2 e caesarean section. Second caesarean section

05.03.2020

Second cesarean section It is often appointed to women who gave birth through surgery. This operation is carried out on medical testimony. Assessment of the state of the future mother is carried out by a physician in the second trimester. Some patients give birth in such a way own willingBut this situation is rare.

The definition of the timing of surgery is carried out by a specialist. The doctor evaluates general characteristics Health for patients and availability of testimony to cesarean section. It is also necessary to take into account the health of the fetus. If a child has various health problems, the woman is prescribed a repeated caesarean section.

Caesarean section for the second time is appointed by the availability of indications. Often such a procedure is carried out after delivery, which passed with surgical intervention.

In this case, there is a scar cloth in the uterine wall. The scar consists of cells that change the properties of the tissue. The damaged section of the wall is not reduced, there is also no elasticity.

The operation is carried out in large sizes of the fetus. If the alleged weight of the child exceeds 4.5 kg, surgical intervention is necessary. In this case, the dice of a small pelvis cannot push up to sufficient size. Fruit can be stuck in the birthway. To avoid possible complication, I need a second caesarean section.

Operational impact is carried out in multiple pregnancy. Childbirth two or more children can be accompanied by a risk for the life of the mother. There may also be problems in children. The preservation of the life of the feminine and children is the main criterion when choosing a type of birth. For this reason, doctors are resorted to the surgical type of labor.

Cesarean is carried out with the wrong position of the child in the uterine cavity. If the fruit took the cross position or settled down at the bottom of the uterus, the operation should be carried out. Natural generic activity May cause fetal death. Death arises when passing by the child's childbirth. Due to lack of oxygen, hypoxia arises. The child suffocates. To avoid fatal outcome you need to conduct a cross section.

Also the cause can be physiological structure Small pelvis. The bones are gradually moving before approaching childbirth. Fruit shifts B. low part. But if the pelvis is narrow, then the child can not shift on the way. The prolonged stay of the fetus in the uterus without spill waters can lead to death.

Relative reasons for the purpose of the operation

A number of relative reasons are allocated for which the second caesarean section is carried out. Such reasons include the following pathologies:

Many women suffering from myopia are highly appointed by the second planned caesarean. The generation process may be accompanied by strong sweats. Incorrect observance of the dug causes an increase in intraocular pressure. Women with myopia can lose their eyesight completely. Also, patients with myopia have problems with brain vessels. Pulls affect and vascular system. To eliminate a further complication of vision of the patient, an operation is recommended.

Oncology is not always the cause of the recommendation of the cesarean section. When evaluating the state of the woman, it is necessary to explore the neoplasm. If cancer cells are actively multiplied, then the woman should not give birth independently. If the tumor does not develop, surgical intervention can be avoided.

Sugar diabetes causes various health problems in humans. The disease has a negative impact on the condition of tissues and vessels. The walls of the vessels are thinned. There is an increased incidence of capillaries. During natural labor, excessive blood pressure on the walls of the vessels can lead to the break of the veins. Such a phenomenon is accompanied by blood loss. The blood loss leads to a serious deterioration of the state of the mother. Increases the risk of child loss during labor. Diabetics Surgical intervention is also dangerous. For this reason, the doctor must weigh all positive and negative sides Both types of birth. Only after that you can make a decision.

Modern girls are often faced with the problem of a long lack of pregnancy. Planning is delayed for several months. There are problems with conception and a second child. The coming pregnancy can break at any time. To preserve the fetus, the woman passes supporting therapy. Such drug intervention may affect the correct course of childbirth. Often there is a strong fixation of the fetus in the uterus. Patient requires stimulation of activity or section.

Sometimes there is a lack of generic activity. The mother's body does not respond to stimulating therapy. The process may not appear after the bubble puncture. In this case, monitoring the extension of the cervix. If the uterus has not revealed for 3-4 cm during the day, it is necessary to make an operation.

Surgical intervention time

The average preliminary delivery period is calculated by the doctor. The preliminary date of natural childbirth is placed on the end of the 38 week of pregnancy. A normal period may vary from 38 to 40 weeks. With a cesarean section, the PRD time should be taken into account. It indicates an approximate time of the onset of natural generic activity. To prevent this, the operation is assigned to the end of 38 weeks.

What time is the second caesarean cross section, many moms ask. Secondary intervention is also held at the end of 38 weeks. If there are additional readings to the operation or pregnancy step less than three years after the last pregnancy, the cross section is carried out from 36 weeks.

Sometimes there are dangerous situations with the general state of a woman. In this case, the secondary intervention is carried out on the period that allows you to preserve the life of the mother and child.

