It happens that pregnancy occurs with some disturbances, due to which it is contraindicated for a woman to give birth on her own. IN similar situations The doctor may prescribe a planned birth by caesarean section. An unambiguous answer on how long it takes to do the planned C-section, no, because every pregnancy is different. Therefore, the time for surgical delivery is determined by the gynecologist on an individual basis.

A planned caesarean section is a pre-planned surgical procedure prescribed for pregnant women who have contraindications to natural childbirth. The operation is prescribed when there are absolute indications for its implementation. The question of the need for delivery in this way is decided in advance by the gynecologist.

Woman passing thorough examination from a gynecologist, ophthalmologist, therapist, endocrinologist and other doctors. If the experts come to the conclusion that a cesarean section is necessary, the woman is given a date for the operation, approximately a week to a week and a half before which the patient is admitted to the maternity hospital. A pregnant woman needs to decide in advance on the type of pain relief. During the operation, the wall of the peritoneum and the uterus are cut, and then the child is removed through the incisions made.

Increasingly, during a planned caesarean section, a transverse incision is made, which is more cosmetic than a vertical suture crossing the peritoneum from the navel to the pubis. Such delivery operations occur quite often in obstetric practice, saving the lives of thousands of babies.

Indications for planned caesarean section

Although delivery by cesarean section is often performed, such an operation cannot be considered the norm, because it is prescribed if there is certain indications, of which there are quite a lot:

In all these clinical cases Traditionally, a planned caesarean section is prescribed. Although it happens that surgical delivery is carried out at the request of the woman in labor, when she is afraid of severe pain or possible complications. But doctors always try to dissuade the patient from cesarean section if there are no clear indications for it.

At what time is delivery performed by elective caesarean section?

Quite often, doctors wait until the last minute to perform a cesarean section, so women are worried about what week such an operation is performed. The reason for such uncertainty is the individuality of each case and the influence of many factors such as the condition of the pregnant woman, the course of pregnancy, characteristics of fetal development, etc. Although there are some generally accepted standards that doctors rely on.

The norm for planned surgical delivery is 39-40 weeks, i.e., a period as close as possible to natural childbirth. Such approximation is necessary to minimize respiratory distress syndrome in newborn babies. The ideal time is considered to be the time when the first contractions appear, the so-called. harbingers. But such terms are generally accepted for normal pregnancies.

If the pregnancy is multiple, then at what period is a planned cesarean section performed? For women with HIV infection or multiple pregnancies, planned surgical delivery is prescribed at 38 weeks. If monoamniotic twins are detected, then the operation is performed at 32 weeks. But these dates are approximate. The final timing depends on various additional factors such as abnormal placental presentation, etc.

For whom cesarean section is contraindicated?

There are no absolute contraindications for surgical delivery, because the factors leading to the appointment of such an operation are quite serious and often involve the issue of preserving the life of the child or mother. Possible contraindications include intrauterine death fetus, severe and long-term fetal hypoxia, various deformities or non-viability of the fetus, high probability postoperative complications in a postpartum mother, etc.

This also includes situations where it is impossible to exclude stillbirth or the death of a child during childbirth. In such clinical situations, the primary task is to preserve women's health and the greatest possible reduction in the likelihood of developing septic or infectious complications during operational activities, because dead child may cause a dangerous infection.

If the indications for cesarean section are absolute, although there is infectious process, then an abdominal type of delivery is performed, i.e., the child is removed along with the uterus.

Preparing for surgery

The operation is serious, so it is necessary to carefully prepare for it. To do this, the woman is admitted to the maternity hospital about a week before the appointed date so that she undergoes a detailed examination. In addition, during this period the intrauterine state of the fetus is assessed, and the pregnant woman is finally determined on the type of anesthesia. To avoid various kinds allergic reactions, it is necessary to study the presence of intolerance or hypersensitivity to the medications used.

