Caesarean section methods

The article was professionally consulted by Specialist Doctor I Pham Thi Yen - Obstetrics & Gynecology - Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital

Until now, vaginal birth is still the method recommended by obstetricians. However, for women who cannot give birth naturally, cesarean section is a reasonable choice.

Cesarean section is the removal of the fetus and placenta from the uterus through an incision in the abdominal wall and the uterus. This definition does not include cesarean section in cases of intra-abdominal ectopic pregnancy and intra-abdominal rupture of the uterus.

Regarding cesarean section methods, currently, doctors often make a horizontal incision in the lower uterine segment to take the pregnancy, so the surgery is called "lower transverse surgery", however in some cases, if the lower segment is established If it is good, you can make an incision along the lower part. Today, the lower transverse approach is the main technique of choice in most obstetric institutions worldwide.
Previously, when operating, it was necessary to close the peritoneum to cover the incision in the lower segment, even the doctor carefully pulled each peritoneal flap above and below the incision across the lower segment so that the incision was covered twice. private. Similarly, the abdominal wall peritoneum was also sutured closed prior to closure of the abdominal cavity. Currently, in many places, people have abandoned the closure of the uterine peritoneum and the abdominal wall peritoneum because it is not necessary, the peritoneum will reattach itself 24 hours after surgery, helping to reduce abnormalities caused by spontaneous suture. cause diarrhea (infection, allergies); Re-operative time is shortened.
Regarding the incision on the abdomen, in the past, people only cut the skin along the longitudinal line from the navel or slightly above the navel down to the pubic area. However, now doctors use a transverse incision on the pubic bone to avoid the scar running along the abdominal wall. Besides the aesthetic effect, this incision also has the effect of strengthening the abdominal wall at the incision site because the outside of the incision is horizontal but inside, when opening the abdominal wall muscle layer, people follow the vertical line.

Caused by pregnancy. Indications due to abnormal fetal position: transverse position, frontal position, posterior chin position, anterior fontanel position.. Fetal fetal failure The fetal pathology is contraindicated for vaginal delivery Due to fetal adnexal causes: Placenta cleft lip, central placenta... Caused by genital tract: septum vagina, 2 uterus... Mother's disease: severe preeclampsia, cardiovascular disease... Other indications

First, the pregnant woman will be fully explained by the medical staff to the reason for the cesarean section, and signed a written commitment to the surgery. After that, the patient will have a urinary catheter, disinfect the abdominal wall, and spread a sterile towel after pain relief.
The steps include:
Then 1. Open the abdomen:
Maybe the middle white line below the navel or the horizontal line above the pubic. Exposing the surgical area: inserting gauze, placing a valve. Then 2. Open the lower uterine peritoneum.
3. Transverse incision of the lower uterine muscle to the amniotic membrane:
Open the lower uterine segment in the middle (be careful not to touch the lower part of the fetus). Extend the uterine incision to the sides. The hysterotomy is parallel to the lower peritoneal opening. The horizontal incision is about 8-10cm below. Then 4. Get pregnant and take the placenta:
Get pregnant: take the reincarnation if it is the first position, take the baby's legs or the buttocks if it is the remaining positions. Use a thin gauze pad to wipe the baby's mouth. Clip and cut the umbilical cord. 10 units of oxytocin by slow intravenous infusion (via the infusion line). Get the vegetables by pulling on the umbilical cord and pressing the fundus of the uterus through the abdominal wall. Cleanse the uterus. Dilation of the cervix if needed. Check and clamp major flowing blood vessels. Then 5. Sewing the uterine and peritoneal incisions:
Sewing to restore the uterine muscle layer using the index number 1. It can be with a separate stitch or a suture with or without a buckle. The suture takes the entire thickness of the myometrium. The endometrial layer should not be sutured. Usually one layer stitch is enough. If necessary, suture a second layer of suture to stop bleeding and cover the first layer. Lower uterine peritoneal occlusion is mandatory when there is a risk of infection. Then 6. Clean the abdominal cavity, check the uterus, appendages and surrounding organs, count enough gauze
Then 7. Close the abdominal wall layer by layer.
Then 8. Take blood and wipe the vagina.

5.1. Postoperative monitoring Pulse, blood pressure, general condition, urine excretion. Uterine contractions, blood flow from the uterus. Abdominal incision. Central convenience. 5.2. Care Maternity is given pain medication after surgery. Pregnant women are given drinking and eating early (drinking, liquid food before defecation, eating normally when having a bowel movement). Early movement. Breastfeeding early. The doctor prescribes antibiotic treatment (if necessary).

6.1. On the mother's side 6.1.1. Complications near
Infection: common are surgical site infections, urinary tract infections Surgical complications such as touching adjacent organs (bladder, intestines), right urinary tract esophagus, vesico-uterine/vaginal fistula. Heavy bleeding, bleeding during or after surgery due to uterine atony; bleeding from a tear in the lower part of the uterus. Intestinal paralysis. Open the incision, hernia of the abdominal wall. Internal bleeding. Venous embolism, thrombosis. Maternal death: it may be due to amniotic fluid embolism, bleeding that cannot be stopped or because there is not enough blood when the mother has a rare blood type. Complications due to anesthesia - resuscitation: there may be complications from anesthesia such as aspiration syndrome (in the case of endotracheal anesthesia); hypotension, postoperative headache (in the case of spinal anesthesia), drug reactions (anaphylaxis).

6.1.2.Distant complications
Intestinal adhesions, intestinal obstruction. Obstruction of the fallopian tubes causes secondary infertility. Endometriosis at cesarean section or abdominal wall scar. In later pregnancies, the scar on the uterine body can crack (cracking before labor or when it's already in labor) In later pregnancies there is an increased chance of having to have a caesarean section and if a vaginal delivery occurs. must assist with delivery by suction or forceps to reduce the risk of old caesarean scar cracks on the lower uterine segment... 6.2. On the child's side The fetus can be affected by the anesthetic. Injury during surgery. Inhalation of amniotic fluid, especially amniotic fluid containing meconium. Newborns born by cesarean section are at risk of severe respiratory failure (pulmonary retardation syndrome) and life-threatening due to intervention when the mother is not yet in labor, especially children who receive cesarean section intervention in the unborn pregnancy. full term (before 39 weeks). Perinatal mortality (within 28 days of birth) was higher in cesarean section than in vaginal delivery. Cesarean section also increases the risk of stillbirth in the next delivery (maybe the uterus is scarred because the previous cesarean section did not create conditions for the placenta to adhere well, so the supply of blood and nutrients is not good.) Inadequate fetal nutrition)... At Vinmec International General Hospital, a package maternity service is available as a solution to help pregnant women feel secure because of the companionship of a team of doctors and nurses throughout. pregnancy. When choosing Maternity Package, pregnant women can:
The pregnancy process is monitored by a team of qualified doctors Regular check-up, early detection of abnormalities Maternity package helps to facilitate the process. Childbirth process Newborns receive comprehensive care >>See more: Prevention and treatment of chills in cesarean section - Posted by Specialist Doctor II Nguyen Thi Hoai Nam - Head of Pain Relief Unit - Department of Anesthesia surgery - Vinmec Central Park International General Hospital