Characteristics of surgical intervention

The cross section is carried out by two methods. The operation depends on the location of the cut. The following types of section are distinguished:

horizontal;
vertical.

The horizontal section is the most common form of surgical intervention. During the operation, the suggestion zone dissect. This section has a fruit convergence of the muscular, epidermal and uterine layer. Such a cut allows you to avoid various forms Postoperative complications.

The vertical intervention is carried out on medical testimony. The incision is carried out from the bottom of the pubic bone to the top of the diaphragm muscles. At this type of operation, the doctor has access to the entire abdominal cavity. Healing of such a cut is more problematic.

Women who have passed the procedure are interested in how the second caesarean cross section do. In this case, the incision is carried out above the zone of the previous scar. This will not allow additional injuries to the fallopian wall and will save appearance Abdominal zone.

Before starting the operation, preparatory activities are carried out. The woman should go to the hospital 2 days before the appointed procedure. During this time, a complete study of the condition of the patient and a doctor is carried out. For the study of the patient, blood and urine sample is taken. If there are suspicions of a bacterial defeat, you need to hand over the vaginal microflora smear. During the day before intervention, a special diet is prescribed, which allows the intestines to cleanse themselves. On this day, a cardiographic study of the fetus is carried out. The device allows you to set the number of child heartbeats. 8 o'clock before the operation, a woman is prohibited from meals. For 2 hours you should refuse drinking.

The course of operation is simple. The average duration of surgical intervention is 20 minutes. Time depends on the nature of anesthesia. With full anesthesia, a woman is immersed in sleep state. The doctor lowers his hand into the incision and pulls the child behind his head. After that, the cord is carried out. The child is transferred to obstetrics. They estimate the state of the fetus along a ten-point scale. The doctor at this time takes out the placenta and the remains of the umbilical cord. The seams are superimposed in the reverse order.

If the second genera Cesarean is prescribed for the first time, then you can carry out incomplete anesthesia. In this case, a woman can see the child, but the pain does not feel.

Possible complications

After cesarean section, a variety of complications may occur. Often they occur when re-interference. The following types of probable pathologies are identified:

development inflammatory process;
bleeding;
endometrial defeat;
the appearance of adhesive fabric.

The development of the inflammatory process is observed against the background of the accumulation of fluid in the uterine cavity. Inflammation may also be observed postoperative Swine.. A frequent problem is bleeding. Blood lord arises against the background of strong inflammation. If it do not stop in a timely manner, the risk of death is increasing.

Sometimes another problem arises. It accompanies vertical seam. The incision in this case is carried out between the diaphragm muscles. During the recovery period, there may be a rectal to the hanzhe gate. The hernia in this case develops rapidly.

Postoperative recovery

The second caesarean section requires a longer recovery period, which is important to know the patients. With the first surgical intervention, the recovery occurs within one and a half months. The second intervention displays the body in order for two months.

Special attention is paid to the health of the first week after childbirth. The first day the woman should not eat food. It is allowed to drink water without gas. From the second day you can eat liquid food and rye unsalted crackers. Nutrition must be treated with special attention. If food is not selected correctly, then the appearance of constipation. It is undesirable in the first month after surgery. It should also be refused to transfer weights. The first week the patient should not wear a child in his arms. Weaving gravity is allowed on 8 day after removal of seams.

Births are a natural physiological process. But they are not always possible. If the doctor appoints surgical interference, he has reasons for it. Therefore, one should not refuse to re-conduct operational intervention. It will preserve the health of the mother and child.

Contrary to popular belief, if the first births passed surgically, the second caesarean during re-pregnancy is appointed not every woman. I, like any specialist, make a decision on an operational objective, only thoroughly analyzing many factors.

The second (emergency or planned) caesarean section is prescribed if:

In the history of the patient there are diseases such as asthma or hypertension, there are endocrine disorders.
The woman recently suffered a serious injury, she has pathological impairment, problems with heart or with vessels, malignant tumors.
The future feminine has been deformed either too narrow pelvis.
Previously, a longitudinal section was made, there is a threat of a violation of the integrity of the old seam, in the region of the scar keloid scarring.
After the previous COP, the patient did artificial or she was miscarriage.
Pathology was found: a big fruit or its misconception, tooling, poor generic activity.
The patient is waiting for twins.
The age of Mom 35+ or after the appearance of her firstborn, a very small period passed - no more than 24 months.

If nothing from this list is found in the patient, I allow (and even insist) to give birth on my own.

Sorry, currently there are no accessible surveys.

