Lecture indications cesarean section

2021-03-21 12:00 AM

Group of causes due to pregnancy: fetal enlargement (32.7%), fetal failure (27.2%), buttock (24.7%), another throne (6.7%), twins (4.7%) , not open all the way (4.0%). In the buttocks, 75% of schools have a cesarean section, 25% deliver lower sugar.

Define

Caesarean section is the removal of the pregnancy and the fetal appendage from the uterus through the abdominal wall incision and the uterine incision. This definition does not cover an open abortion in the case of intra-abdominal pregnancy and rupture of the uterus that is already in the abdomen.

Rate of cesarean section

In many countries around the world the rate of cesarean section has increased rapidly over the past 20 years, especially in developed countries (Notzan et al., 1987). In America, the cesarean section rate was 4.5% in 1965 up to 23% in 1985, so in just 20 years the cesarean section rate has increased more than 5 times. By 1988, the average rate of cesarean section in the United States was 25%, meaning that 1 out of 4 people who gave birth, had a cesarean section. In France, within 10 years (1972-1981), the rate of cesarean section nearly doubled from 6% to 11%. People give many reasons to explain this phenomenon of the increasing rate of cesarean section:

The woman gives birthless, the percentage of children is much higher. Some problems related to the baby compared with poisoning pregnancy, difficult delivery ... will be more encountered.

The gestational age of the woman is increasing day by day.

Monitoring of labor with a monitor increases the likelihood of detecting pregnancy failure and increases the rate of cesarean section.

The rate of cesarean section in the buttocks is increasingly high.

The forxep rate decreased.

The rate of cesarean section in the case of the uterus with scarring old cesarean section increases significantly.

The ability to nurture low birth weight and preterm infants have made much progress, making obstetricians braver and braver in appointing cesarean section in these cases.

Questions and litigation of the patient's family also have a significant influence. Physicians and hospitals will have to suffer many problems when the result of lower birth is not perfect, especially in the case of the woman or the woman's family has suggested a cesarean section. The number of women who earnestly require cesarean section is increasing. This is an undeniable social factor that affects the indications for cesarean section.

According to the 2002 Vietnam Demographic and Health Survey (VNDHS), the rate of cesarean section in Vietnam is generally 9.9%. At one time, the rate of cesarean section differs greatly between hospitals. In 1992, the rate of the cesarean section of the Institute for the Protection of Mothers and Babies was 22.25%, while in the obstetric department of Bach Mai hospital was 7.0%. However, it is easy to see a significant increase in the rate of cesarean section over time in a hospital (Table 1). The rate of cesarean section is increasing gradually, although many efforts have been made to control but has not brought results.

Indicated cesarean section

Indications for cesarean section are an extremely difficult and complicated problem. In addition to the absolute indications for cesarean section (for example, the role in the human figure, the central striker vegetable ...), there are many indications for cesarean section of relative nature (for example, children compared to old age, rare children ...). In many cases of cesarean section for a relative set of indications, it is difficult to identify the dominant reason in this population. The trend of difficult and dangerous lower line procedures is increasingly reserved for cesarean section because it is safer and faster (abortion, internal rotation ...).

Caesarean section is indicated when labor is unsafe for the mother and fetus, when forced to remove the pregnancy but does not cause labor, when labor is difficult, or because the characteristics of the fetus make it impossible to deliver lower sugar and In a state of emergency, it is necessary to take out the pregnancy quickly and give birth to the lower line is not qualified. Because of their complexity, there are many types of classification of caesarean section indications. Each classification has its advantages and disadvantages.

By the time of appearance of the indication for cesarean section, one can divide the indications for cesarean section into two large groups:

indicated active cesarean section (also known as a prophylactic cesarean section) when indicated from before labor. In the case of an active cesarean section, the operation can be performed in the absence of labor or at the onset of labor.

indicated cesarean section during labor.

According to the indications for cesarean section, one can be divided into:

Indication of absolute cesarean section: Just one single reason is enough for cesarean section.

Indications for relative cesarean section: These are indications that if it alone is not enough for cesarean section.

Indications for the cesarean section will be presented in each specific article. We would like to present some information about the indications of a cesarean section of the Central Obstetrics Hospital. This is only the indication for cesarean section in one hospital, which can be very different from other settings, especially since its function is the last line to accept all difficult delivery cases of other facilities.

Genital causes include: uterus with old surgical scar (56.1%), cervical progression (36.5%), uterine hyperstimulation (3.8%), causes other (3.6%). For the uterus with old cesarean section scarring, 91.9% had to re-operate, only 8.1% had lower sugar delivery.

