Caesarean section with swelling


All indications for this kind of operationare divided into absolute (which do not allow the delivery of births through the natural birth canals under any circumstances) and relative (the presence of which does not always lead to an operative delivery of a woman). In turn, all indications for cesarean section are divided into maternal and fetal indications.

Absolute indications for cesarean section

Absolute indications for cesarean section from mother's side

1. Anatomically narrow pelvis, III-IV degree of pelvic narrowing.

The anatomically narrow pelvis is classified according to the shape and degree of constriction:

1) transversely narrowed pelvis;

2) flat pelvis - a simple flat pelvis, a flat-skeleton pelvis, a pelvis with a reduced direct dimension of the plane of the wide part of the cavity of the small pelvis;

4) skewed and skewed pelvis;

5) the pelvis is deformed by fractures, tumors, exostoses (bone growths on the bones).

The causes of the formation of an anatomically narrowed pelvisvarious: malnutrition or excessive physical activity in childhood, rickets, injuries, tuberculosis, poliomyelitis. Contribute to the formation of this pathology of the violation of hormonal status during puberty: estrogens stimulate the growth of the pelvis in transverse dimensions and its ossification, androgens - the growth of the skeleton and pelvis in length.

Diagnosis of the transversal pelvis is veryis difficult, since it is possible to measure only the external dimensions of the pelvis, which with such a pelvic narrowing, as a rule, normal. Therefore, it is possible to judge the shape and size of a small pelvis with the greatest certainty on the basis of additional research methods.

However, this pathology can be assumed onthe basis of available data, which can lead to the development of bone marrow pathology (diseases, injuries, sports, ballet in childhood). Also pay attention to the course and outcome of previous births (stillbirths, birth injuries in the fetus, surgical interventions, traumas of the birth canal in the mother). The examination of a woman in a woman's consultation and a maternity hospital also helps. Examination of a woman begins with the measurement of height, body weight - attract attention to changes in the physique, the presence of deformities of the bones of the skeleton, lameness. Exterior examination of women with a narrow pelvis often reveals a pointed form of the abdomen in primiparas, otviselyu - in the re-birth. Often in pregnant women with a narrow pelvis, transverse and oblique fetal positions are encountered. With special care, measure the external dimensions of the pelvis. Reducing the size of the pelvis and breaking their relationships make it possible to establish not only the presence of a narrow pelvis, but also its shape. Information on the thickness of the pelvic bones can be obtained using the Soloviev index: the circumference of the radiocarpal joint, exceeding 15 cm, indicates a significant thickness of the bones and, consequently, a decrease in the volume of the small pelvis. Also helps to diagnose vaginal examination, in which it is possible to determine the capacity of the small pelvis, the shape of the sacral cavity, the presence of changes in bones, such as outgrowths (exostoses) and other deformities of the bones.

2. Premature detachment of the normally located placenta (in the absence of conditions for rapid delivery through the natural birth canal).

Normally, the placenta is separated only after birththe fetus. When separating the placenta before this time (during pregnancy, in the I or II period of labor), this condition is called premature detachment of a normally located placenta.

To the causes of premature detachmentNormally placed placenta can include mechanical factors - abdominal trauma, increased uterine volume, as well as rapid emptying of the uterus (with polyhydramnios, multiple pregnancies, large or giant fruit), a small length of the umbilical cord, a belated rupture of the bladder, dystrophic changes in the endometrium. At present, great importance in the occurrence of premature detachment of the normally located placenta is due to changes in blood vessels due to late toxicosis of pregnant women, hypertensive disease or kidney disease. The influence of stressful situations on premature separation of the placenta was noted.

Premature detachment is normally locatedthe placenta arises sharply. During pregnancy or during labor, there is a rapidly increasing pain, initially localized at the site of the placenta and gradually spreading to other parts of the uterus. The intensity of the pain syndrome is different and depends on the place of occurrence of placental abruption (the pain is most pronounced when the placental abruption begins from the center). There is also an increase in the tone of the uterus, the uterus becomes tense, painful on palpation, enlarged in size.

Premature detachment is normally locatedthe placenta is mild and severe. This division of the flow of this process depends primarily on the blood loss caused by both the placental abruption area (partial, complete) and the speed of the rejection process, as well as the cause of the detachment and accompanying diseases of the woman.