What time is the second cesarean section

Here you need to repel from the reasons to indicate the need for an operation. But in any case, to minimize risks, the timing is shifted. For example, if the woman has too big belly, it means that the baby is large and significantly pulls the walls of the uterus. That is, the threat of breaking the seam is quite high. Operation in such cases is carried out on 37-38 weeks.

What time will the second caesarean section will do, even depends on arterial pressure women. If the hell is very high and not shot down by medicines, the operation can take place already at the 39th week. In any case, we try to appoint childbirth to the date, which is closer to 40-41 weeks, having discussed this issue in advance with the future guinea.

In patients with complicated pregnancy, the fights can start from the 35th week. In such cases, for my part, I apply every effort to help the future mammy to convey the crumb at least until the 37th week. Of course, during this period therapy is appointed, stimulating the ripening of the respiratory system of the fetus.

Each second my patient is confident that if she has already moved the operation once, then the second caesarean she will be "like oil." It should noted that a positive attitude and calm in this case is already half of the success. But such confidence must be supported by the actions of the future mother. Excessive negligence and frivolity can lead to deposits. If you already know that the CS is inevitable, start acting.

During pregnancy

It is important to provide absolutely everything that the second caesarean can be connected with. Here are some recommendations that I give to my patients:

Sign up for special courses for future mothers who will have CS.
Tune in to what it is possible to be in the hospital for a long time before and after delivery. Decide in advance where and with whom all these days your elder child will be, so that it does not have to worry about him, which is extremely undesirable in your position.
Consider and discuss with the spouse the option of partnerships. If epidural anesthesia is applied, and you will be in wakeful state, you may be easier and more pleasant to transfer the whole process when there is a close person nearby.
In no case do not skip the planned inspections appointed by the doctor.
Do not be afraid to ask your gynecologist all the questions that exciting you (about when they are made by the second COP, and why do you have a childbirth on this date, what tests you need to pass, do you have complications, why don't the doctor attributed to you and other drugs .). So you will ensure the necessary confidence and calm.
Get in advance things that need for you and baby in the maternity hospital.

Be sure to find out which group of blood from your relatives (especially important if you have it rare). There are situations in which the guinea carries large blood loss during the operation. The reason for this may act coagulopathy , preeclampsia , anomalous placental presence, etc. In such cases, the donor may urgently need to urgently need.

A few days before the operation

As a rule, in the last period of pregnancy, the patient is in the hospital. At least two days of previous operations need to refrain from solid foods and products that cause gas formation. 12 hours before delivery, it is generally forbidden to drink and eat, since the anesthesia used during the COP may cause vomiting. And most importantly, the future mother is sure to sleep. Consider what to restore this time it will be more difficult than after the first primacy, therefore a full-fledged rest is a necessary measure.

Stages, how is the operation

Naturally, mammallow experienced, which give birth not for the first time with the help of surgeons, already know how the planned caesarean cross section do. Operations are really identical and pass one scenario. Therefore, you should not wait for surprises. So, consider it in stages, as the second Cesarean do.

Preparation for the operation

Even if the cesarean cross-section will be the second time, I still give a detailed consultation with each patient. I answer all questions, talk about the advantages and disadvantages of surgical intervention, possible complications.

Directly in front of the births themselves prepare for the operation to the patient also helps the nurse, which:

Checks the main indicators of the health status of women: temperature, cardiac activity (pulse), blood pressure.
Puts the enema to empty the stomach and prevent thus jeeping during the generic process.
Shaves the pubic zone to hair, hitting in open wound, did not cause inflammation.
Sets the dropper C, the action of which is aimed at preventing infection, and with a special composition that impedes dehydration.
Introduces catheter in the urethra.

Surgical stage

If the childbirth is carried out surgically, it does not matter, they are the first or second, be prepared for the fact that there will be many doctors in the operating room. As a rule, the "team" works in Rozale, consisting of:

two surgeons;
anesthesiologist;
anesthesiological nurse;
neonatologist;
two operating nurses.

First of all, anesthesiologist introduces anesthesia - local or common. When anesthesia works, surgeons begin to work - perform a longitudinal or transverse section (depending on the indications). After receiving access to the uterus, doctors with the help of special equipment sucking the oily water and get the baby from the womb. After that, the child takes a neonatologist or nurse to carry out the primary care (cleaning of the mouth and nose from mucus and fluid, measurements on the apgar scale, inspection and medical careIf this is required).

All these manipulations take no more than 10 minutes. After that, the surgeon extracts the placenta, testing the uterus and overlapping the seams. Stick organs for quite a long time - about an hour. After that, the patient introduces medicines that contribute to the uterine reduction.