Group of causes due to pregnancy: fetal enlargement (32.7%), fetal failure (27.2%), buttock (24.7%), another throne (6.7%), twins (4.7%) , not open all the way (4.0%). In the buttocks, 75% of schools have a cesarean section, 25% deliver lower sugar.

Group of causes due to pregnant women: placenta (61.0%), amniotic fluid (22.8%), amniotic fluid (11.4%), premature peeling vegetable (2.6%), sa vegetable wire (2.2%).

Indications for active cesarean section (prophylaxis)

Abnormal pelvis

If it is not a crown, a cesarean section is required.

If the throne:

Caesarean section if the pelvis is absolutely narrow, the pelvis is distorted, the lower pelvis is narrow, and the fetus is large.

Do a laparotomy test to challenge lower fertility if the pelvis is limited (pregnancy is not large).

The way out of the fetus is blocked

Striker tumors: common are fibroids in the uterus or cervix, ovarian cysts, other tumors located on the way out.

The type of striker that covers the entire cervix (the vegetable for the center striker completely) or the striker vegetables causing heavy bleeding forced emergency surgery to stop the bleeding to save the mother.

The uterus has scarring in the following case

Surgical scars on the body of the uterus: fibroids dissection scars, uterine scars, rupture scars, perforation of the uterus, scars of angioplasty, uterus, uterine horns.

Scarring of subuterine transverse surgery:

Had the cesarean section lower section from two or more times.

The previous cesarean section was less than 24 months ago.

Indicated surgery for the cause of the mother

A mother with chronic or acute systemic illnesses, if she has lower delivery, can be at risk to the mother's life (heart disease, hypertension, severe pre-eclampsia and eclampsia).

Abnormalities in the mother's lower genital tract such as: vaginal narrowing (congenital or acquired), history of fistula surgery, genital surgery.

Malformations of the uterus such as: the twin uterus (the uterus that does not become pregnant often becomes a forward tumor), the bipedal uterus ... especially when accompanied by an abnormal fetal position.

Causes on the part of the fetus

If the fetus has severe malnutrition or blood group disagreement, there is a risk of stillbirth in the uterus if the fetus is not removed.

Indicated cesarean section during labor

These designations are mostly relative indications. There need to be a lot of relative indications to form an indication for cesarean section.

Indicates surgery for the cause of the mother

Elderly child is a pregnant woman aged 35 and over. May be with or without the reason for infertility.

History of infertility treatment, rare and precious children.

The maternal pathology can still allow monitoring the labor, which will be cesarean if another difficult birth factor appears.

Surgery indicated for the cause of the fetus

An enlarged pregnancy is not caused by an abnormal pregnancy.

Anomalous throne: shoulder (no indication for internal rotation), frontal throne, anterior dwarf, posterior chin face. Buttocks if there is another difficult birth factor.

Old pregnant women (past the date of birth) often have to undergo caesarean section because the fetus is not able to endure labor.

Multiple pregnancies: if the first pregnancy is the buttocks or shoulders.

Acute contraceptive failure in labor when the lower route is not yet qualified. The phenomenon of acute fetal failure is more likely to occur on the basis of chronic fetal failure, rapid and strong uterine contractions.

Surgery is indicated for abnormalities in labor

Abnormal uterine contractions after unsuccessful corrections have been taken with an inotropic or contraceptive drug.

The cervix does not erase or open even though the uterine muscle is synchronous, consistent with the cervical opening. It is possible that the cervix has physical damage such as fibrosis, edema.

Premature rupture of the amniotic fluid, premature rupture of the amniotic fluid, the labor has stopped progressing, potentially causing infection of the amniotic fluid, after actively correcting uterine contractions. The consequences of premature rupture of membranes often make it difficult for the cervix to open, postpartum infection.

The head does not fall when the cervix has fully opened, although the contraction is strong enough, possibly due to the disproportionate reason for the reincarnation of the rather discreet pelvic area.

Indicated cesarean section for complications in labor

Bleeding because of the striker vegetables, young vegetables. In many cases, a cesarean section is required even after the fetus is dead.

The threat of rupture and rupture of the uterus.

Umbilical cord prolapse while still alive.

Sa chi after trying to push but failed.

In summary, the indications for cesarean section are very rich, presented in each specific article. This article is synthesized to clearly see the indicated groups for cesarean section, but can not present all the indications for cesarean section.