In general, anesthesia comes in several varieties:

1. General. This general anesthesia, which involves immersing a woman in labor into artificial medical sleep. Usually used in emergency cases, since it does not require much time, although it has a lot of undesirable consequences;
2. Endotracheal. This is also a type of general anesthesia, in which a tube connected to a ventilator is inserted into the woman’s trachea. Such anesthesia is often combined with general anesthesia;
3. Epidural. This anesthesia is the most common and involves the introduction of an anesthetic drug into the epidural cavity. A woman is fully conscious during the process of childbirth;
4. Spinal. Such anesthesia is considered the most preferable today, as many patients note. In this case, the drug is administered into the spinal cavity.

In addition to the choice of anesthesia, preparation for a planned cesarean section includes a thorough collection necessary accessories which will be needed in the maternity hospital after surgery. This includes hygiene items, documents, things for the mother and child, money, etc. Some mothers try to shave their pubic hair at home on their own. But doctors do not recommend doing this. The problem is that after such shaving, inflammation appears, which can lead to the development of infection. Also, before the operation, you need to prepare drinking water, because after a caesarean section you can’t eat anything, and after anesthesia there will definitely be extreme thirst.

Regardless of how many weeks the operation is performed, it is necessary to purchase post-operative care in advance. postpartum bandage. Wearing such a bandage from the first days after cesarean helps eliminate pain and accelerates the healing process of the suture. The quality of the preparation for caesarean section determines the favorable outcome of the operation and the absence of postoperative complications. Absolutely all mothers are worried before a planned operation, so everything is recommended exciting questions Discuss with your doctor in advance.

Progress of planned surgical delivery

IN operating room woman A cap and shoe covers are provided. To avoid the development of thrombosis, the pregnant woman's legs are tightened with special elastic bandages or put on compression stockings. The rest of the clothing is removed and the patient is placed on the table. Then, when anesthesia is given, the woman may be placed on her side ( spinal anesthesia) or ask to sit up (epidural anesthesia). After this, the infusion is connected, and a cuff is put on the arm to control blood pressure.

A special screen is installed just below the woman’s chest to isolate the area of ​​surgical operations. A woman is having a catheter installed skin the abdomen is treated with a special disinfectant solution and covered with a special sterile cloth.

How is a planned caesarean section performed? When the anesthetic begins to act, the pregnant woman is dissected into the peritoneum and uterine wall, after which the baby is carefully removed. The doctor cuts the umbilical cord and transfers the baby to a neonatologist for treatment, examination and evaluation. vital signs. All this is done in a short period of time, taking about 10 minutes. If the woman in labor feels well, the baby is placed on her chest for a short time.

After which the placenta is removed. The surgeon carefully examines the uterine cavity and, if there are no deviations, sutures its wall with absorbable material. The abdominal wall is sutured in the same way. To avoid leaving a disfiguring scar, the doctor makes a cosmetic suture, which is then processed antiseptic and is covered with a bandage. From the beginning to the end of surgical delivery it takes about half an hour.

Possible complications after cesarean section

In some cases it is likely postoperative complications, usually removable and passing in nature. They affect the mother herself, but may
touch the child too. The most common problems are:

• Anemia caused by heavy blood loss during surgical delivery;
• Absence or difficulty with the onset of lactation;
• Adhesive processes in the abdominal cavity;
• Varied menstrual irregularities, for example, the first period may last more than a week, or it does not come sufficiently long time etc.;
• Problems with the baby's blood circulation;
• Trobophlebitis of the pelvic veins, endometritis, etc.

Irreversible complications include hysterectomy or infertility. After cesarean section, most women lose the opportunity natural birth, which also cannot be corrected. There is a theory that during cesarean delivery in babies there is a disruption in the production of hormones and proteins, which can negatively affect extrauterine adaptation and mental activity newborn But this is just a theory that has not been definitively confirmed.