The dangers of the second cesarean section

The risks that the second caesarean are individual. It all depends on both the features of the course of pregnancy and from general status Health of women in labor. Mom, who gave birth to re-through surgical manipulations, may be violated, seam. Rarely, such complications arise as, anemia and thrombophlebitis.

For a child, the consequences can also be different, ranging from circulatory disorders and to hypoxia caused by a long exposure to anesthesia (since the re-COP has always lasts longer than the previous one).

But any complications are very easy to avoid, if it is properly prepared for the operation and comply with all the recommendations of the attending physician.

Second caesarean section: What is important to know

As I said above, any operation is individual, and you cannot pass the same way. But these differences should not cause worryers to excite and panic. The main thing is to familiarize yourself with them and correctly configure yourself before the operation.

So, the second caesarean section: what is important to know:

What how many weeks? Most often - by 37-39, but if there is indications, the doctor may insist on an earlier delivery.
When are sent to the hospital? If pregnant and the fruit is absolutely healthy - a couple of days before the appointed date. But better - in a week or two.
What anesthesia use? Both local and general, but the dose is stronger than at the first COP, as repeated childbirth lasts longer.
How are cut? According to the old rubles, so the new scar will not appear.
How much does the process last? A little longer than the first birth, about 1-1.5 hours.

It is also worth considering that the recovery process in this case will be longer and complex. This is due to the fact that the skin, which excishes re-heal longer. The involution of the uterus is also slower, causing discomfort. But if you comply with all the rules of the rehabilitation period, it will be held in the shortest possible time.

Previously, obstetrician-gynecologists almost unanimously opposed repeated surgical labor. Laparotomy in Pfanenschtil (that is the so-called this operation in scientific) really has its own risks and consequences. But modern medicine stepped far ahead. And today the COP is perceived as a completely normal option of the delivery. Of course, before you decide on the birth of a child in this way, you must consult in detail with the doctor so that it determines if indications and / or contraindications. A woman must once again explore possible outcome options for surgical manipulations, considering that with difficulties will have to face not only in the process of childbirth, but also when the kid is already born. After all, the recovery period during the re-operation occurs more difficult, the seam, which remained after the second cesarean, will long heal, the cycle is not normalized immediately. And only after weighing everyone for and against, you can take a final decision.

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Despite not the warning of gynecologists, many women are resolved for a third pregnancy, having two cesarian cross sections by shoulders. Is it possible to make the third cesarean section after 2 cesarean and what dangers can these manipulation be entrusted?

Pregnancy after the second Cesarean: When is it forbidden?

After the second operation of the cesarean section, most doctors insist on dressing pipes - sterilization. Such a manifestation of women's health care is not accidental - without complications, to make a third pregnancy after two operational generations do not succeed. Problems can start from the first weeks. To minimize them, the pregnancy needs to be planned together with the doctor.

Why are gynecological obstetricists so worry when it comes to third pregnancy after 2 operational births? There are several reasons for it.

First, the previous Cesarean, like any extensive operationmay result in formation.

Spikes are heavy tissue tissue that can change position. internal organs, drag the fallopian tubes And thereby narrowing their lumen. Pelvic pains have the surrendous operations are an indirect indicator of the development of the adhesive process. In such a situation, even becomes pregnant problematic.

Secondly, the frequent consequence of Cesarean becomes genital, which reduces the chances to become a mom. But even if the pregnancy took place, there is a threat of spontaneous miscarriage. Especially high probability of tragic outcome on early timingBut at later the risk of pregnancy interrupt is.

Thirdly, the scar in the uterus can be an obstacle to the normal attachment of the placenta. In the search for a suitable place of the placenta can migrate along the wall of the uterus. Another associated complication is the rustling of the vigor, which leads to.

Disorders of the attachments of the placenta can lead to chronic fetoplacentage insufficiency and hypoxia of the fetus, which is dangerous delay in intrauterine development.

The most Grozny complication is the uterus break - an acutely developing state, which is accompanied by massive bleeding. Often the child after that does not survive, all the efforts of doctors are aimed at saving the life of the mother.

When the uterus is breaking, the syndrome of the disseminated intravascular blood coagulation syndrome: the increased blood coagulation is first developing, then an aditional state occurs, in which the blood clots alternate with the liquid part, after it is developing hypocoagulation and strong bleeding, which is almost impossible to stop.

Before you pregnant for the third time, you need to weigh everything "for" and "against". Absolutely contraindicated combination of the third pregnancy - the third cesarean when signs of the insolvency of the scar in the uterus. These include:

The presence of ultrasound results.
Thickness 1.5-2.5 mm.
Even in the scar.

