Swelling of the legs after cesarean section

Recovery after childbirth is not an easy processeven for women who gave birth through natural birthmarks. What can we say about Caesarean section, when all postnatal problems are joined by post-operative ones! We will talk about what a young mother can do for a more rapid recovery after this surgery.

Cesarean section is a fetal birth operationby extraction through the incision of the abdominal wall and uterus. The postpartum uterus returns to its original state within 6-8 weeks. Trauma of the uterus during surgery, swelling, hemorrhages in the seam area, a large amount of suture material slows the involution of the uterus and predispose to the emergence of postoperative purulent-septic complications in the pelvic region involving the process of the uterus and appendages. These complications after cesarean section are found 8-10 times more often than after vaginal delivery. Such complications as endometritis (inflammation of the inner layer of the uterus), adnexitis (inflammation of the appendages), parametritis (inflammation of the periarticular tissue), subsequently affect the reproductive function of the woman, tk. can lead to disruption of the menstrual cycle. syndrome of pelvic pain, miscarriage. infertility.

Initial state of woman's health, choicerational method and technique of performing the operation, the quality of the suture material and antibacterial therapy, as well as the rational management of the postoperative period, the prevention and treatment of complications associated with operative delivery, determine the favorable outcome of the operation.

Cross section in the lower segment of the uterusis carried out parallel to the circular muscle fibers, in a place where there are almost no blood vessels. Therefore, it less traumatizes the anatomical structures of the uterus and, therefore, to a lesser extent disrupts the course of healing processes in the operating area, and the use of modern synthetic absorbable filaments contributes to the long retention of the wound edges on the uterus, which leads to the optimal healing process and the formation of a well-developed scar on the uterus, which it is very important for subsequent pregnancies and childbirth.

Preventing complications after caesarean section

Currently, for the purpose of preventionmaternal morbidity after cesarean section, modern highly effective antibiotics of a wide spectrum of action are applied, since the role of microbial associations, viruses, mycoplasmas, chlamydia, etc. is great in the development of infection. During the operation of cesarean section, prophylactic antibiotics are administered after crossing the umbilical cord to reduce their negative impact on the baby . In the postoperative period, preference is given to short courses of antibiotic therapy, in order to reduce the flow of drugs to the child through the mother's milk; with a favorable course of cesarean section after surgery, antibiotics are not administered at all.

In the first day after the operation of cesarean sectionthe mother is in the intensive care unit under the close supervision of medical personnel, while monitoring the activities of her entire body. Algorithms for the management of puerperas after cesarean section have been developed: adequate replenishment of blood loss, anesthesia, maintenance of cardiovascular, respiratory and other body systems. It is very important in the first hours after the operation to monitor the secretions from the genital tract, tk. the risk of uterine bleeding is high because of a breach of the uterine contractility, caused by the operating trauma and the effects of narcotic drugs. In the first 2 hours after the operation, a continuous intravenous drip of uterine contracting drugs is made: oxytocin, methylergometrine, an ice bubble is placed on the abdomen.

After general anesthesia, there may be pain and sore throat, nausea and vomiting.

The removal of pain after surgery is of great importance. Already after 2-3 hours, non-narcotic analgesics are prescribed, 2-3 days after the operation, anesthesia is performed according to indications.

Operational trauma, entering the abdominal cavityduring the operation of the contents of the uterus (amniotic fluid, blood) cause a decrease in intestinal peristalsis, paresis develops - bloating, gas retention, which can lead to infection of the peritoneum, sutures on the uterus, adhesion process. An increase in blood viscosity during and after surgery contributes to the formation of thrombi and possible clogging of various vessels.

In order to prevent intestinal paresis,thromboembolic complications, improvement of peripheral circulation, elimination of stagnant phenomena in the lungs after artificial ventilation, early activation of the puerpera in bed is important.

After the operation, it is advisable to turn inbeds from side to side, by the end of the first day it is recommended to get up early: first you have to sit in bed, lower your legs, and then start to get up and walk a little. To get up it is necessary only with the help or under the supervision of medical staff: after enough long lying, it is possible for dizziness, falling.

Not later than the first day after the operation,begin medical stimulation of the stomach and intestines. To do this, use proserin, cerucal or ubretid, in addition, an enema is made. If the postoperative period is uncomplicated, the intestinal peristalsis is activated on the second day after the operation, the gases leave on their own, and on the third day, as a rule, there is an independent chair.