With mild severity, the general conditionpregnant woman or parturient child suffers insignificantly. Severe degree of placental abruption is accompanied by worsening of the patient's condition, up to the appearance of symptoms of shock: pallor of the skin, palpitations, falling blood pressure. In this situation there is marked fetal suffering in connection with circulatory disorders and lack of oxygen. In this situation, the condition of the fetus depends primarily on the area and speed of placental abruption. Most authors believe that with an acute detachment of less than 1/3 of the placenta, the fetus is in a state of hypoxia (but suffering at this stage is compensated and when the placental abruption is not progressing the life of the child is out of danger), whereas in acute detachment of 1/3 and more, the fetus always dies .

Bleeding from the genital tract differ induration and quantity of blood. Bleeding can be internal, external and combined. Even if the internal and external bleeding is equal, internal bleeding is considered the most dangerous and is often accompanied by a shock from massive blood loss. The color of the blood flowing through the vagina with a sharp detachment is scarlet, whereas with a detachment of considerable prescription it is brown, serous-bloody with dark clots.

Modern diagnostic methods, primarily ultrasound scanning, facilitate the diagnosis of placental abruption, make it possible to accurately determine the area of ​​detachment and the magnitude of the hematoma.

3. Threatening or beginning rupture of the uterus.

The incidence of uterine ruptures is 0.1-0.05% of the total number of births. The threatening and, the more so, the beginning of the rupture of the uterus, which occurred in the hospital, is always the result of incorrect birth management.

At the time of occurrence, a threatening rupture of the uterus can be during pregnancy and during labor.

The causes of uterine rupture are different:

1) spontaneous uterine ruptures occur whena mechanical obstruction to delivery and a healthy uterine wall; with pathological changes in the uterine wall; when a combination of mechanical obstruction and changes in the uterine wall is combined;

2) violent ruptures of the uterus are due to rough interventions during childbirth, with no overextension of the lower segment or accidental trauma;

3) mixed are caused by external influence - mechanical, in the presence of hyperextension of the lower segment.

At present, it is proved that the mainin the emergence of this process have a combination of pathological changes in the uterine wall (chronic inflammation of the endometrium and other layers of the uterus when exposed to an infectious agent) with a mechanical factor.

As a rule, rupture of the uterus is a consequence ofoverstretch of the lower segment, associated with a mechanical obstruction to fetal birth. Under the influence of labor, the fetus is, as it were, driven into the overstretched lower segment. As a result, at this moment, any, even the most insignificant, effect leads to the rupture of the overstretched lower segment of the uterus. Obstacles in childbirth that contribute to rupture of the uterus are very diverse; this is a narrow pelvis, a large fetus, an incorrect insertion of the head, an incorrect position of the fetus, significant cicatricial changes in the cervix. As a result of recent studies, it has also been found that, during prolonged labor, a significant disturbance of energy metabolism occurs, leading to the accumulation of toxic compounds that damage tissues. The muscle of the uterus becomes flabby, easily torn. The rupture takes place against a background of weakened uterine contractions or discordant labor. Changes in myometrium can occur due to various diverse causes: underdevelopment and malformations of the uterus (the uterus, poor in muscle tissue, is less elastic), cicatricial changes due to abortions complicated by the course of previous births, infection. The most common cause of inferiority of the muscular layer of the uterus is the scar after the previous cesarean section, especially when the placenta is attached to the rumen.

To cesarean section, as a rule,begin with a threatening rupture of the uterus, surgery is much less common with the uterine rupture already under way (the operation is performed by women whose uterine rupture occurred outside the hospital).

The threatening rupture of the uterus, as a rule,is characterized by a clear definite symptomatology. The onset of symptoms coincides with the onset of the second stage of labor. There is a restless state of the woman, complaints of a sense of fear prevail, strong incessant pains in the abdomen and lower back, despite the introduction of pain medications. Generic activity is often strong, contractions are frequent, very painful. During the period between contractions, the uterus practically does not relax. Insufficiently pronounced labor can be observed in women who have been re-born. The uterus because of this overstretch, especially the lower segment, so when his palpation marked sharp soreness.