The list of other contraindications corresponds to those when planning any pregnancy. Mainly:

chronic diseases of the internal organs of high severity;
diseases in the decompensation stage;
autoimmune diseases;
infectious diseases in the aggravation stage.

What is the danger of the third cesarean?

Any operation carries a hidden threat. This also applies to cases when the third cesarean section is carried out.

Fears of doctors about the progress and results of the operation are related to the following:

spikes after previous interventions increase the risk of intestinal injury or bladder;
perhaps the true increment of the placenta is possible - in this case, the operation is completed by removing the uterus without appendages.

Despite the danger of cesarean sections, it is not necessary to think about childbirth naturally. The presence of two or more scars in the uterus is an absolute indication for the operation.

Features of the third cesarean and possible complications

How to spend a third cesarean? In general, the procedure for action is the same as with the previous ones. Nevertheless, there are some features:

The operation is carried out within the already existing scar on the uterus.
During manipulation, hemostasis control is very important in order to prevent the development of bleeding from the vessels of the uterus or abdominal cavity.
The uterus with the scar is worse than the prevention of hypotonic bleeding - intravenous administration Oxytocin.

At what week of pregnancy make the third cesarean? It depends on the state of the mother and the child. By medical standards You can relate already from 38 weeks. Some maternity hospitals prefer to conduct subsequent cesarean on the same period as the previous one.

According to life testimony, the operation is performed at any time.

After surgical intervention, various complications may arise:

bleeding B. postoperative period;
intestinal hypotension;
purulent-septic infection;
thrombotic complications;
substitution of the uterus;
failure of the scar;
anemia.

When to plan a pregnancy after 2 Cesarean?

If a woman plans children, then the third pregnancy a year after the cesarean section is not the most suitable option. It is recommended to wait 2-3 years, carefully examined and only then to be solved for the next birth.

However, if pregnancy has come during the year after the second cesarean, abortion is not a safe way to solve the problem! In this case, it is necessary for the ultrasound method to explore the state of the scar on the uterus and visit the obstetrician gynecologist.

Any intervention in the uterus can lead to serious consequences and worsen pregnancy forecast. Therefore, it is important to choose the most suitable method of contraception after childbirth.

Yulia Shevchenko, obstetrician gynecologist, especially for the site

Useful video

The child does not always appear in a natural way. Sometimes to avoid additional risks, the gynecologist is forced to decide on cesarean section. The operation may be a planned or emergency, while the first type is preferable because it is carried out in a more relaxed atmosphere. The choice of a specific date of the planned operation depends on many factors.

Indications and contraindications for repeated cesarean section

The second caesarean section is assigned to the same testimony as the first. These include:

network Diseases;
varicose veins on the legs;
cardiology disorders;
diabetes;
high blood pressure;
chronic respiratory diseases;
large fruit;
narrow pelvis pelvis;
recently transferred cranknaya injury;
the first birth of a woman over 30 years old;
misconception of placenta;
transverse or pelvic prevention
multipleness;
myoma uterus.

Some features of the seam left may also affect the decision on the operation remaining after the previous delivery. Second caesarean section can be appointed at ::

the threat of his discrepancy;
longitudinal location;
the appearance of connective tissue on the RubE.

They are not allowed to give birth independently after the operational permission of the previous pregnancy, a woman who made an abortion before pregnancy, since additional injuries of the uterus increase the risk of seam divergence. Very often, doctors prescribe a re-operation after the first caesarean, even in the absence of the above risk factors, as it allows to protect the life and health of the mother and child.

In some cases, to predict how childbirth will be, it is very difficult, so doctors try to protect mom from unnecessary suffering. Knowing in advance when she has an operation, a woman will be able to tune in to her, prepare morally and physically.

How to prepare for the planned Cesarean?

A future mother who knows exactly that he will not give birth herself, throughout the pregnancy, you should prepare for the operation. The most significant events for this are:

A visit to the school of future mothers, in which they will tell in detail how the doctor performs the operation.
Search options for a senior child's device while mom is in a hospital with a newborn.
Discussion with your husband the possibility of its presence in the operating room.
Select anesthesia. Some women are afraid to stay in consciousness at the time of the operation. Others, on the contrary, feel fear general anesthesia. To get rid of negative emotions, it is better to meet with all the features different species Drugs and choose the option that scares the least.
Acquisition of all things needed to stay in the hospital: toiletries, clothes, slippers.
Mood for a prosperous outcome.

Immediately before the operation, a set of activities should also be performed. During the day on a trip to the hospital, you need:

Take a bath. You can remove hair on the pubic razor. Before that, it is recommended to remove the nail polish.
Pretty sleep. Since after 2 operations recovery harder than after 1, the future mom must be fully relaxed.
Charge the phone.
Refuse the use of products that increase gas formation.

