2. There are special courses designed to prepare women in labor for a planned cesarean section. It would be good for you to sign up for them.
3. Visit your gynecologist regularly.
4. If you notice any abnormalities in your condition, immediately report them to your doctor.
5. Eat right.
6. Lead healthy image life.
7. Be physically active, but to the extent your health allows, because it’s not for nothing that you were scheduled for a planned operation.

We are going to the maternity hospital

Find out in advance and make a list of things to take to the maternity hospital:

• documents: passport, referral for a planned caesarean section, exchange card, insurance;
• money;
• things: robe, nightgown with buttons, special bras, towel, slippers;
• hygiene items: pads, disposable diapers, toilet paper, shower cosmetics (preferably natural);
• water;
• disposable tableware;
• for the child: diapers, nappies, rompers, powder;
• charged phone.

Before a planned cesarean section, it is better not to shave your pubic area. First of all, it's inconvenient. Secondly, you can get an infection, which will complicate the operation. It is better to find out in advance how women in labor are prepared in the hospital where you will be operated on: sometimes midwives prefer to do it themselves, but in others they swear if this area turns out to be unprepared. In addition, 2 days before the CS you will not be able to take solid food, and 12 hours before you will not be able to eat at all, so that the anesthesia does not provoke vomiting.

Knowing how to prepare for surgery effectively and fully, you will no longer be afraid of it, as you will be confident in successful outcome. You will do everything in your power to help your baby be born into this world without complications. To ensure an ideal delivery, the date for the planned cesarean section must be set in advance.

Deadlines

Most women are interested in what week a planned caesarean section is performed, because very often doctors are silent until the last minute and delay setting the date for the operation. The fact is that the timing in this case is very individual and depends on a combination of many factors: the characteristics of pregnancy, the state of the mother’s health, the intrauterine development of the fetus, and even the operating hours of the hospital in which you will be operated on. You can only take the following dates into account.

1. The norm for a planned cesarean section: 39-40 weeks, i.e. the timing is as close as possible to natural childbirth. This is in order to minimize respiratory distress syndrome in a newborn. The first contractions are considered perfect time for surgery.
2. Multiple pregnancy and maternal HIV infection: 38 weeks.
3. Monoamniotic twins: planned caesarean section at 32 weeks.

In certain cases, the timing of a planned cesarean section is not dictated by the child. If the placenta previa is incorrect, the operation is performed before the first contractions begin. There are other reasons when there is no time to wait for a natural birth - it is too dangerous.

Knowing for sure how many weeks you will have surgery will help you prepare for a specific date. This will reduce the threshold of anxiety, allow you to maximize time distribution and effectively prepare for a planned caesarean section, which in this case takes place with minimal risks.

Progress of the procedure

It is quite natural that expectant mother worries about how a planned caesarean section will go, how painful the operation is, what type of anesthesia will be used, how long all this will last. It is better to discuss all these exciting moments in advance with your doctor so that they do not interfere with enjoying your pregnancy and preparing for the birth of your baby.

Preparation

1. Conversation with the doctor, discussion of details.
2. In the evening you are allowed to eat something light. In the morning they will not give you any breakfast or even a sip of water.
3. On the day of a planned cesarean section, you will be asked to shave your pubic area in the morning. They will do an enema (read why it is done before childbirth).
4. A catheter will be inserted into the bladder.
5. They will put you on a drip with antibiotics.
6. They will give you an anesthetic injection. The method of anesthesia for a planned cesarean section is discussed in advance. Most women in labor want to see the baby in the first minutes of his birth, and therefore choose local anesthesia.

Caesarean

1. An incision is made. If it is, it is made along the old seam.
2. The child is removed.
3. The wound is stitched up. This is the longest stage of the operation, requiring almost jewelry work from the surgeon. After all, how he applies the stitches will depend on cosmetic defect, and the healing process.

Rehabilitation

1. The woman in labor is transferred to the anesthesiology and intensive care unit for 1-2 days.
2. Support the body various drugs, which are administered through an IV.
3. On days 3-4, if there are no complications, the young mother is transferred to the ward.
4. You will also be allowed to get up on the 3-4th day.
5. Weights over 3 kg will not be lifted for 2 months.
6. If there is pain in the lower abdomen, special medications are prescribed.

Planned caesarean section today is a common operation performed by many maternity hospitals, the technique of which has been honed to perfection. Doctors know all the nuances of surgical delivery, even if something goes wrong. So there is no need to worry and be afraid in vain. Trust the doctors, follow all their instructions - and then you will not face any complications.

