Indications for complicated cesarean section

A cesarean section is a surgical procedure applied to a woman to remove the fetus, placenta, and amniotic fluid from the woman's uterus through an incision made in the wall of the uterus. This is a technique that requires a lot of expertise because it has the potential to leave a lot of complications for the mother, especially complicated cesarean sections or large pregnancies.

Cesarean section is a special method in obstetrics, with the aim of removing the fetus from the mother's uterus through laparotomy and hysterectomy.
In the past, cesarean section caused a lot of dangerous complications for the mother such as bleeding, infection and even death, however, along with the advancement in cesarean technique, aseptic procedure, antibiotics as well as anesthesia for patients that cesarean section is increasingly applied to be able to bring the fetus out in the safest way.
Indications for cesarean section include:
Problems from the fetus such as abnormal fetal position, large fetus, fetal failure or pregnancy diseases with contraindications to vaginal delivery. Problems with the appendages of the fetus Problems related to the mother's genital tract The mother has some medical conditions and cannot perform a cesarean section Some other reasons. In clinical practice, there are many different cases where the doctor prescribes cesarean section surgery, some common examples are:
Pelvic head asymmetry Maternal narrow pelvis Large fetus In clinical examination , when the test is performed, it is not successful. The woman has a threatened uterine rupture. The mother when the induction of labor is performed but it is unsuccessful and no uterine contractions appear. The mother experiences the condition uterine contractions disorder and not treated with drugs Due to the mother's uterus has old scars, cut apex... Pregnant women have cervical cancer, which can be local or diffuse. Placenta previa central, semi-central with bleeding phenomenon Placental abruption Abortion of umbilical cord Some abnormal fetal position such as posterior chin position, anterior fontanel position, transverse chin position... Calculating fetal weight greater than 3kg Pregnant women experiencing abnormally slow progress of labor Pregnant women with old cesarean sections from previous births Fetal failure during labor Poor development of fetuses overdue Expected delivery in patients with certain medical conditions that are contraindicated to induction of labor.

However, there are also cases of complicated cesarean section that women need to be aware of. Typically, cesarean section surgery on patients with old surgical scars. When performing cesarean section on these women, it will be very difficult because the woman has undergone the surgery before, causing the abdomen to be attached by many ligaments as well as the internal omentum. Abdominal.
In addition, some anatomical structures may also be changed from the original position, making the cesarean section very difficult, including many stages such as removal of adhesions, hemostasis... and There are many risks for pregnant women during and after surgery.
Therefore, cesarean section needs to be specifically indicated by the treating doctor through taking the patient's history, clinical examination as well as a number of paraclinical support to be able to make an informed decision. the most exactly.

When performing a complicated cesarean section, typically with an old scar on the pregnant woman's body, there are a few things to pay attention to as follows:
Step 1: Laparotomy Perform laparotomy with the white line between the pregnant woman's navel, An elective laparotomy is also possible with a transverse line above the pubic area.
In case the old surgical scar is located on these two lines, continue to make the incision along the old incision line to enter the inner layers of the abdomen, taking care not to cause damage to some organs in the body.
Step 2: Expose the lower part of the uterus Remove the adhesion caused by the old incision, then stop the bleeding for the patient.
Step 3: Proceed to open the lower peritoneum of the uterus. Incision across the uterine muscle, make an incision to the lower part of the uterine muscle until it meets the amniotic membrane.
Next, open the lower part of the uterus in the middle position and be careful at this stage because it is easy to touch the baby below, widen the incision to the sides for easier follow-up stages. .
Step 4: Perform cesarean section and placenta. Wipe the mucus around the baby's mouth with a thin gauze, then use forceps to clamp and cut the umbilical cord, and finally give the baby 10 units of Oxytocin slowly intravenously.
Perform placental removal by pulling the umbilical cord while pressing on the bottom of the uterus, cleaning the uterine cavity and checking the patient's bleeding.
Suture the uterine incision and peritoneum Wipe the abdomen and perform an examination of the uterus, appendages and surrounding organs, possibly placing an abdominal drainage in some cases when necessary Counting gauze to avoid omissions during surgery Close the abdominal cavity according to anatomical layers Collect blood, wipe the vagina for pregnant women. After cesarean section, it is necessary to monitor the patient's general condition including pulse, temperature, blood pressure, urine, uterine contractions, uterine bleeding, incision as well as drainage. of the patient to promptly handle abnormal conditions that occur. It is possible that the mother should take pain relievers, eat liquid foods, and exercise early in the first few days after cesarean section.

Cesarean section, especially complicated cesarean section, is a surgical method on pregnant women to remove the fetus and its appendages as prescribed by the doctor. Because this is an invasive measure that can endanger the health of both mother and baby, it should be clearly prescribed by the treating doctor, avoiding the worst possible situations.
At Vinmec International General Hospital, there is a package maternity service as a solution to help pregnant women feel secure because of the companionship of the medical team throughout the 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. birthing process Newborns receive comprehensive care.

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