Cases in which pregnant women are forced to give birth by cesarean section

This is an automatically translated article.

The article was written by Specialist Doctor II Nguyen Dinh Toi - Obstetrician and Gynecologist, Obstetrics Department - Vinmec Times City International General Hospital.
FIGO recommends a caesarean section rate of about 20%, the rate of cesarean section tends to be increasing in developing countries. Caesarean section will greatly increase the risk of serious harm to the mother and child, so the indication for caesarean section should not be expanded if it is not necessary. However, in some cases, cesarean section is mandatory.

1. Abnormal pelvis

Make the test pass if it is the top - the bounding box. Cesarean section if the pelvis is absolutely narrow, the pelvis is distorted, and the pelvis is limited, causing the cephalocele test to fail. Cesarean section for non-crescent pelvic abnormalities.

2. The way out of the fetus is obstructed

Tumors of the prostate: the most common are fibroids of the uterus or cervix, ovarian cysts, and other tumors located on the way out of the pregnancy. Central placenta previa or cases of placenta previa bleeding require emergency surgery to save the mother.

3. The uterus has a surgical scar in the following case

Surgical scars on the uterine body: fibroid removal scars, uterine reconstruction scars, suture scars at the rupture site, uterine perforation, scars from corner amputation surgery, uterine horns. Scars from 2 or more transverse cesarean sections of the uterus, consider if the previous cesarean section was less than 24 months ago.

4. Indication for surgery for the mother's cause

The mother has chronic or acute systemic diseases if the lower birth canal is at risk of life (severe heart disease, severe pre-eclampsia and eclampsia...). Abnormalities in the lower genital tract: vaginal stenosis (congenital or acquired), transverse vaginal septum, history of rectal fistula, caesarean section, history of previous birth with grade 4 perineal tear Uterine malformations such as: double uterus (non-pregnant uterus often becomes a prostate tumor), bicornuate uterus... especially when accompanied by abnormal fetal position, uterine septum affect the fetal outlet.

5. Causes on the side of the fetus

Fetal malnutrition/severe intrauterine growth retardation Anemic fetus: blood group disagreement with mother at risk of stillbirth in utero Abnormal positions: shoulder/horizontal, frontal, anterior fontanelle, back chin face. Multiple pregnancy: if the first pregnancy is not in the first place. Labor has progressed to fetal failure when there are not enough conditions for lower birth.

6. Indication for cesarean section because of abnormal developments in labor

The cervix is ​​fully dilated and does not pass through. Acute fetal distress. Protracted labor, cervical non-progression has had intervention but not effective. Bleeding from placenta previa , placenta abruption . Threatened rupture and rupture of the uterus. Umbilical cord prolapse while the fetus is still alive. Prolapse after trying to push up but unsuccessfully Pregnancy and labor is a "dynamic" process, so the indications for cesarean section can be proactive, which can be semi-emergency, emergency or ultimatum. Depending on the specific case to have appropriate indications.

7. Risks of cesarean section

Vaginal delivery is always recommended if there are no absolute indications for cesarean section, the possible risks of cesarean section are as follows:
7.1 Maternal side Complications
Bleeding: internal bleeding or bleeding after surgery due to uterine atony; bleeding from a tear in the lower uterine segment that tears into an artery. The risk of maternal mortality is higher: it may be due to amniotic fluid embolism or thrombosis, bleeding that cannot be stopped or because there is not enough blood when the mother has a rare blood type. Complications due to surgery such as touching adjacent organs (bladder, intestines, ureters), bladder-uterus/bladder-vaginal fistula. Infection: wound infection, urinary tract infection, pneumonia. Common is surgical site infection; peritonitis Intestinal paralysis. Open the incision, hernia of the abdominal wall. 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). Distant complications
Intestinal adhesions, intestinal obstruction. Obstruction of fallopian tubes, scarring from incisions causing secondary infertility Endometriosis at cesarean section scars or abdominal wall scars Treatment of incisions, placenta previa, placenta previa in subsequent pregnancies Scars on the body the uterus can crack in later pregnancies (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 you have a vaginal delivery, you'll need to have a caesarean section. surgery, pregnancy in old caesarean section... 7.2 On the child's side The fetus can be affected by anesthesia. Injury during surgery. Newborns have a higher risk of respiratory failure, delayed pulmonary drainage and can threaten the life of the child, especially when the mother is not in labor, especially the child who has undergone cesarean section in the period of gestation. Perinatal mortality (within 28 days of birth) was higher in cesarean section than in vaginal delivery.

8. Note before cesarean section

All information about the surgery, indications and risks during and after surgery of both mother and child should be clearly consulted and discussed with the pregnant woman and family before the surgery. Complete the required legal procedures. Programmatic surgery – proactive: Prepare from the night before surgery Fasting Enema Hygiene of the abdomen to limit the risk of infection Vinmec International General Hospital offers a Package Maternity Care Program for pregnant women right from the start. when starting pregnancy from the first months with a full range of antenatal checkups, periodical 3D and 4D ultrasounds and routine tests to ensure that the mother is always healthy and the fetus develops comprehensively. Pregnant women will no longer be alone when entering labor because having a loved one to help them during childbirth always brings peace of mind and happiness.

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