Possible complications

Negative consequences of a planned caesarean section are still possible in in rare cases. And they can affect the health and life of both mother and child. The most common and dangerous include:

• excessive blood loss often leads to anemia;
• difficulties with lactation, in some cases - its absence;
• impossibility;
• anesthesia provides harmful effects for the baby;
• there is an assumption that during any cesarean (planned or emergency) a child does not produce proteins and hormones, which subsequently have a huge impact on his mental activity and adaptation to the environment;
• menstruation disorders;
• abdominal injury;
• infertility;
• thrombophlebitis of the pelvic veins, endometritis;
• removal of the uterus;
• disturbance of the baby's cerebral circulation.

Complications arise only in cases where a young mother ignored doctors’ orders or led an incorrect lifestyle during pregnancy. If you think first of all about your baby, he will definitely be born healthy, without pathologies, despite surgery. High-quality, comprehensive preparation for this event will shorten the period of your rehabilitation period after surgery. This will allow you to quickly return to your normal rhythm of life.

I knew from childhood that I would have a caesarean section. No ophthalmologist would allow me to give birth myself.

When they ask me how it all went, I answer that I’m ready to go through it every day. And it's true!

No, I'm not a masochist at all. It’s just that the very fact of the birth of a long-awaited son overshadowed all the difficulties that I had to go through. And this operation is not as scary as they say it is.

I hope my positive experience of going through a cesarean section will dispel your fears and help you know what you are going through and what to be prepared for.

The most important thing

The main thing is your adequate attitude towards a caesarean section: if it is not possible to give birth yourself, a caesarean section is an excellent alternative.

I am not tormented by a feeling of guilt or shame that I could not give birth myself. Don’t be afraid of the possible consequences - I have a separate article about this. Thanks to the right attitude I avoided postpartum depression, problems with lactation and other horror stories that are written about on the Internet.

Positive attitude towards caesarean section will help you avoid many of the problems that young mothers often face when undergoing this operation, especially an emergency one.

When to have a planned caesarean section

Ideally, as close to the expected due date as possible.. In practice, doctors often rush to admit a pregnant woman to the hospital - just in case.

The doctor also sent me to the maternity hospital 2 weeks before giving birth. Fortunately, in reception department returned home to carry out the pregnancy. As a result, I went to bed 5 days before the operation. And it's still early!

The operation was performed 1–3 days before the expected date of birth. But according to my feelings, it should have been done a week later (at 41 weeks). It’s not without reason that birth usually occurs at 38–42 weeks, when the baby is ready to be born.

Preparing for a caesarean section

Blood and urine tests are taken in advance. There is a conversation with the anesthesiologist. In my case, it’s also a trip to the ophthalmologist. For elective surgery, epidural or spinal anesthesia is used. General anesthesia are used less and less - in special cases or during an emergency caesarean section.

The night before, the nurse gave instructions on how to prepare for the operation and what to bring.

From 18:00 you cannot eat or drink anything. At night - a valerian tablet. At 5 am – cleansing enema, shower, hair removal. Then she bandaged her legs with elastic bandages.

Packed my bag for surgery:

• rubber slippers,
• mug,
• a bottle of water,
• telephone (it was later taken away because it was not allowed).

Personal belongings and things for the newborn, clothes, watches, rings and even earrings - all this is given to the nurse for safekeeping (they are then brought to the postpartum ward).

And finally, they came for me. In the treatment room I undress and lie down on the gurney. IN urethra a catheter is inserted. I was afraid of this moment, but it didn’t really hurt, just unpleasant.

They take you on a gurney to the elevator. Let's get up. Winding empty corridors and here it is - the operating room, the place where my son will be born.

How is a caesarean section performed?

I had spinal anesthesia. It worked quickly. A screen was placed in front of the stomach. When the doctor made the incision, it felt like they were making a pencil, no pain.

After 5 minutes they began to take out the child. I expected it to happen quickly and easily, like in the videos I once watched. But no. The doctor and nurse (or midwife) made great efforts, I saw how difficult it was for them.

And then I started to feel pain. She told me about it, but the doctors reacted calmly. I realized that since they had such a reaction, then everything was fine. All that remained was to wait until they finally got their son. The main thing is that everything is fine with him! I don’t know how long it lasted, it seemed too long to me.

And then my baby screamed. The neonatologist took it to her table. I turned my head, trying to see what she was doing to him. She lay there looking at her son. The pain has disappeared. Instead, a feeling of euphoria came. I became a mother!

