The process of cesarean section The steps and time of cesarean section

Steps of Caesarean Section

1. The doctor should examine the pregnant mother and determine the site for the operation. In addition, the doctor should prepare some work related to delivery, such as cleaning, shaving, disinfection and anesthesia for the pregnant mother.

2. The doctor makes an arc-shaped incision at the determined part, and cuts the skin and muscles step by step according to the skin tissue. First, cut the skin and muscles of the pregnant mother, then cut the external oblique muscles, and then cut the internal oblique muscles, transverse abdominal muscles, and some fascia step by step. If some blood vessels are encountered during the process of cutting the skin and flesh, the doctor will definitely avoid these blood vessels or perform double ligation.

3. After the doctor cuts the peritoneum, he gently picks up the peritoneum with forceps and cuts a small hole on it. Then the doctor will put his fingers into the hole and slowly cut the peritoneum with scissors along the direction of his hand. After a certain degree of exposure to the rumen, he will stop cutting.

4. After handling the peritoneum, the doctor will disinfect his arms and hands again, and then insert his hands into the pregnant mother's abdominal cavity to check the pregnant mother's uterus. The doctor needs to check the condition of the fetus in the uterus and whether there are any problems with some organs near the fetus.

If the doctor finds that the organs near the fetus are not ruptured or adhered, the rumen of the pregnant mother will be slowly moved forward, and the uterus of the pregnant mother will be exposed. The doctor will slowly lift the uterus of the pregnant mother to the incision of the abdomen. During this process, the doctor must move slowly and gently, otherwise it is easy to hurt the uterus.

5. After the doctor takes out the uterus, he will stuff some sterilized gauze on the cut edge of the uterus and the abdomen. This is mainly to prevent the fluid inside from flowing back into the abdominal cavity after the uterus is broken, causing some infection.

6. After determining the greater curvature of the uterus, the doctor will avoid the uterine caruncle of the pregnant mother and then gently cut the uterine wall with a knife.

7. After the doctor cuts open the pregnant mother's uterus, the uterus will definitely bleed, so the doctor will perform ligation on the pregnant mother's uterus at this time. Then the doctor will cut off the adjacent fetal membranes to separate them. If the fetal fluid in the fetal membrane is relatively full, the doctor will make a small cut on the fetal membrane to slowly release the fetal fluid. During the release process, some measures will be taken to prevent the fetal fluid from flowing back into the abdominal cavity and causing infection.

8. After completing the above work, the fetus can be taken out of the pregnant mother's belly. When taking out the baby from the uterus, the doctor will gently follow the incision of the uterus, grab the hind limbs or forelimbs of the fetus in the belly with his hands, find the appropriate direction and angle, and gently pull the fetus out of the belly. If the incision is found to be too small, the doctor will use scissors to expand the incision appropriately.

9. After the doctor takes the fetus out, he will take some measures to fix the pregnant mother's uterus to prevent it from retracting into the abdominal cavity and perform a series of nursing work.

10. Next, the doctor will peel off the placenta in the belly according to the pregnant mother's physical condition. If the placenta can be completely peeled off, it will be peeled off. If there are parts that cannot be peeled off, the placenta will be left in the uterus, and after a period of time, it will automatically fall out of the pregnant mother's body. In this process, the doctor must peel off the fetal membranes on both sides, otherwise it will cause certain obstacles to the subsequent suturing work.

11. The doctor needs to suture the uterus of the pregnant mother. Before suturing the uterus, the doctor will sprinkle some anti-inflammatory powder in the uterus. In the process of suturing, two sutures are usually performed, one is a continuous suture of the whole process, and the other is a suture of the serosal muscle layer embedding suture.

12. Next, the doctor needs to suture the cavity wall for the pregnant mother, and the peritoneum needs to be sutured during the process of cleaning the abdominal wall. In the process of suturing, intestinal sutures are usually used for continuous sutures. After suturing the peritoneum, the doctor writes some antibiotics into the peritoneum through cutting, which can prevent infection and peritoneal adhesion. Then, continuous sutures are performed by gluing layer by layer.

Who must choose caesarean section

Indications for cesarean section

Dystocia (1) Cephalopelvic disproportion: refers to the narrow plane of the pelvic inlet. In layman's terms, it means that the fetus's pelvic inlet is too large relative to the mother's.