In the 1st day the mother is given a drink of mineral waterwithout gases, tea without sugar with lemon in small portions. On the 2nd day a low-calorie diet is appointed: liquid porridge, meat broth, soft-boiled eggs. From 3-4 days after an independent chair, the woman is transferred to a general diet. Do not take too hot and too cold food, solid foods in your diet should be introduced gradually.

On the 5th-6th day, ultrasound examinations of the uterus are performed in order to clarify its timely reduction.

In the postoperative period, dailychanging dressings, inspection and treatment of postoperative sutures with one of the antiseptics (70% ethyl alcohol, 2% tincture of iodine, 5% potassium permanganate solution). Sutures from the anterior abdominal wall are removed on the 5th-7th day, after which the issue of discharge is decided. It happens that the wound on the anterior abdominal wall is sutured with an intracutaneous "cosmetic" suture resorbed suture material; in such cases, there are no external removable seams. The extract is usually held on the 7th-8th day.

Breastfeeding after cesarean

After a caesarean section,difficulties with breastfeeding. They are caused by a number of reasons, including pain and weakness after the operation, drowsiness of the child against the background of painkillers or violation of the newborn's adaptation during operative delivery, use of mixtures to give a "rest" to the mother. These factors make it difficult to initiate breastfeeding. In connection with the need for a low-calorie diet for 4 days, the formation of lactation occurs against the backdrop of a deficit in the diet of a nursing woman of macro- and microelements, which is reflected not only in the quantity but also in the quality of milk. Thus, the daily secretion of milk after cesarean section is almost 2 times lower in comparison with spontaneous childbirth; in milk, the content of the main ingredients is low.

It is important to ensure that the baby is placed inthe first 2 hours after the operation. Currently, most maternity hospitals work on the principle of joint stay of mother and child.

Therefore, if everything went without complications, you canto express the wish to leave the child next to him and start breastfeeding under the supervision of the staff, as soon as anesthesia goes away and the forces come to take their baby in their arms (approximately 6 hours after the operation). Babies with feeding delayed for a variety of reasons at a later time (birth of children requiring special treatment, complications of the mother), it is necessary to resort to decanting milk during the feeding hours to stimulate lactation.

One of the main conditions for a successful breastfeeding after cesarean section - to find a position in which it is convenient for a woman to feed her baby. In the first day after the operation it is easier to feed lying on its side. Some women find this position uncomfortable, because thus there is a stretching of seams, therefore it is possible to feed sitting and holding the child under the arm ("a soccer ball from under the mouse" and "we lie across the bed"). In these poses, pillows are placed on their knees, the child on them lies in the correct position, simultaneously the load is removed from the area of ​​the seams. As the recovery in the future, the mother can feed the baby and lying down, and sitting and standing.

In order to stimulate lactationphysiotherapeutic methods of stimulation of lactation (UF of mammary glands, UHF, vibration massage, ultrasound, sound "bioacoustic" stimulation), phytotherapy: decoction of cumin, dill, oregano, anise, etc. To improve the quality of breast milk, it is necessary to introduce nutritional additives (specialized protein and vitamin products): "Femilak-2", "Milky Way", "Mama Plus", "Enfimam". All these measures have a favorable effect on the indicators of the physical development of children during their stay in the maternity hospital, and the mother is discharged with a well-established lactation.

Restoration of the physical form after cesarean

Warm showering of the body in parts from the shower is possiblealready from 2 days after the operation, but you can fully take a shower after discharge from the maternity hospital. When bathing the seam, it is better to use soap without fragrances, so as not to injure the crust. It is possible to immerse in a bath not earlier than 6-8 weeks after the operation, tk. by this time the inner surface of the uterus completely heals and the uterus returns to normal. The trip to the bath is possible only 2 months after the examination of the doctor.

To postoperative scar more quicklyresolved, it can be lubricated with prednisolone ointment or gel kontrabetubeks. In the scar area up to 3 months, numbness can be felt until the nerves crossed during the operation are restored.