Rehabilitation and recovery period

About a day after a cesarean section, the postpartum woman is in the intensive care unit, where her condition is closely monitored. Immediately after surgery, cold is applied to the abdomen to speed up uterine contractions and stop bleeding. When the anesthetic effect wears off, the woman begins to feel uneasy severe pain, for the relief of which the patient is given painkillers. Additionally, saline solution is administered to replenish lost volumes of fluid, and drugs to normalize gastrointestinal activity.

During the first hours after a cesarean section is performed, the postpartum woman should lie down. Usually at this time women note weakness and chills, mild nausea and dizziness. This is where pre-prepared water comes in handy, since patients are worried about extreme thirst. You are allowed to sit down after 6-8 hours, and when the dizziness goes away, you can go to the toilet. The newborn remains in the neonatal department all this time, from where his mother periodically brings him.

The next day, the postpartum woman is transferred from the PICU to the department, where she takes care of the baby independently. After about 3 days, the patient stops receiving pain-relieving injections, but the suture continues to be treated daily. Approximately on the 5th-6th day, the postpartum woman undergoes tests, does ultrasound diagnostics scar and organs of the abdominal and pelvic region. If there are no complications, on the 7th day the mother goes home with the baby.

At home you should also follow certain rules postoperative rehabilitation. You are allowed to wash in the shower after about one and a half to two weeks, and in the bathroom after a month and a half. Sexual rest and abstinence from physical activity are observed for 8 weeks. Next pregnancy will become possible only in a couple of years, so it is necessary to competently approach the issue of protection.

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Natural childbirth is, of course, the most suitable way delivery. However, unfortunately, such births are not always possible. For a variety of reasons, a woman may be advised to have a planned caesarean section. For many women who are committed to natural childbirth, such advice can come as a real shock.

This condition also includes fear of abdominal surgery, and fears for the child and even some psychological complexes associated with the fact that the woman was unable to give birth herself. In order to somehow smooth out this condition, it is necessary to understand how a planned caesarean section works, the preparation for it and the postoperative period. This will help get rid of fears about a caesarean section.

Indications for caesarean section

Why might doctors insist on elective surgery? There can be many reasons for this, and they can be related directly to the development of the fetus or the condition reproductive system women, and with others internal systems body.

Thus, the indication for surgical delivery may be partial or full presentation placenta. In this case, the placenta partially or completely blocks the baby's exit from the uterus. Natural childbirth in this case is not only impossible, but also dangerous. Contractions can cause placental abruption and excessive bleeding.

That is why doctors closely monitor the position of the placenta throughout pregnancy. As the uterus grows, the position of the placenta may change, and a low-lying placenta may rise higher or block the cervix.
Placental abruption may also be an indication for caesarean section. In this case, the fetus stops receiving nutrients and oxygen from the mother's blood. Acute hypoxia develops, threatening the child's life.

The presence of scars on the uterus after previous operations, as well as the presence pathological changes in the uterus, for example, fibroids - all this may well become a reason for an operation. The mere presence of scars, of course, does not make natural childbirth impossible. But it is important to understand that a fresh or poorly healed scar may not withstand stress. Therefore, before giving consent to childbirth, doctors assess the condition of the suture.

A planned caesarean section will also be relevant in the case of multiple pregnancies. Moreover, if in the case of twins, obstetricians monitor the associated factors, and may well allow natural birth, then three or more children will most likely be born through surgery.

The position of the fetus can become an obstacle to natural childbirth. So, with transverse, leg or frontal presentation, obstetricians will clearly recommend a cesarean section. The same can be discussed in the case of breech presentation, but here doctors are likely to be less categorical.

Ophthalmologists can also insist on a planned caesarean section if a woman is diagnosed with retinal detachment or a high degree of myopia. Natural childbirth with such pathologies can lead to complete or partial loss of vision.

How should you prepare for a caesarean section?

The date of the operation is set in advance based on several indicators.

First, they focus on the expected date of birth. The body of the mother and child must be fully prepared for childbirth. This will ensure the timely appearance of milk in the mother, as well as good condition child after surgery.