In the clinical picture of an already accomplishedrupture of the uterus, the severity of all symptoms increases dramatically: against the background of all the above symptoms, there is a sensation of a strong sudden "dagger" pain, sometimes a feeling that something bursts in the stomach, ruptured. Generic activity, which until then was a violent or medium force, suddenly ceases. There may be bloody discharge from the genital tract, although more often bleeding is noted in the abdominal cavity. In the future, the picture of shock associated with blood loss and trauma develops. If you do not provide urgent qualified medical care (fighting blood loss and an emergency operation of cesarean section), a woman and a child may die.

4. Full placenta previa or bleeding with incomplete presentation.

Placenta previa is characterized by abnormalits location: instead of the body of the uterus, the placenta to some extent captures the lower segment. The frequency of this complication is 0.5-0.8% of the total number of births.

The following variants of placenta previa are most often distinguished:

1) central, in which the placenta is located in the lower segment and completely blocks the internal shed;

2) lateral, in which the placenta is partially located in the lower segment and does not completely cover the inner pharynx;

3) marginal, when the placenta is also located in thethe lower segment, reaching the edge of the inner throat. It should be noted that in the clinical practice of a doctor, the presentation of a presentation is possible only when the opening of the uterine pharyngeal (about 5-6 cm). Therefore, almost obstetrician-gynecologists use a simplified classification - the division of placenta previa into full and incomplete (partial). The causes of this pathology include traumas and inflammatory diseases of the endometrium, multiple births, abortions, etc. Placenta prevalence usually occurs in re-births (about 75%) and significantly less in primiparas (about 25%). Among the factors contributing to the presentation of the placenta, it should be pointed to genital infantilism, violations in the endocrine system (a violation in the thyroid gland, ovaries, etc.), scars on the uterus, myoma. To this pathology may cause some diseases that disrupt blood circulation. These include diseases of the cardiovascular system, kidneys and liver.

It is noted that this pathology is much more frequentoccurs in the I trimester of pregnancy, whereas in the subsequent there is a shift in the location of the placenta due to the growth of the uterus body in length. The possibility of migration of the placenta is also explained by the "search" for naps more favorable than the lower parts of the uterus (isthmus - the lower segment), places to provide the necessary nutrition of the fetal egg. The placenta during presentation is usually different from normally attached: it is thin, enlarged in size. It is noted that migration of the placenta is more often observed when it is located on the anterior wall of the uterus.

Placenta previa recurringbleeding from the genital tract during pregnancy. Bleeding can be short and minor, prolonged and plentiful, spontaneous or conditioned by provoking factors (physical activity, sexual intercourse, defecation, vaginal examination). The appearance of bleeding is noted at the time from 12 to 40 weeks of pregnancy. During pregnancy, the cause of bleeding with placenta previa is its detachment. At the end of pregnancy, the appearance of bleeding is associated with the formation of the lower segment of the uterus: a poorly elastic placental tissue is not able to stretch after the stretching of the uterine wall, partly its separation and detachment occurs, while the intervillous spaces are opened and bleeding begins. In childbirth this process is expressed to a greater extent, which can lead to severe profuse bleeding. There is a connection between the time of bleeding and the location of the placenta. At occurrence for the first time a bleeding can be both moderate, and plentiful, sometimes there is an intensive bleeding, very dangerous for a life of mother. In the vast majority of women after the onset of bleeding, premature birth occurs.

In most cases, the diagnosis of presentationthe placenta is not particularly difficult. It is very important to follow all safety precautions. Vaginal examination can be carried out only in a sufficiently equipped hospital with a deployed operating room, as internal research can provoke profuse bleeding. In the diagnosis of placenta previa, the most informative method is ultrasound scanning.

In connection with insignificant bloodysecretions appoint bed rest, drugs that reduce the contractile capacity of the uterus, improve blood circulation between the placenta and the fetus. It is also necessary to carry out anti-anemia therapy (anemia develops as a result of periodic bleeding). Pregnant women with a placenta before the end of pregnancy are in the hospital under strict supervision of the staff. In the case of severe bleeding or frequent recurring minor bleeding, it is advisable to perform a cesarean section at any time of pregnancy. If a woman with full placenta presentation delivered pregnancy to the end, the only way to deliver is by elective cesarean section.