It is of no small importance to restorephysical form after cesarean section. From the first day is recommended wearing a postpartum bandage. The bandage relieves back pain, helps maintain proper posture, accelerates recovery of muscle and skin elasticity, protects seams from divergence, helping to heal a postoperative wound. However, its prolonged wearing is undesirable, because muscles must work, shrink. As a rule, the bandage is worn for several weeks after childbirth, focusing on the condition of the abdominal muscles and overall health. Therapeutic gymnastics should be started 6 hours after the operation, gradually increasing its intensity. After removing the joints and consulting a doctor, you can begin to perform exercises to strengthen the muscles of the pelvic floor and the muscles of the anterior abdominal wall (Kegel exercise - compression and relaxation of the pelvic floor with a gradual increase in the duration of up to 20 seconds, stomach pulling, lifting the pelvis and other exercises) a rush of blood to the pelvic organs and accelerates recovery. When performing exercises, not only the physical form is restored, but endorphins are also released - biologically active substances that improve a woman's psychological state, reduce stress, a sense of depression, and low self-esteem.

After the operation for 1.5-2 months is notweight lifting is recommended more than 3-4 kg. More active activities can be started 6 weeks after the birth, taking into account the level of their physical fitness before pregnancy. The load is increased gradually, avoiding force exercises on the upper part of the trunk, because this can reduce lactation. Active types of aerobics and running are not recommended. In the future, if possible, it is desirable to engage in an individual program with the coach. After high-intensity training, the level of lactic acid may increase, and as a result, the taste of milk deteriorates: it becomes acidic, and the baby refuses the breast. Therefore, the occupation of a sport for a nursing woman is possible only after the end of breastfeeding, and not breastfeeding - after the restoration of the menstrual cycle.

Sexual relationships can be renewed 6-8 weeks after the operation, visiting the gynecologist and consulting about the method of contraception.

Gradual restoration of muscle tissue inThe scar area on the uterus occurs within 1-2 years after the operation. About 30% of women after cesarean section later plan to have more children. It is believed that more favorable for the onset of pregnancy and childbirth is the period 2-3 years after the previous operation of cesarean section. The thesis "after cesarean section of birth through natural birth can not be possible" is now becoming irrelevant. For several reasons, many women are attempting vaginal delivery after cesarean section. In some institutions, the percentage of natural births with a scar on the uterus after a cesarean section is 40-60%.

Starting with gymnastics
After 6 hours after the operation, you can proceed to the simplest medical gymnastics and massage of the chest and abdomen. You can perform them without an instructor, lying in bed with slightly bent knees:
  • Circular stroking of the palm over the entire surfaceabdomen clockwise from right to left, up and down the straight muscles of the abdomen, from below upwards and from top to down obliquely - along the slanting muscles of the abdomen - for 2-3 minutes;
  • stroking the anterior and lateral surface of the chest from below upwards to the axillary region, the left side is massaged with the right arm, the right side with the left arm;
  • hands are planted behind the back and the stroking of the lumbar region is performed with the back and palmar surface of the hands in the direction from top to bottom and to the sides;
  • deep chest breathing, to control the palm of your handput on top of the chest: at the expense of 1-2 deep breathing in the chest (the chest rises), at the expense of 3-4 deep exhalation, while on the chest slightly press the palms;
  • deep breathing of the belly, palms, holding the area of ​​stitches, 1-2 to inhale, inflating the stomach, at the expense of 3-4 exhale, drawing as much as possible the belly;
  • the rotation of the feet, without lifting the heels from the bed, alternately in one and the other side, describing the largest circle possible, bending the feet to itself and from itself;
  • alternating flexion and extension of the left and right legs, the heel slides on the bed;
  • Coughing, supporting the area of ​​the seams with the palms.
    Exercises should be repeated 2-3 times a day.

Lyudmila Petrova,
Doctor obstetrician-gynecologist of the highest qualification
category, head of the clan department
Maternity Hospital No. 16, St. Petersburg

Cesarean section - how to take care of a wound on the abdomen? [link-1]
External seams are removed usually after eight daysafter leaving the hospital. Rana after cesarean will sooner heal, if you will often air it - expose her to the air, wear spacious clothes and clothes. Do not lift the weight, start gymnastics two months after the operation of cesarean.

Cesarean section - how to take care of a wound on the abdomen?
[link-1]
External seams are removed usually after eight daysafter leaving the hospital. Rana after cesarean will sooner heal, if you will often air it - expose her to the air, wear spacious clothes and clothes. Do not lift the weight, start gymnastics two months after the operation of cesarean.

a very interesting article I have it all happened. Tell me, and after keserevo when you can press

For gymnastics, the author of the article is especially thankful. I gave birth to two on my own, and here's the third with KS. About complications - with a seam I had problems. And it's not that the operation was a bad thing - it's my, apparently. Now everything is working out. Thank the doctors and my family for their support.

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