Secondly, the diagnosis is also important, because of which the birth should end with an operation. Thus, multiple pregnancies are rarely carried to term.

Thirdly, each maternity hospital has its own schedule of operations, in accordance with which cesarean sections are prescribed for patients. Thus, it is very difficult to know in advance when a planned caesarean section will be performed.

1-2 weeks before the appointed date, the woman is admitted to the maternity hospital to carry out all the necessary examinations. In particular, it is necessary to donate blood, urine and a smear for analysis. This allows you to assess the mother's health status. If any deviations are detected, carry out necessary treatment. In addition, a test for blood type and Rh factor is required.
It is equally important to assess the condition of the fetus. For this purpose, ultrasound and CTG are required, and in some cases Dopplerometry. If the pregnancy is proceeding calmly, all these studies can be done in advance and last days before surgery at home. In this case, the woman appears at the maternity hospital the day before the caesarean section.

The day before, the obstetrician and anesthesiologist talk with the woman. They talk about various types anesthesia, find out whether the patient has encountered anesthesia before and how she endured it. Based on the data obtained and the woman’s wishes, the most suitable anesthesia option is selected. Most often, epidural anesthesia is recommended. It has less effect on the fetus, and is safer for the woman’s body. In addition, in this case, the patient remains conscious and can see her baby immediately after birth.

What happens on the day of surgery?

As a rule, a caesarean section is scheduled for the morning or afternoon. After 6 pm the day before, a woman should not eat or drink. The patient's stomach should be empty. Otherwise, the contents of the stomach may enter the respiratory tract due to anesthesia. Before surgery, it is also necessary to cleanse the intestines. To do this, they do an enema in the morning.

After this, the woman changes into a shirt and robe provided by the maternity hospital. The list of things that can be taken to the operating room depends on the specific maternity hospital and its specific procedures. Some places will allow you to take a bottle of water, a phone, a charger with you; in others, all this will be prohibited. It is better to ask your doctor in advance what their procedures are.

How does a planned caesarean section occur?

In the operating room, the woman is placed on a table and anesthesia is given. Then a screen is installed in the chest area so that the patient does not see the operation process. Only after this is the first incision made on the abdominal wall, and after that on the uterus. Already 5-8 minutes after the start of the operation, the child is taken out. The next stage is assessing the condition of the uterus, removing the placenta and suturing the incisions. As a result, the entire procedure takes about 40 minutes.

That's probably all that can be said about how a caesarean section goes. Video from detailed description process will help to more fully and clearly show how such an operation proceeds.

In some cases, if no complications are expected, the patient's husband or mother may be allowed to be present in the operating room. Naturally, they will be at the head of the room, and, just like the child’s mother, they will not see the process itself. But they will be able to support the woman and see the child immediately after birth.

Postoperative period

For the first 24 hours, the woman should be in intensive care, where her condition will be constantly monitored. During the first few hours she will come to her senses and recover from the anesthesia. She will be given painkillers. After 6-8 hours, the patient will be helped to get up and go to the toilet.

The next day the new mother is transferred to postpartum ward, where she will receive pain medication and other medications. In addition, her stitch will be treated every day. It is also necessary to undergo a daily examination, which will allow you to assess the degree of uterine contraction.

On the 5th day, if there are no deviations, the suture is removed, and after another day they are discharged from the hospital.
Behavior of a woman at home after a planned caesarean section

It is very important to follow some stitch care rules after returning home. It needs to be treated regularly and its condition monitored. It must be dry and clean.

You can wash after a caesarean section after 1.5 months, and after 2 months you can take a bath. It is necessary to abstain from physical activity and sexual activity for approximately the same amount of time. Otherwise, the seam may come apart.
Helps significantly speed up wound healing postoperative bandage. It will support the abdominal muscles and reduce the load on the spine. However, you should not wear it all the time, since the abdominal muscles must work independently.