Terms of operation in the second and third pregnancy

What time does the planned caesarean do with the second pregnancy? It is important to understand that the operation date will depend on how the fetus is tooling, as it feels pregnant, how long ago the previous operation was carried out. It is also taken into account when the previous Cesarean was made.

As a rule, doctors prescribe an operation for the period from 34 to 37 weeks. Up to 39 weeks, doctors are rare, it is too dangerous. At the date 2 of the cesarean section, the following circumstances affect:

If the first caesarean was held at 39 week, the following will be accomplished much earlier, about 7-14 days.
The pelvic prevention of the fetus is an indication for the operation of the 38-39 week.
Cross preview carries a greater danger to the health and life of the child. In this case, the cesarean section is prescribed to the date preceding the estimated date of delivery by 7-14 days.
Full preview of the placenta. If the future mother has bleeding, it needs to be equipped as soon as possible, but then the operation will be very risky. For these reasons, with the complete presence of the placenta, women are trying to operate up to a 38-week period.
The state of the scar in the uterus. The repeated and third cesarean is always a new risk. The incision on the place of the old seam is hard, so, the worse the state, the earlier the operation is carried out.
Multiple pregnancy. If a woman gets into two kids, then at second kinds, it may have difficulties, so it usually makes a planned operation of 36-37 weeks. With monoamniotic double, the operation can spend on 32 weeks.
HIV infection. Women who are carriers of this hazardous infection, "Caesaryat" 14 days before the expected date of birth.

Sometimes about how many weeks the operation will be carried out, women do not report for a very long time. It happens because doctors watching the future mother, decide to act in terms of the situation. In the absence of any difficulties in the course of pregnancy, surgical intervention can be postponed before the bout.

How is the operation?

The operation consists of two stages: Patient preparations for operational intervention And the operation itself. Today to Cesarean section, no matter what kind of account is the first, second or third - are like enough simple way Rhodewords.

After 30-40 minutes after entering the operating pregnant woman, it can already hear the crying of his baby. If there will be no difficulties in surgery in the course of surgical intervention, very soon after childbirth, mom and crumb write home (we recommend reading: when they write out of the hospital after the cesarean section?).

Preoperative stage

Before surgical intervention, a woman is offered to lie down in the hospital in advance to undergo a survey. In the hospital, she will take the necessary analyzes designed to determine the state of the mother and the fetus. The day before the operation for the future mother comes an anesthesiologist who will warn her about what sensations are expected after the introduction of anesthesia, as it is done, as it acts.

On the day of the delivery, the patient warn the need to refuse eating and food, clean its intestines, offer to wear a special bathrobe. She will also need to remove the cosmetics: it will simplify the process of observing its condition in the operating room. Before the entrance to the operating woman put a dropper, and Foley catheter is introduced into the urethra.

Operational period

Anesthesia do in the operating patient. Then there is an incision, which can be both longitudinal and transverse. Most often doctors choose the last option, since the horizontal incision is safer for a woman, and the period of recovery after the cesarean, spent with such a cut passes easier and faster.

Through the incision, the doctor extracts the fruit, cuts the umbilical cord and transmits the baby to neonatologist. After that, the surgeon, which operates the woman, removes from the uterus, connects the cutting tissues and imposes the seams. The last stage is to disinfect the seams and the imposition of bandages. The duration of all manipulations is about 40 minutes.

The new Mom is delivered to the postoperative chamber. If she feels good, she will be offered to attach a baby to the chest.

What is important to know?

The future mother, who re-appointed Cesarean, it is important to remember that the operation may differ from the previous one. You can select several features of the recycling of the uterus:

The second time the operation lasts a little longer.
More powerful anesthesia is used.
In the hospital lay for about a week before the designated date.
Restore the second time will be more difficult than in the first. The period itself will proceed more difficult.
Seam is done in the same place as the first time, therefore there will be no new scars.

At the same time, these differences should not cause any panic from Mom. She needs to take note that before the operation will have to manifest a little patience, and then it will need help and support close.

The fact that until the full healing of the seam will need to be particularly carefully referring to their health, moms who have experienced such operations are already well known. At full return to normal life, they will most likely need at least 2 months. In some particularly severe cases, the duration of the postoperative period can be achieved 3-4 months.

What could be the consequences?

As a rule, the planned caesarean has no serious consequences. Sometimes, during surgery or after it, complications arise:

anemia to which the abundant loss of blood leads;
lack of milk;
prohibition of subsequent births naturally;
development of adhesive disease in the abdominal cavity;
infertility, ban on subsequent natural childbirth;
violation of cerebral circulation in the newborn;
menstrual disorders.

