Gynecology And Obstetrics-

Caesarean section on request

Synonyms

Caesarean section, Caesarean section

English: abdominal delivery

definition

Caesarean section is an operative method of giving birth to a child. A surgical incision through the mother's abdominal wall, which usually runs transversely - rarely longitudinally - opens the uterus and the child is delivered, bypassing the natural birth canal. Indications for a caesarean section can be medical reasons, but it can also be carried out at the express request of the expectant mother. Then one speaks of a caesarean section on request. Medical occasions for a caesarean section are usually safety reasons in the case of risky conditions of the child or mother or are carried out due to mechanical obstacles. This is the case, for example, if the child is lying in a horizontal, foot or breech position instead of in a normal position (with the head towards the pelvis). Anatomical mismatches between the mother's pelvic outlet and the child's head size also make it difficult to give birth in a normal way, e.g. with a water head of the child (so-called Hydrocephalus) or a narrow pelvis of the mother. In the case of twin or multiple pregnancies, the caesarean section is the method of choice in most cases.

High-risk situations that mainly affect the child and thus make a caesarean section necessary include malformations, premature birth, premature rupture of the bladder, premature detachment of the placenta, rhesus blood group intolerance of mother and child, incidents in which the umbilical cord can be threatening for the child, or the child's previous illnesses that have already been diagnosed. On the part of the mother, a caesarean section is indicated, in addition to the express wish of the mother, also if the mother is seriously ill, e.g. in the case of HIV infections, serious injuries or very heavy bleeding, etc. Tears in the uterus and eclampsia (severe clinical picture, which is mainly associated with cramps and can lead to unconsciousness) are absolute indications for an unnatural birth process or an emergency caesarean section.

Epidemiology

In Germany, almost every third child comes by Caesarean section to the world, but only a small percentage due to express caesarean section at the request of the mother. Seen worldwide, the average rate of Caesarean sections is around 20%, but varies considerably from country to country.

Forms of caesarean section

It lets itself in primary of a secondary cesarean section distinguish. Unless the birth has not yet been initiated, that is, no rupture of the bubbles has occurred and / or none have yet Labor pains have started, one speaks of a primary caesarean section. This includes both the caesarean section on request as well as other situations described above in which a caesarean section was already planned in advance. One speaks of a secondary caesarean section if it takes place during childbirth, that is, if the Labor pains have already started. This is mainly at birth complications indexed.

execution

There is a Anesthetic procedure necessary as anesthesia, either in the form of a general or a Regional anesthesia. Normally, regional anesthesia is preferred to general anesthesia, as the mother can experience the birth with full consciousness despite being pain-free. However is a Caesarean section sometimes only possible under general anesthesia, as there are certain contraindications for regional anesthesia such as Coagulation disorders exist. In the case of an emergency caesarean section, regional anesthesia is also usually dispensed with due to time constraints. In addition, the patient's psychosocial situation must be taken into account when choosing the procedure.

With the much more common regional anesthesia, a distinction is made between two procedures: Spinal anesthesia and epi- / or. Epidural anesthesia (so-called PDA). Both procedures lead to a loss of pain perception in the lower half of the body, but in no way affect the expectant mother's consciousness. Through a puncture with a very thin needle in the area of the Lumbar spine a local anesthetic is introduced into spaces near the spinal cord, which blocks the transmission of pain in the Spinal cord and the nerves going out from it. The main difference between the two methods is the location where the pain reliever is applied. The advantage of an epi- / or. Epidural anesthesia versus spinal anesthesia consists in that Pain can also be regulated during or after the operation, since after the puncture there is still access to the spinal canal via which it continues Medication can be applied from the outside. This is not possible with spinal anesthesia due to a single puncture and injection.

Before the actual operation can begin, the pubic area must be shaved and the entire operating area must be thoroughly and extensively disinfected. In order to be able to work under sterile conditions, the surgeon will stick a sterile film around the area on the skin. The operation begins with an incision through the abdominal wall, which is usually made across the pubic mound. In principle, there is also a longitudinal incision between the navel and Pubic bone possible, but is hardly used today. In the past it was still common practice to open up the deeper tissue layers by incision, but today the so-called "gentle caesarean section", also Misgav-Ladach-Sectio called, a surgical method in which the abdominal wall, cavity and uterus are opened wider and sufficiently stretched with the help of the fingers. This protects the tissues, blood vessels and nerves are damaged less often and the surgical wound heals more quickly, so that the mothers can usually be discharged from hospital more quickly. After the uterus has been opened, the child is removed and the umbilical cord is cut. The entire process usually takes no more than a few minutes. While the child is first cared for by a midwife, the surgeon has to take care of those who remain in the uterus Plaster cake (placenta) together with the umbilical cord and carefully close the individual layers again with seams. The incision is held together with surgical clips. If the operation and the following time have passed without complications, the mother is usually mobile from the third day after the operation and can be discharged home with her child after an average of seven days in hospital.

Complications and risks

In general, the risk of death for healthy women with a caesarean section is higher than with a natural birth. One assumes about two to three times the risk. Probably the most common complications are wound healing disorders and infections. Adhesions can also occur in the wound area, which can affect a subsequent pregnancy. As with any other operation, caesarean section can lead to increased bleeding and damage to other organs and structures located in the vicinity of the operation area. The intestines, bladder, ureters and nerves are particularly at risk. There may be perforations, which are often life-threatening inflammation of the peritoneum (Peritonitis) entail. The damage to nerve structures leads to a feeling of numbness, in the worst case to permanent paralysis. Urinary tract infections and bladder emptying disorders can result from the urinary catheter required for the operation. Because the mother is initially bedridden after the caesarean section, the risk of thrombosis and embolism is increased.

On the part of the child, complications rarely arise during a caesarean section. Injuries are rare, most likely the child's breathing can be restricted by adjustment disorders or the penetration of the amniotic fluid into the airways (so-called amniotic fluid aspiration). Furthermore, breastfeeding problems after caesarean sections are described more frequently. In principle, after a caesarean section, it is possible to give birth to the child naturally in a subsequent pregnancy. In the past, the principle "once caesarean, always caesarean" was adhered to. Nowadays there is no longer any reason to refuse a natural birth after a caesarean section, unless the reason for the first caesarean section persists, for example a narrow pelvis in the mother or an unfavorable position of the child in the mother's stomach.

In principle, each pregnancy should be carefully weighed up again whether a caesarean section is necessary or desired by the mother and this should be discussed critically with the treating doctor and the midwife, taking into account the advantages and disadvantages.

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