As additional material It makes sense to watch the video “How to do a caesarean section.” It will help the woman to be in a positive mood, to accept and understand the necessity and safety of this operation. And the success of the operation largely depends on the woman’s mood.

Useful video on how to perform a caesarean section

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 labor activity and 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 time for a cesarean section is 40 weeks, but it could be a week earlier or later; an 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 can 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 the physiological state of the baby to 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 set 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 caesarean 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. Let us 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 caesarean 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 numbs only the lower part of the 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 caesarean 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 nearby is simply necessary, in particular to remind 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:

• the pelvis of the woman in labor is too narrow, 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.

The patient is admitted to maternity ward a few days before the planned surgery. At what time a cesarean section should be performed is determined by analyzing the condition of the mother and fetus. On the day of surgery, a cleansing enema is prescribed. The operation is performed under an epidural or spinal anesthesia. In some cases, general anesthesia is used. The operation lasts less than an hour. In the postoperative period, blood replacement solutions are administered, since up to 1000 ml of blood is lost during surgery.

Carrying out a caesarean section according to plan

Caesarean section is usually performed at 39 weeks or urgently during contractions. If emergency surgery occurs before 39 weeks, babies may have breathing problems. Most often, this option is possible with a repeat cesarean section. A second caesarean section is performed at the same time.

Postoperative period

For the first day, the woman in labor is under observation in the postpartum ward. For the first few days, painkillers and medications to contract the uterus are prescribed. Within 24 hours after the operation, the patient is transferred to the postpartum ward. The suture is treated daily with antiseptic solutions before removal. To normalize the condition of the intestines, a special diet is prescribed. As a rule, discharge is made a week after the operation, according to the decision of the attending physician.

If the doctor leading the pregnancy finds serious abnormalities in the woman or the unborn child, he may decide to perform a planned caesarean section. When the operation is scheduled in advance, the patient has the opportunity to properly prepare for it, including psychologically.

Who should have a planned caesarean section and at what time?

The timing of a cesarean section is determined strictly individually, but doctors try to bring them as close as possible to the time physiological birth, i.e. by 39-40 weeks. This allows you to avoid development in a newborn caused by hypoplasia (underdevelopment) of his lungs. When setting a date for intervention, several factors are taken into account, the main ones being the health status of the pregnant woman and the development of the fetus. A pregnancy is considered full-term when the gestational age reaches 37 weeks.

It is believed that perfect time To start a cesarean section, this is the period of the first contractions, but if the placenta previa is incorrect, they do not wait for them.

In case of multiple pregnancy or detection in the patient, the operation is performed at 38 weeks. With monoamniotic twins, cesarean section is performed much earlier - at 32 weeks.

There are certain indications for surgical intervention.

Please note

If there is at least one absolute indication or a combination of two or more relative indications, delivery naturally impossible!

TO absolute indications include:

• history of corporal caesarean section;
• previous operations on the uterus;
• large fruit (≥ 4500 g);
• monoamniotic twins;
• complete placenta previa;
• anatomically narrow pelvis;
• post-traumatic deformation of the pelvic bones;
• transverse presentation of the child;
• after 36 weeks of gestation and weight > 3600 g;
• multiple pregnancy with malpresentation of one fetus;
• growth delay of one of the twins.

Relative indications are:

A planned caesarean section is mandatory if the unborn child is diagnosed with diaphragmatic hernia, non-union of the anterior abdominal wall or teratoma, as well as in the case of fusion of twins.

Please note

In some situations, the operation can be performed without special indications at the request of the woman. Some expectant mothers prefer a caesarean section under anesthesia because they fear pain during natural childbirth.

The process of preparing for a planned caesarean section

If your doctor has informed you that a planned cesarean section is necessary, do not hesitate to ask him any questions you may have. Check the date of hospitalization and find out if everything is in order with your tests. A number of measures to improve the condition of the body must be taken in advance, i.e. during pregnancy.