All of the above complications usually arise only in those women who during pregnancy did not adhere to the recommendations of doctors. In the overwhelming majority of cases, the delivery by caesarev pass absolutely normal, without particular difficulties, and the baby is born healthy and no different from its peers, which appeared on the light naturally.

Repeated caesarean section is recommended for women who cannot or do not want to give birth to a second child independently, since the very fact of the presence of the first operation does not exclude the possibility of giving birth to the second pregnancy. If the second surgical childbirth is coming, the woman is important to know some of them characteristic of them. In this article we will tell, on what time a re-operation is being held than it differs from the first.

Need for re-operation

The second birth after cesarean section should not be surgically carried out. Under certain conditions, the woman may well afford to give birth independently. But there are no more than a third of pregnant women with one cesarean cross section in history. Categorical disagreement of the patient for physiological genera with the scar in the uterus is the first and most fun base for repeated operational delivery.

But even when pregnant dreams to give birth on his own, she may not allow it if there is absolute readings to the second operation.

Small or large period of time after the first birth. If less than 2 years or more than 7-8 years have passed, then "reliability" of the connective tissue of the royal scar will cause informed concerns from doctors. Only 2 years after the birth of the firstborn, the place of the healing of the scar becomes quite strong, and after a long break it loses elasticity. In both cases, the danger represents the likely rupture of the reproductive organ at the place of the scar at the time of strong bouts or fence.

Complications after previous birth. If a rehabilitation period After surgical generations, it takes hard: with an increase in temperature, inflammation, joining infections, uterine hypotension, then the second child, with great probability, will also have to give birth on the operating table.
Insolvent scar.If at the time of the pregnancy planning its thickness is less than 2.5 mm, and by 35 week - less than 4-5 mm, then there is a possibility of breaking the uterus during independent birth.
Large kid (regardless of its preview). Repeated after cesarean section can give birth to kid through natural physiological paths only with the estimated weight of the child less than 3.7 kg.
Incorrect kid location.Options with a manual toddler turn for a woman with a scar are not even considered.
Low placenta location, placenta prediction on the scar zone.Even if the "child seat" is affected by the region of the scar, it is impossible to give birth - just operate.
Vertical scar.If the incision during the first delivery was made vertically, independent generic activities are subsequently excluded. Only women with a wealthy horizontal scar in the lower uterine segment may be theoretically allowed to be admitted to independent birth.

Besides, absolute indications Repeated surgical fees are considered fatal reasons that led to the first operation: a narrow pelvis, the anomalies of the uterus and the birth paths, etc.

There are also relative readings to the second operation. This means that the woman will be offered a cesarean section with a second pregnancy, but in case of its failure, a natural way of delivery can be chosen. These indications include:

myopia (moderate);
oncological tumors;
myoma uterus;
diabetes.

The decision on a re-operation, if a woman does not object to such a method of the delivery and there is contraindications from the discharge of absolute, is taken when it is pregnant. If there are no contraindications, the woman wants to give birth herself, then choose a way of birth will be after 35 weeks of pregnancy on medical consultation.

Dates of carrying

Ministry of Health of Russia strongly advises maternity hospitals and clinics clinical recommendations When carrying out the cesarean section. This document (letter of the Ministry of Health of the Russian Federation of May 6, 2014 No. 15-4 / 10/2-3190) prescribes the operation after 39 weeks of pregnancy. This also applies to the first and repeated cesarean section. As a justification, the risk of possible immaturity is indicated. pulmonary fabric Fetal up to 39 weeks.

In practice, the second caesarean section is trying to spend a little earlier than the first, since the independent occurrence of childbirth, the fights that appeared may be a fatal danger associated with the rupture of the uterus. Most often, the second surgical genera makes the 38-39 week of pregnancy.

If the doctor will detect precursor from a woman in late terms: the displacement of the cork, the readiness and maturity of the cervix, its smoothing, the period of operation can be transferred at earlier time.

According to emergency testimony, the operation with a second pregnancy is carried out at any time to save the lives of the fetus and mother. Emergency situations include the deposition of umbilical cord, signs of the beginning of the uterus break during the toaling, detachment of the placenta before the deadline, signs of acute hypoxia and other disadvantage of the fetus, in which to remain fatally dangerous in the maternal womb.

If a woman is a supporter of the opinion that the COP should do as close as possible to the estimated date of birth, then theoretically, the operation can be carried out (in the absence of contraindications for expectant tactics) at any time from 39 to 40 weeks.