5. Eclampsia during pregnancy or in the first stage of labor; the lack of the ability to quickly give birth to a pregnant woman with severe gestosis, not amenable to therapy. The appearance of renal-hepatic insufficiency.

Development of severe gestosis during pregnancysecond half of pregnancy adversely affects the condition of the fetus and the mother's body. And the importance is not only the severity of gestosis, but also the duration of its course. Thus, the negative effect on the body of long-term, mild forms of gestosis is no less significant than the effect of their rapidly progressing forms of severity.

Gestosis (late toxicosis) is a complication of the secondhalf of pregnancy, is characterized by a violation of the normal functioning of the organs and is manifested by the appearance of edema, proteinuria (the detection of protein in the urine), hypertension (lifting of blood pressure).

Gestosis occurs in 2-14% of pregnant women. There is a more frequent occurrence of this pathology in women suffering from various chronic diseases of internal organs, as well as in women with first births, especially in young (under 18), and in pregnant women over 30 years. Often there is the occurrence of gestosis of the second half of pregnancy in women who had a development of this pathology during pregnancy in the family (mother, sister, daughter).

Gestosis is divided into 4 stages:

2) nephropathy (kidney pathology) - mild, moderate, severe;

There are many theories advancedvarious authors about the cause of gestosis of the second half of pregnancy, but to this day its nature continues to remain unclear. There is no doubt only the relationship of the disease with pregnancy: gestosis appears during pregnancy, and if it does not manage to lead to serious complications, it disappears after the termination of pregnancy.

Symptoms of gestosis of the second half are quite clear(very rarely occurs atypical course of this disease), and are represented by various combinations of the three above symptoms - swelling, proteinuria (determination of protein in the urine), hypertension (high blood pressure).

Not always, especially in the initial stagesdisease, a woman feels bad, swelling can be minor, and pressure rises may not be felt or interpreted by a woman as fatigue, headache. As a rule, the initial manifestations of gestosis of the second half of pregnancy are suspected in the women's consultation with constant monitoring of the woman.

In consultation, however, all the features are taken into accountwomen in assessing the size of the increase in body weight of a woman, because there are factors that affect this process, namely age, the initial body weight before pregnancy, the diet, work and rest. Now it is considered that starting from about 32 weeks of pregnancy, the weight of a woman should increase by 50 grams per day and, therefore, 350-400 g per week or 1 kg 600 g (but not more than 2 kg) per month, and for the whole pregnancy - no more than 10-12 kg. Of course, all these data are averaged. It is possible to calculate for each woman individually the rate of weight gain, taking into account the ratio of body weight to the height of the woman. It can be assumed that the weekly weight gain should not exceed 22 g for every 10 cm of growth and 55 g for every 10 kg of the initial mass of the pregnant woman. For example, if the height of the pregnant woman is 160 cm, then her weekly increase should be 350 g, and with a body weight of 60 kg before pregnancy, 330 grams weekly.

Edema. as a rule, expressed in different ways. Depending on this, three degrees of severity are distinguished:

I degree - localization of edema only on the lower extremities,

II degree - spreading them to the abdominal wall,

III degree - the spread of swelling up to edema of internal organs.

High blood pressure more common with edema and proteinuria,However, this form of gestosis of the second half of pregnancy is rarely isolated. There is also a division of the height of arterial pressure figures of severity:

I degree - arterial pressure not higher than 150/90 mm Hg. p.

II degree - arterial pressure from 150/90 to 170/100 mm Hg. p.

III degree - arterial pressure above 170/100 mm Hg. Art.

Impaired renal function one of the most frequent forms of late gestosis (it is 60% of all other forms). This form of gestosis is also divided according to the severity of changes on the part of the kidneys.

The gestosis of the second half will be an indicationto a caesarean section only if there is a severe or unresponsive form of gestosis and also with developing complications of the disease (cerebral hemorrhage against increased pressure, retinal detachment, acute renal-hepatic insufficiency, when the liver and the kidneys do not cope with their work and the metabolic products accumulate in the body).