Please note

During the examination, the expectant mother must consult a neurologist, an ophthalmologist (or ophthalmologist), a therapist and an endocrinologist. If necessary, carried out drug correction diagnosed disorders.

It is advisable to attend special courses for women in labor who are preparing for a CS.

Try to eat right and go out more. Be sure to take daily walks - physical inactivity can harm both you and your baby.

Get checked regularly at the antenatal clinic. Be sure to report any changes in your condition to your doctor.

What to take with you to the maternity hospital?

List of documents and necessary things:

Don't forget to bring diapers, diapers and baby powder for your newborn.

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Preoperative preparation a few days before the CS

Be sure to check whether you need to shave your pubic area yourself. It is better to entrust this manipulation to medical workers (to avoid cuts, infection and inflammation), but some institutions recommend preparing this area in advance.

After admission to the antenatal department (usually 2 weeks before the intervention), a series of tests will be required so that doctors can objectively assess the condition of their patient at the present time.

List of required tests:

• blood group and Rh factor;
• vaginal smear.

Additionally carried out hardware examination– and CTG – cardiotocography.

You need to give up solid food for 48 hours. On the eve of the CS, you cannot eat after 18-00, and on the day of the operation it is extremely undesirable to even consume liquid. In the morning before the intervention, you need to cleanse the intestines, using an enema if necessary.

The method of anesthesia is discussed in advance. Local anesthesia(spinal or) is recommended for those who want to see their child in the first moments of his life. Besides, It should be taken into account that anesthesia can negatively affect the baby’s condition. In any case, the procedure will not be associated with pain.

Please note

In most specialized maternity hospitals, mothers are allowed to hold their newborn for a short time immediately after the CS.

The patient is taken from the ward to the operating room on a gurney.

Already on the table in bladder a catheter is inserted. A dropper with a solution must be placed or a drug injection must be given.

Operating field ( bottom part abdomen) is carefully processed antiseptic solution. If it is expected that the patient will remain conscious, then a screen is installed in front of her at chest level, blocking the view (to avoid mental trauma).

After anesthesia, two incisions are made (most often transverse) in the lower abdomen. During the first, the skin, the layer of fiber and the abdominal wall are dissected, and during the second, the uterus. The baby is removed and, after cutting the umbilical cord, transferred to a neonatologist. The newborn's mouth and nasal passages are cleaned. His condition is assessed using the generally accepted ten-point APGAR scale.

Please note

If a caesarean section is not being performed for the first time, the incision is usually made along the line of the old suture.

The longest stage is suturing. It requires jeweler precision from the obstetrician, since not only the degree of severity will depend on the quality of suturing cosmetic defect, but also the healing process of soft tissues. Neat transverse seams are practically invisible in the future, because they are hidden under the hair.

The advantage of a horizontal incision above the pubis is that it practically reduces to zero the likelihood that the bladder or intestinal wall will be accidentally hit. In addition, the risk of hernia formation is minimized, and healing proceeds faster. An incision in the vertical direction from the navel to pubic bone more often done during an emergency caesarean section, when the need to save the mother and child comes to the fore, rather than aesthetic considerations.

At the final stage of a planned cesarean section, which in the absence of complications lasts only 20-40 minutes, the suture is treated with an antiseptic and covered with a sterile bandage.

Postoperative period

The baby can be put to the breast immediately after the operation is completed.

At the end of the procedure, the woman is usually transferred to the intensive care unit, where she stays for 24-48 hours (provided there are no complications). However, now in many maternity hospitals, already 2 hours after the operation, a woman and a child are immediately transferred from the operating room to a shared ward.

Drugs are administered intravenously to the mother to stabilize and generally improve the condition.

A woman is allowed to get out of bed 12 hours after surgery(in the absence of complications).

Both general and spinal anesthesia negatively affect intestinal motility, so on the first day you can only drink liquids ( clean water); The recommended volume is at least 1.5 liters. On the second day, you can drink low-fat kefir or yogurt without chemical colors and flavors, and also consume chicken broth with crackers.