It seems to me that the maternal instinct woke up in me at the moment when I saw two stripes on the test. Every day and every month he gets stronger. And here, in the operating room, it reached its climax.

For doctors, this is ordinary everyday life. For mom - one of the most important events in life. Thanks to the neonatologist who, even without asking, brought my son to me for a kiss. For her it’s a small thing, for me it’s a moment that will forever remain in my memory. The son looks like a little gnome with a wrinkled nose. Our first kiss. And so they take him away. All I have to do is wait—there’s still a whole day until our next meeting.

For the remaining time, the anesthesiologist entertained the doctors by reading bad reviews from the Internet about our maternity hospital. The whole operation lasted about 40 minutes.

What happens after the operation?

After the operation you need to stay in the ward for another day intensive care. I have the most unpleasant memories of this place.

There are five of us in the ward. Everyone has just been cut through. The nurse may not bad person, but no one felt any special kindness from her. When the anesthesia began to wear off, oxytocin drips to contract the uterus only increased the pain.

But the pain is nothing compared to the feeling of helplessness when you are forced to ask permission even to go to the toilet. In addition, you were not allowed to talk to your bedmates. Just sleep, drink and turn from side to side. It was not even allowed to walk around the ward, although it is known that what formerly a woman gets up and starts moving, the better. True, no one wanted to go.

All this time my thoughts were only about my son. I dreamed that the next day would come soon and we would see each other again. Fortunately, At night they put a drip with a strong soporific painkiller. And there is morning and a long-awaited meeting.

As you can see, the operation itself, despite some pain, left only pleasant memories. Subsequent rehabilitation is a small matter. The most important thing awaited me ahead - in

Caesarean section is one of the most popular operative obstetric practices. Over the past 30 years, the share of surgical total number childbirth has grown all over the world. In Russia back in the 80s of the last century surgically no more than 3% of children were born. Today - about 15%, and in some large perinatal centers the number of operative births exceeds the average, and this number approaches 20%.

Expectant mothers who are about to give birth to their baby on operating table, I am concerned about the timing issue: which week of pregnancy should be considered optimal for the birth of a child? In this material we will explain how the timing for surgical births is determined and why they may change.

Who needs surgery?

Surgical childbirth, named after the Roman emperor Gaius Julius Caesar, does not imply the passage of the baby through birth canal mother. The child is born as a result of laparotomy and hysterotomy - incisions abdominal wall and the walls of the uterus.

This method of delivery is sometimes life-saving. It is carried out urgently to save the lives of the woman and her baby, if in the process physiological birth or something went wrong as a result of an injury. Emergency caesarean section accounts for no more than 7-9% of all surgical births. The remaining share is allocated for planned operations.

A planned caesarean section always involves careful preparation, as a result of which the risks of complications are significantly reduced.

Indications for elective surgery may appear from the very beginning of pregnancy, or may become obvious only at the end of the gestation period. Therefore, the decision on the timing of the operation is made at different times.

For an emergency caesarean section, the issue of timing is irrelevant. It is carried out when there is an urgent vital need for it. A planned operation is performed according to the indications provided for in the list in clinical guidelines Ministry of Health of Russia. This list is regularly reviewed and adjustments are made to it.

Today it provides for the following situations:

• Pathological location of the placenta - low placentation with incomplete overlap of the internal os or full presentation placenta.
• Postoperative scars on reproductive organ from cesarean or other surgical procedures on the uterus. Caesarean section is also recommended as the only delivery option if there is a history of two or more cesarean sections.
• Clinical narrowness of the pelvis, pathologies of the bones and joints of the pelvis, trauma and deformation, tumors of the pelvic organs, polyps.
• Pathological discrepancy of the bones of the pubic symphysis - symphysitis.
• Pathological position of the fetus. By the 36th week of pregnancy - pelvic, oblique, transverse. Also pathological include some types of presentation, for example, breech presentation.
• The estimated weight of the child is more than 3.6 kg and its position in the uterus is incorrect.
• Multiple pregnancy, in which the fetus closest to the exit is located in the breech position.
• Monozygotic twins (twins are inside the same fetal sac).
• IVF pregnancy with twins, triplets, and often singletons.
• Incompetent cervix, with scars, deformation, scars in the vagina left after difficult previous births, which occurred with ruptures above the third degree of severity.
• Significant developmental delay in the baby.
• Lack of effect from conservative stimulation of labor during post-term pregnancy – after 41-42 weeks.
• Severe form and degree of gestosis, preeclampsia.
• The inability to push due to a ban on such an action in case of myopia, retinal detachment of a woman’s eyes, certain heart diseases, as well as in the presence of a kidney transplant.
• Long-term compensated fetal hypoxia.
• A bleeding disorder in the mother or baby.
• Genital herpes, maternal HIV infection.
• Fetal developmental anomalies (hydrocephalus, gastroschisis, etc.).