Preeclampsia refers to severe forms of gestosis. Along with all the listed symptoms in this course of gestosis, there are signs of disturbances in the work of the nervous system and the brain under the influence of an increase in blood pressure. These include headache, dizziness, visual impairment, retardation, tinnitus. This often causes nausea, vomiting, pain in the abdomen, which is associated with a violation of blood circulation in the stomach and liver. Pre-eclampsia is a serious condition, indicating a convulsive readiness of the pregnant woman's body. Any stimulus (loud sound, bright light, pain and even ordinary vaginal examination) can lead to the development of a convulsive fit. As a rule, preeclampsia is preceded by the gestosis clinic of the second half of pregnancy, and the appearance of such a form can be associated with either inadequate treatment or with its absence, although the course of the disease is rarely enough without effect on adequate therapy.

Eclampsia - a very rare form of gestosis secondhalf of pregnancy. It can complicate the course of pregnancy, childbirth and the postpartum period. Its main manifestation is seizures with loss of consciousness. This form of gestosis, like eclampsia, indicates severe violations of organs and systems, which can lead to the death of the patient. The most common cause of death with this form of gestosis is cerebral hemorrhage or other vital organs. The fetus may die from lack of oxygen and nutrients due to a violation of uteroplacental blood supply, including due to premature detachment of the normally located placenta.

Cesarean section with eclampsia is carried out ifthere are no conditions for rapid delivery (no birth canals, etc.), in the absence of the effect of intensive care and resuscitation; deterioration of the maternity (the increase in the numbers of blood pressure, increased heart rate, headache, weakness).

6. Cicatricial changes in the pelvis and genital organs (rare cases of stenosis of the vagina and cervix due to such infectious diseases as diphtheria, scarlet fever and others, as a result of various manipulations with a criminal abortion, etc.); genitourinary and intestinal fistula. Tumors of the soft and bony parts of the pelvis, uterine fibroids, ovarian tumors, with unfavorable localization may be an insurmountable obstacle to the extraction of a small fetus.

Genitourinary and intestinal fistula most oftenarise in the preceding labor with prolonged standing of the head in one plane, which leads to compression of soft tissues and subsequent necrosis. Regardless of whether a plastic surgery was performed or the fistulas were healed independently, the scar tissue during labor does not lend itself to stretching, it tears. Therefore, it is more expedient to perform births by cesarean section.

Scars of the cervix and vaginal walls ariseas a result of operations on these organs, as well as after their ruptures in previous births, especially those who have not been nursed. This creates insurmountable obstacles for opening the cervix and stretching the walls of the vagina, necessary to expel the fetus. Childbirth through the natural birth canal leads to deep ruptures of the cervix and vaginal walls, and neighboring organs are also involved, which does not justify such tactics of delivery.

Tumors of the pelvic organs (uterine myoma, tumorsovaries, bony exostoses) are an absolute indication to caesarean section only in those cases when they reach significant sizes, as a result of which the birth of the fetus through the natural birth can not be possible. If we consider uterine fibroids, then the choice of the method of delivery is important not only for the size of the node, but also for the location of the node.

The presence of an ovarian tumor is also aindication to caesarean section. This is due to the fact that in a pregnant woman, tumors reduce the capacity of the pelvis, and, blocking the birth canal, interfere with the advancement of the head. In addition, in childbirth, malnutrition of the tumor is possible, with the formation of necrotic changes. All this determines the need for delivery of women with an ovarian tumor by the abdominal route, followed by removal of the tumor.

It is also possible to interfere with the advancement of the head with bonetumors - exostoses, located most often in the symphysis and sacral Cape. Bone tumors can reach quite large sizes (osteosarcoma,) and occupy a significant part of the cavity of the small pelvis, and, therefore, are an obstacle to the birth of the fetus through the natural birth canal.

Varicose veins of the genitals havevalues ​​for determining the method of delivery. The pronounced varicose veins of the cervix, vagina and external genitalia represent an extremely high risk in maternity deliveries. Varicose ruptures arising from the pressure on them of the fetal head can cause fatal bleeding, which is also determined by the most appropriate method of delivery by the abdominal route.