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For at least 1 week you need to abstain from fatty and fried foods, as well as seasonings and spices.

It is necessary to take measures, since excessive straining increases the risk of suture divergence. It is advisable to consume foods with laxative properties, and if they do not give the expected effect, you will have to resort to laxatives.

The suture is cleaned and the sterile dressing is changed daily.

If the patient complains of painful sensations, she is given analgesics as needed.

Before healing and removal of sutures physical activity excluded. It is strictly forbidden to lift weight more than 3 kg in the next 2-3 months.

The recovery period after a CS lasts slightly longer than after a natural birth. The uterus returns to its physiological state on average after one and a half to two months.

Please note

Resumption of sexual activity is permissible after two months from the date of surgery.

Possible complications after cesarean section

The technique of performing a CS has now been honed to perfection. The likelihood of complications when the mother in labor follows all the instructions of the attending physician is minimized.

IN in rare cases possible:

Please note

In severe cases (in particular, with massive bleeding), doctors have to resort to hysterectomy to save the mother’s life.

Previously, there was an opinion that a child born via CS does not produce certain hormones and protein compounds that are natural adaptogens. In this regard, disturbances in the process of the baby’s adaptation to environment and certain disorders mental sphere. This statement is now considered erroneous.

A planned caesarean section is an operative birth that is known in advance. If you have an indication for this intervention, the decision can be made by doctors long before you approach full-term pregnancy.

Knowing that a planned operation is ahead, all pregnant women are most worried about its timing. And this is not surprising, because often doctors do not say until the last minute when this will happen.

Previously, it was believed that it was necessary to operate on a pregnant woman without waiting for the onset of labor. The 40 week mark is approaching, and you are placed on the operating table.

Now the approach has changed, the child himself chooses the deadline. It is he who decides in what week a planned cesarean section will be optimal, because the most important thing is his health and the health of his mother. If the mother’s body is ready for childbirth, the first contractions are the ideal time for the operation, because if it had not been done, the baby would have come out anyway, because he is completely ready for birth. With this approach, the mother’s milk comes as after a natural birth, at the same time, and the baby does not have any difficulties adapting to extrauterine life.

However, in some cases, an operation is performed, the timing of which is not dictated by the child. If you have to do a cesarean section a little earlier than the first symptoms begin, or rather, you can’t wait for contractions. There are other reasons for surgery similar to this, when it is undesirable to wait for a natural birth.

The timing of how many weeks a planned caesarean section is performed is also determined by the work of the maternity hospital. Most hospitals have operating days, scheduled surgery days, such as Tuesday and Thursday. In addition, the choice of date may be influenced by the workload of doctors and his anesthesiology service. If there are no places in the intensive care unit, it is better to keep you in the antenatal department for an extra couple of days until a place becomes available, even if your pregnancy has already come to an end.

In general, don’t guess when a planned caesarean section is performed, it is impossible to predict at what time this event will take place for you, you can only be sure of one thing, this will be the best time for the birth of your baby. There is no specific date, for example, 40 weeks and not a day earlier or later, the approach is always individual.

So, based on the results of the examinations, your doctor antenatal clinic is inclined to believe that you will have an operative birth. We described it in a separate article. If this is your second experience, you, of course, already know everything, if not, this article contains everything you need to know about what will await you in the maternity hospital.

Preparation involves advance hospitalization. When the deadline approaches, you will be given a referral for hospitalization.

There are important little things you need to know about:

- If you are undergoing a planned operation, you cannot shave your pubic and abdominal area at home. Why? Because if inflammation appears in this area as a result of injury to the skin during shaving, the operation will be dangerous. Small pustules on the skin as a result of unsuccessful shaving will become a source of infection for the wound. Shaving should be postponed until the morning before surgery, just don’t forget to take a good razor with you to the hospital.