On an individual basis, a decision may be made about elective surgery for some other reasons.

Optimal time

If circumstances that are an indication for surgery arise already during the process of bearing a baby, for example, breech presentation is detected with a large fetus or placenta previa, then doctors wait until 34-36 weeks of pregnancy. This period is considered the “control” period. If by 35 weeks the baby does not turn over into the correct position, if the placenta does not rise, then the indication for surgery becomes absolute. An appropriate decision is made and a date for surgical delivery is set.

When circumstances implying surgical delivery as the only possible or the only rational one occur from the very beginning after the onset of pregnancy, then the issue of caesarean section is not considered separately. Operative delivery is assumed a priori.

Contrary to the widespread belief among women that a caesarean section is best performed when contractions have begun, since it is “closer to nature,” doctors prefer to operate on relaxed and calm muscles of the uterus rather than those tense during labor contractions.

It will be so fewer complications, And surgical birth will go more smoothly. Therefore, it is better to perform the operation before the onset of physiological labor.

The Russian Ministry of Health in the protocol and clinical recommendations for caesarean section calls certain deadlines, in which surgery is considered most desirable. It is recommended to have a planned cesarean section after the 39th week of pregnancy.

How long before a caesarean section is performed? Yes, on any one, if necessary. But the 39th week is considered the most favorable, because by this time, in the vast majority of children, the lung tissue has matured sufficiently for independent breathing to be possible, the child is ready, he will not need resuscitation care, risks of distress syndrome, development of acute respiratory failure minimal.

Children are considered viable from the 36th week of pregnancy and, children born earlier also survive, but the risks of respiratory failure increase in proportion to the period of prematurity.

If there are no reasons for early delivery, then it is better to give the child the opportunity to gain weight and his lungs to mature.

When pregnant with twins or triplets, the likelihood of the onset of physiological labor a couple of weeks before the expected date of birth is higher, and therefore, in case of multiple pregnancies, they try to schedule a planned cesarean section at 37-38 weeks, and sometimes before 37 weeks. Children may require intensive care in the first hours of life, and therefore not only surgeons, but also a team consisting of a neonatologist and a pediatric resuscitator always prepare for such operations in advance.

When the doctor decides on the date of the operation, he takes into account not only the wishes of the pregnant woman, her state of health and the totality of indications, if there are several, but also the interests of the child. If the results of examinations reveal any signs of trouble in the baby, then the date of the operation can be scheduled at an earlier time.

Does this mean that a woman is not given the right to participate in the discussion of the birth date of her own child? Not at all. The doctor can indicate a time frame - several days, in which he considers it appropriate to perform the operation. A woman can choose one of these days at her own discretion. They try not to perform elective surgeries on weekends and holidays.

Reasons for changing deadlines

If we talk in more detail about the reasons that can lead to a change in the timing of surgical delivery, then it should be taken into account that there are two types of influencing factors: indications from the mother and indications from the fetus.

• According to maternal indications the operation may be postponed until later early dates due to the fact that the woman’s body begins to actively prepare for childbirth. The woman’s cervix begins to smooth out and shorten, the amount of cervical mucus increases, and the mucous plug comes out of the cervical canal, a slow and gradual leakage of amniotic fluid begins. Also, the time frame will be reduced if signs of threatening uterine rupture along the old scar appear. Deterioration of a woman’s condition due to gestosis, increased blood pressure, severe swelling - grounds for earlier delivery if conservative therapy turns out to be ineffective and it is not possible to stabilize the pregnant woman’s condition.

• Earlier delivery due to fetal factor carried out if the child shows signs oxygen starvation if there is an umbilical cord entwined around the neck with associated symptoms troubles, with pronounced Rh conflict. If the child has congenital pathologies identified during prenatal screening diagnostic studies, then the deterioration of his condition is also the basis for postponing the date of surgical delivery.

Referral for hospitalization to a maternity hospital or perinatal center issued in antenatal clinic, where a woman is observed at 38-39 weeks during her first pregnancy, at 37-38 weeks if a repeat cesarean section is necessary for a singleton pregnancy. In case of multiple pregnancy, as already mentioned, above, they are hospitalized earlier by an average of 2 weeks.