Absolute indications for cesarean section from the side of the fetus

1. Improper fetal position: transverse, oblique or pelvic position, if a large fetus is to be born.

The wrong position of the fetus is formedcan for various reasons. From the mother's side, the causes of fetal malformation can be caused by: congenital malformations of the uterus (for example, the presence of a septum in the uterus, etc.), uterine tumors, a narrow pelvis, a large number of births in the past, and a decrease and increase in the tone of the uterine musculature. Many of these causes are themselves indications for delivery by cesarean section. Fetal factors are fetal development anomalies, prematurity, decreased motor activity of the fetus, multiple pregnancies (twins or triplets). Such changes can also be caused by placental factors, namely, placenta previa, placenta localization in the area of ​​tube angles and the uterine fundus, polyhydramnios or hypochlorism.

If there is a pelvic presentation, independentbirths are possible with a small fetus and no other pathology on the part of the mother. However, labor in pelvic presentation is often complicated by untimely outflow of amniotic fluid, weakness of labor, umbilical cord proliferation, fetal hypoxia.

Currently pregnant with pelvicThe presentation of the fetus is hospitalized in the hospital 7-10 days before the expected date of delivery, where on the basis of a thorough analysis of all risk factors plan the tactics of delivery. In favor of the planned cesarean section, the question is solved in the presence of such concomitant diseases and complications as a narrow pelvis (I, II degree of narrowing), a large fetus, the age of the woman giving birth to 35 years and older, the presence in the past of the birth of a dead child, on the uterus, etc. Naturally, such pathological processes as placenta previa, pelvic organs tumors and others, themselves are an indication to the caesarean section.

Therefore, at present, the tactics of obstetrician-gynecologists in pelvic presentation of the fetus without the above mentioned complications is the management of labor through natural birth canals.

The only absolute indication for a caesarean section in the interest of the fetus with uncomplicated pelvic presentation is the estimated weight of the fetus over 3500 g.

2. Incorrect insertion of the head.

Incorrect insertions of the head can be attributed extensor insertion of the head into the entrance to the small pelvis. Depending on the degree of extension, this or that variant of insertion arises: anterolateral - moderate extension, frontal - moderate degree of extension, facial - maximum extension.

Causes of incorrect insertionheads can serve as deviations from the norm of the shape and size of the pelvis of the mother, a decrease in the tone of the uterus, a decrease in the tone of the pelvic floor muscles, small or excessively large fetal dimensions, congenital fetal thyroid tumor, stiffness of the atlanto-occipital fetus joint, polyhydramnios and multiple pregnancies. Also, extensor insertion can lead to a violation of the fetus's position, in particular, tipping the handles around the neck. A certain role is played by the condition of the abdominal press. Hanging belly and displacement of the uterus to the side (more often to the right) lead to the fact that the axis of the uterus and the axis of the fetus do not coincide with the axis of the pelvis. As a result, the head goes into one of the lateral parts of the pelvis, and if the trunk of the fetus is deflected towards the occiput, the chin is removed from the chest and an extension of the head arises. In addition, the deformation of the skeleton in the mother (kyphosis - curvature of the spine) can contribute to the extension of the head.

Of all types of mis-insertion of the head, not all are absolute indications for cesarean section. To such prepositions include frontal, a front view of the facial, posterior insertion and a rear view of a high straight standing. Childbirth through the natural birth canal alivefull-term fetus with these kinds of insertion of the head are impossible even with normal pelvic dimensions. Timely execution of caesarean section will allow to receive a live child and prevent birth trauma from the mother.

The situation is more complicated when choosing the method of delivery with other insertions of the fetal head: front-head, rear view of the facial (definition on the frontal back), before the insertion, the front view of a high straight head stand. Genera at the above insertions endsafely for the mother and child with normal pelvic size, small fruit, good labor activity, so timely evaluation of the condition of the fetus, the mother's birth canal, the size of the fetus and the pelvis of the woman is very important for the proper choice of the route of delivery in this situation. It is more expedient to change the tactics of delivery in favor of cesarean section if any of the above conditions are detected.