When you are assigned a day for surgery, you should take care of what you will drink on the first day after surgery in the intensive care unit. You won't be able to eat at first, but you can and should drink. Prepare yourself clean water without gas and...a lemon.

After surgery, you will need a postpartum bandage from the first days. It relieves pain. Choose a wide model that covers the tummy as much as possible; you can simply buy a postoperative bandage.

Be sure to prepare yourself a charged phone, a full battery and enough money in your account so that you don’t get too bored during your first days in intensive care. After giving birth, you will definitely want to talk to your loved ones.

Hygiene products such as pads and disposable diapers should also be prepared for yourself.

The child may need diapers, you may need some medicine or dressing, a list of such things is usually given in the antenatal clinic when referred for hospitalization.

How is a planned caesarean section performed?

On the eve of the operation, a detailed conversation will take place between you and the anesthesiologist, during which a decision will be made on the method of pain relief for labor. Of course, I would really like to see the moment the baby is born, to hear his first cry. often offered in conjunction with cosmetic stitch in a paid surgery package, if you are willing to pay for your comfort, how much it will cost depends on the clinic. Still, it is more correct to choose this particular path; the first minutes of meeting the child are very important, as is the possibility of the husband being present at the birth.

The evening before the operation, you will have to give up a full dinner, limiting yourself to something very light, and on the morning of the operation you will be left without breakfast and even without a sip of water. There's not a lot of anticipation for you in the morning pleasant procedures, enema and shaving.

Then there will be an operating room.

The duration of a caesarean section does not exceed 40 minutes, and very little time passes before the baby is born; they try to extract it as quickly and carefully as possible. You will not see what is being done to you; the surgical field is protected from the woman’s gaze.

What feelings await you?

If it is general anesthesia, you will feel how they put an IV in you, insert a catheter into your bladder, treat the skin of your abdomen, feel a mask on your face, and then complete darkness and emptiness will come, as if the lights have been turned off... You will come to your senses after the operation.

If you are given a spinal anesthetic, in the operating room you will be asked to lie on your side with your legs pressed against your stomach. Will painful prick in the back, after which you will feel your whole body lower chest You lose all feeling and you can no longer move your legs. During the operation itself, you may experience nausea and vomiting (that’s when you’ll be glad you didn’t have breakfast), severe weakness and dizziness.

When your baby takes his first breath, you will hear his first cry... Perhaps you will experience almost no emotions due to severe weakness, but they will bring the baby to you and show you, and they will definitely ask you to touch him with your hand... Then you will always remember this moment with gratitude , because it is this first contact, the first touch to the child that will connect you with the baby forever.

After the operation, the postpartum woman is transferred to the anesthesiology and intensive care unit, where she will have to spend the first day or two.

After spinal anesthesia Sensitivity will begin to return, and with it pain will come. Don’t be afraid of it, they will definitely help you, easing it with medications.

When you come to your senses in a few hours, your baby will be brought to you. It is unlikely that he will take the breast, most likely he will just sleep, and you will look at him, surprised and happy, and the happiness of being a mother will push aside all your fears and the pain you have experienced...

Home » Childbirth » How many weeks does a third elective caesarean section take place? Reasons for prescribing a cesarean section. We are preparing for a fateful meeting.

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 childbirth is determined and why it 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 in the abdominal wall and uterine wall.

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

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. The planned operation is carried out according to the indications provided for in the list of clinical recommendations of the Russian Ministry of Health. This list is regularly reviewed and adjustments are made to it.

Today it provides for the following situations:

• The pathological location of the placenta is low placentation with incomplete overlap of the internal os or complete placenta previa.
• 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, it is discovered breech presentation If the fetus is large or placenta previa, 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 of 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 the antenatal clinic, where the woman is observed, at 38-39 weeks during the first pregnancy, at 37-38 weeks if a repeat cesarean section is necessary in a singleton pregnancy. In case of multiple pregnancy, as already mentioned, above, they are hospitalized earlier by an average of 2 weeks.