Among them, "absolute cephalopelvic disproportion" occurs when the pregnant woman's pelvis is obviously narrow or deformed, or the fetus is obviously too large. The full-term live fetus of this type of pregnant woman cannot "enter the pelvis" and cannot be delivered vaginally. A cesarean section is required at full-term pregnancy. The indications are clear and it is easy to make a decision. However, "absolute cephalopelvic disproportion" is rare in clinical practice, and "relative cephalopelvic disproportion" is more common. Pregnant women with "absolute cephalopelvic disproportion" can try vaginal delivery if the fetus is estimated to be not too heavy, the fetus is estimated to have good tolerance, and the pregnant woman has sufficient physical strength and labor power.

However, since current pregnancy testing methods for measuring the inner diameter of the fetus and pelvis are mostly "estimated", and the delivery process involves the fetus passing through the birth canal in multiple planes and diameters (such as shoulder dystocia: after the fetal head is delivered, the fetal shoulder is stuck at the pelvic outlet and cannot be delivered), it is impossible to ensure before delivery whether these pregnant women with "relative cephalopelvic disproportion" can eventually give birth vaginally, and it is even more impossible to accurately predict the delivery process.

(2) Abnormalities of the bony or soft birth canal: Abnormalities of the bony birth canal, such as a pregnant woman with a coccyx fracture, may have the tip of the coccyx tilted upward, narrowing the effective birth canal. Abnormalities of the soft birth canal, such as severe vaginal malformation, scar stenosis, or pregnancy complicated by rectal or pelvic benign or malignant tumors that block the birth canal. In these cases, even if an episiotomy is performed, it is estimated that the full-term fetus cannot pass through the birth canal, and a cesarean section is preferred.

(3) Abnormal fetus or fetal position: For example, some breech presentation, transverse presentation, and abnormal head presentation (high upright presentation, frontal presentation, posterior chin presentation, etc.) are not suitable for vaginal delivery. Certain situations of twins and multiple births (the first twin is breech or transverse, or conjoined twins, etc.) are also not suitable for vaginal delivery. In addition, some fetal abnormalities that can be corrected, such as the fetus being unable to tolerate the delivery process, or some abnormal part of the fetus that cannot pass through the birth canal, are suitable for cesarean section.

(4) Umbilical cord prolapse: In some pregnant women whose fetal membranes have ruptured, the fetal umbilical cord passes over the fetal presenting part and first prolapses from the cervix into the vagina, or even outside the vagina. This is called umbilical cord prolapse. At this time, the cervix, fetal presenting part, etc. squeeze the umbilical cord, and the fetus may quickly suffer from intrauterine distress or even stillbirth. Therefore, once umbilical cord prolapse is found and the fetal heart is still present, the fetus should be delivered within a few minutes.

(5) Fetal distress: refers to fetal hypoxia in the uterus, which causes fetal acidosis and damage to the nervous system. In severe cases, it may leave sequelae or even fetal death in the uterus. It is a common complication in obstetrics. In this case, if vaginal delivery is not possible in the short term, cesarean section should be performed immediately.

(6) History of cesarean section: Uterine rupture or threatened uterine rupture is likely to occur.

Things to note after cesarean section

1. Try to move around early

Once your catheter is removed, you should try to move around as much as possible to speed up your recovery. However, you may feel dizzy, so move slowly.

2. Pay attention to your diet after childbirth

You may not be able to eat at first, but when you can eat, don't eat spicy hot pot or cake. Caesarean section will make your digestive system uncomfortable, so avoid acid reflux and gastroesophageal reflux problems.

3. Avoid lifting heavy objects

In addition to holding your baby, you should not lift any heavy objects, because this will put pressure on your wound. It will take at least 2 weeks after delivery for your wound to recover to a certain extent.

4. Don’t exercise too fast

Don't start exercising right after giving birth, at least wait until your doctor gives you the OK. Applying pressure to the abdomen too early is dangerous and may cause bleeding. You can try walking with a stroller, which is enough exercise for you.

5. Take good care of your wound

Follow your doctor's instructions and take good care of your wound. Avoid hot baths or showers until the wound has fully healed, as this may cause the wound to become infected.

6. Adopt a comfortable sleeping position

After giving birth, you may find it difficult to fall asleep due to the discomfort of the wound, and lying flat may make you more painful. Therefore, you may still need to sleep on your side.

7. Prevent yourself from constipation

You should drink plenty of water and eat foods rich in fiber to prevent constipation. Straining during bowel movements may put pressure on your abdomen and affect your wound.

8. Watch for unusual signs

If you experience any unusual symptoms while your wound is still healing, such as fever, headache, nausea, etc., these may be signs of infection and you should see a doctor.