Preparation

Preparation to the second planning operation begins even during pregnancy. A woman with a scar in the uterus should more often visit her obstetrician-gynecologist than other pregnant women. In the third trimester it is necessary to track the state of the scar to notice in time possible signs His thinning. For this, every 10 days is recommended to do ultrasound with Doppler.

In the hospital, a woman is hospitalized in advance. If, with the first planned operation, you need to go to the hospital about a week before the operation, then for the repeated COP, you need to go to the hospital under the supervision of doctors at 37-38 weeks to prepare for the upcoming birth.

Doctors are preparing in their own way: they must once again examine the pregnant woman, to establish the exact location of the scar, its features, take tests, agree with the patient the method of anesthesia.

During the day before surgery with a woman, a conversation anesthesiologist. From the evening, premedication begins in front of the operation: the future girlfriend gives a strong sedative (usually barbiturates) in order for it to sleep as much as possible and relax at night. This will protect it under anesthesia from blood pressure drops.

In the morning on the day of operation, a woman shake the pubis, put an intestine to purify the intestines, can recommend binting the legs with elastic medical bandages to prevent thrombosis.

Features of the operation

The main feature of the re-cesarean section is that the operation lasts a slightly longer than the first. This woman should warn relatives so that they do not worry about. An extra time is necessary for surgeons in order to remove the first scar. Each subsequent surgical delivery is carried out by the previous log. And therefore, the situations in which, after the first operation, the woman had a vertical seam, and after the second would be horizontal.

If the operation was with a longitudinal cut, then the second time to do incisions will be in the same place, the study is old connect fabricSo that the new scar can be formed freely. Whether it is necessary to say that with each cesarean section, the scar is becoming thinner and thinner, and risks to carry are increasing!

If a woman no longer plans to give birth, then she can sign agreement on surgical sterilization in advance. After extracting the baby, the doctors begin to tie up the uterine pipes - the onset of subsequent pregnancy becomes impossible. This simple manipulation can extend the total time that the patient will spend in the operating room for another 10-15 minutes.

Opening abdominal cavityThe doctor carefully not to injure, removes muscle tissue towards the muscular fabric, as well as the bladder. Then there is an incision on the edges of the uterus directly, the fetal bubble is pierced with amniotic fluid and baby. Water merge, the child is getting out of the cut, cut off the umbilical cord and transmit to neonatologists. If a woman is not in a state of deep medication sleep (common anesthesia), then it can look at his baby at this stage, touch him. Such an opportunity is given to such types of anesthesia as epidural or spinal anesthesia.

While the mother admires the tea or firmly sleeping under general anesthesia, the doctor separates the placenta with his hands, checks whether its particles remain left in the uterine cavity and imposes several rows of internal seams to the reproductive body. In the final part of the operation, the normal anatomical arrangement of the muscles and the bladder is restored and impose an external seams or brackets. This is considered to be completed. The lounge for the coming hours is determined in the ward of intensive therapy for attentive observation of it in the early postoperative period. The kid leaves B. children's officewhere it is treated, reaches, will examine the doctors, and the baby will take blood tests.

How is the recovery?

The recovery period after repeated cesarean section also has its own characteristics. The woman is restored longer than after the first operation, and it is quite natural, because the muscles of the uterus are stronger stretched, and the re-autopsy of this muscular organ makes the postpartum involution of the uterus. After the operation, the uterus remains quite large, but more reminiscent of a bleached ball or a blank bag. She needs to be reduced until former sizes. This process in the involution is considered the most important.

To help the maternity hospital, doctors from the first hours after the translation from the operating room in the ward of intensive therapy begin to introduce reduced drugs to it. After a few hours, the woman is translated into the general postpartum ward, where she is recommended for a long time not to lie down. Optimally climbing after 10-12 hours after surgery. Physical activity will contribute to the involution of the uterus. With the same purpose (and not only with this!) it is recommended to attach baby to the chest as early as possible.The crocha will receive a satiety and useful colostrum, and the production of its own oxytocin in the body of his mother will increase, which will definitely affect the contractile ability of the uterus.

A woman is shown a diet up to 4 days after surgery, aimed at preventing constipation and intestinal pressure on a injured uterus. The first day is allowed only to drink, on the second you can eat broth, kissel, white crackers without salt and spices. Only by the fourth day, a woman can have everything, but avoid products that stimulate the production of intestinal gases.

Lochi (postpartum discharge) after the second operation usually end completely to 7-8 week after surgery. The seams take off 8-10 days after surgery (in consultation at the place of residence), write out a woman from the maternity hospital in the absence of complications for the fifth day, as in the case of the first surgical clauses.