3. Presentation and prolapse of the umbilical cord.

When the umbilical cord falls, the risk of fetal deathbirths through the natural birth canal is extremely high. Causes of presentation and prolapse of the umbilical cord are in many respects identical with those due to incorrect insertions of the head and fetal positions: narrow pelvis, polyhydramnios, pelvic presentation, oblique and transverse position of the fetus, premature and early discharge of amniotic fluid with a high-standing head. The prolapse of the umbilical cord is more dangerous in the head presentation of the fetus than in the pelvis, since the head is closely adjacent to the walls of the small pelvis, because of which the umbilical cord can be more strongly clamped. Attempts to direct the loops of the fallen cord by the anterior head are always ineffective. The only way to get a living baby with an umbilical cord is to have an emergency caesarean section.

4. Acute hypoxia of the fetus.

This condition is characterized by a lack of fetusoxygen and nutrients from the mother. Causes: development of bleeding during presentation and premature detachment of the normally located placenta, anomaly of labor activity (for example, absence or weak labor activity), untimely outflow of amniotic fluid, improper insertion of the head, pelvic presentation and transverse position of the fetus, cord obtuse the cord, umbilical cord prolapse and others. As can be seen, the reasons are different in origin, but they are united by the fact that all these complications lead to an acute disruption of uteroplacental blood circulation and a severe condition of the fetus, expressed in varying degrees depending on the type and severity of the cause that caused it.

In the diagnosis of acute fetal hypoxia in the firstturn helps to determine the heartbeat of the fetus - (listened to by a stethoscope) or the recording of a cardiotocogram by a special device where it is possible to record the change in the fetal heart rate on the film. In the absence of the effect of the current treatment of this condition, it is necessary to change the tactics of delivery in favor of caesarean section, since further suffering of the fetus is unjustified and will lead to severe asphyxia of the newborn or his death.

5. The state of agony (dying state) or death of a mother with a live fetus.

At the present moment the legislation of our countrydoes not regulate the tactics of doctors' behavior about caesarean section on a dead and dying woman. In modern literature, extremely rare reports of this operation. Some authors determine the maximum time for obtaining a live child of 21-23 minutes. Sometimes, caesarean section on a dying woman is of special importance, because in some cases the woman's condition after the extraction of the fetus improves, and she survives.

Relative indications for cesarean section

Relative indications for caesarean section from the side of the mother

Relative indications include situations,when the possibility of delivery in a natural way is not excluded, but the risk of complications for the mother and / or the child exceeds the risk of complications of abdominal delivery (caesarean section operation).

1. Clinically narrow pelvis - the situation that arises in the process of giving birth andcharacterized by mismatch of the fetal head with the size of the mother's pelvis. At the same time, the anatomically narrow pelvis at I, II degrees of the pelvic narrowing can be normal for passage of a small fetus and good labor. As a rule, a clinically narrow pelvis is diagnosed in labor, but at the end of pregnancy, it is possible to predict the likelihood of a functional mismatch between the fetal head and pelvis, especially in the case of an anatomically narrow pelvis and the expected large fetal dimensions. To presume a possible clinical mismatch can be based on measurements of a woman's pelvis and the calculation of the estimated weight of the fetus according to the formulas. It helps to determine the mass of the fetus, the nature of the presentation and insertion of the ultrasound scan method with dopplerometric examination. Usually, with careful measurement of the pelvis, there is no difficulty in diagnosing a clinically narrow pelvis. The exception is the transversal pelvis, since in this case measurement of the external dimensions of the pelvis does not provide reliable information.

Complications that may occur for the mother andfetus with a clinical narrow pelvis, are serious enough and numerous. These include: untimely outpouring of amniotic fluid, prolonged standing of the head in one plane leads to the formation later of urogenital and intestinal fistula, rupture of the uterus, weakness of labor, hypoxia and craniocerebral trauma of the fetus, up to his death. Therefore, when exhibiting the incompatibility of the size of the pelvis of a woman and the size of the fetus, it is more expedient to resort to a cesarean section.

2. Long-term gestosis of the second half of pregnancy, lack of treatment effect or severe atypical course of this type of disease.

As already described above, absolute indicationsTo the delivery by cesarean section will be severe forms of gestosis - eclampsia, pre-eclampsia. However, it should be noted that the long-term non-treatable gestosis of the second half of pregnancy is not a favorable condition for the normal life of the mother's organism and, accordingly, the fetus.

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