Notes during cesarean section

The article was consulted professionally by Specialist I Le Thi Phuong – Obstetrics and Gynecology Department – Share99 Ha Long International Health Hub. Dr. Le Thi Phuong has 29 years of experience in obstetrics and gynecology.

Cesarean section is surgery to remove the fetus, placenta and amniotic membrane through an incision in the abdominal wall into the uterus intact. Compared to vaginal birth, cesarean section is applied in urgent cases, it is necessary to remove the pregnancy in order to reduce the dangers to the fetus and the mother.

1. Causes of cesarean section surgery

The causes of cesarean section are:

Abnormal mother's pelvis:If it is not a crown, it must be cesarean section, if it is a crown, it must also be cesarean section in case the pelvis is absolutely narrow, the pelvis is distorted; test the crown to challenge lower sugar birth if the pelvis is limited (the pregnancy is not large), if it fails, a cesarean section is in place.

The way out of the pregnancy is hindered such as: Forward tumors, commonly fibroids in the waist of the uterus or cervical, ovarian cysts, other tumors located on the way out of pregnancy; each other central strikers or each other strikers causing a lot of bleeding forced emergency surgery to prevent bleeding to save the mother.

The mother's uterus has surgical scars in case: The surgical scars in the body of the uterus are scarred with fibroids, scars of uterine plastic surgery, scars stitched in the rupture, perforation of the uterus, scars of surgery to cut the corners of the uterus, horns of the uterus; scars of a lower-ervical sectional surgery of two or more times or a previous cesarean section less than 24 months ago.

Pregnant women with dangerous diseases: Pregnancy surgery is in place because the mother has chronic or urgent general medical condition if lower sugar can be at risk for the mother's life (severe heart disease, hypertension, severe pre-convulsions and seizures); abnormalities in the lower genital section of the mother such as vaginal stenosis (congenital or acquired), history of fistula surgery, genital mus sections; malformation of the uterus such as the double uterus (the uterus without pregnancy often becomes a forward tumor), a two-horned uterus….

Fetal problems: Caesareansection is in place when the pregnancy is severely malnourished/delayed in intra-uterus growth, or the pregnancy is > 4,000g is not due to abnormal pregnancy; the fetus has a blood type disagreement with the mother if the pregnancy is not removed, there is a risk of the fetus being still in the uterus

History of pregnancy: Pregnant women aged 35 years and older. May or may not be accompanied by infertility reasons: history of infertility treatment, rare children.

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Pregnant women with a history of infertility treatment should perform a cesarean section

Pregnancy problems: Abnormalstars such as shoulders/horizontal,forehead, frontal, back chin, buttocks and asymmetry of the pelvis.

Multiple pregnancies: if the first pregnancy is not the first.

Abnormalities during labor: Cesarean section is in order to be prescribed because of abnormal labor abnormalities such as abnormal uterus contractions after having taken drugs that increase contraction or reduce contraction to regulate without success; the cervical does not erase or open despite the synchronized muscles of the uterus, which are suitable for cervical opening; The amniotic fluid ruptures prematurely, stopping the labor, urging the birth to fail.

Other complications: Cesareansection is in order to be prescribed because of labor complications such as bleeding for each other strikers, young peeling each other; the threat of rupture and rupture of the uterus; umbilical cord prolapse while the fetus is alive; post-fetal kimchi when tried to push up but was unsuccessful.

2. Note in cesarean section

2.1. Preparation before cesarean section

Sick people and family:

  • Be consulted on the full reasons and risks of accidents that may occur during pregnancy surgery,sign a surgical commitment
  • Preparation from the eve of surgery: Sedative drinking at 20h; fasting from 22h; indentation at 5am on the day of surgery
  • Abdominal hygiene and TSM

Implementer:

  • Department of Obstetrics and Gynecology Team prepares for surgical disease
  • Resuscitation anesthesia crew
  • Surgical crew
  • Newborn care crews in need of newborn resuscitation

Means, tools and drugs:

  • Kits, medications for spinal/sural anesthesia, body anesthesia
  • Sterilized cesarean kits
  • Newborn care and resuscitation facilities
  • Medicines for resuscitation and medicines used in obstetrics and newborns

2.2. Steps to carry out a cesarean section

Step 1. Insymity:

Body anesthesia or sural anesthesia or spinal anesthesia

Step 2. Into the abdomen:

  • Incision of the middle line under the navel or horizontal line on the guard depending on the ability of the surgeon, maternity and fetal condition
  • Incision of subcutaneous fat layer
  • Incision of white line between 2 straight abdominal muscles (can be incised a small section and then separated by fingers) if pecked along the vertical line
  • If the cesarean section is horizontal, slit the scales to the sides according to that incision, separate the weight from the wide muscle layer upwards and then open the line between the two straight abdominal muscles
  • Enter the mesitonees by surgically pairing the mesitonees with a toothless surgical clip, which dissects the opposite side of the mesitoneal pair with a toothless hematoma clip. Surgeons and surgeons in turn release and pair back before using a knife or scissors to open a hole in the peritoneea. Use scissors to extend the peritonees upwards and below
  • Insert wet gauze on both sides, leave the wire out
  • Place the valve on the bladder cover and clearly reveal the area under the uterus
  • Peritoneal incision in a horizontal line about 2cm below the "fastening line of the peritoneous"
  • Using the curved head of the prison to separate the mucous peritoneous part of the lower segment upwards and downwards, the nose pulls upwards to avoid damage to the arteries of the uterus
  • Use a knife to slit a small section 1-2 cm across the lower segment and then use 2 index fingers to tear the incision horizontally to the sides

Step 3. Take the pregnancy and placenta out of the uterus:

  • Surgeons take the pregnancy with the left hand while the woman sucks blood and amniotic fluid (if the head is too high it is possible to use Forceps)
  • After the crown is exposed to the incision, the woman presses the bottom of the uterus to help the fetus' head book out. Horizontal case: pregnancy with the fetal leg. If it is an inverted throne: get pregnant with a buttock (butt-style inverted throne) or with your legs (fully inverted)
  • Dry, Slow umbilical cord clip, transfer the pregnancy out to wipe, let the baby lie on the mother's chest (if the mother is anestocesced spinal cord or sacrum)
  • Put 10 units of oxytocin in a flowing infusion bottle and let it flow quickly so that the uterus recovers well (do not inject oxytocin directly into the vein)
  • Proceed to take vegetables, wipe the uterus with large gauze. If during cesarean section,the maternity has not gone into labor, the cervical nod with the finger and then replaced the cast iron

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Cesarean section

Step 4. Restoration of the muscles of the uterus:

  • Restore the sub-uterus muscles with Vicryl 0, starting with stitching 2 corners of the uterus, avoiding corners
  • Continue continuous stitching of the nasal muscles or separate nose 1cm apart, can stitch a second layer to bury the head layer, check the bleeding
  • Neotriosis of the uterus with Catgut 00 only with continuous stitches, hem bleeding examination
  • Remove the valve on the guard, take the gauze, wipe the abdomen, check 2 ovaries, 2 ovulation tubes, the back of the uterus and the bag with Douglas behind

Step 5. Abdominal closure:

  • Suture of the abdominal wall with Catgut 00 with continuous stitches
  • Stitch 2 straight abdominal muscles close together with 2-3 separate catgut stitches
  • The balance is only Vicryl 0. If the fat layer is thick, stitched with a separate nasal Catgut or a continuous nose
  • Stitch the skin with flax, separate nose or continuous stitching under the skin with small Vicryl index
  • Reseptic of incisions and scorobial bandages
  • Surgeons keep hands clean to remove stagnant blood in the vagina and see if the uterus recovers well, antiseptic vagina
  • Wipe off the blood on the patient before transferring it to resuscitation

3. Post-cesarean care

3.1. On the doctor's side

In the first week after the pregnancysurgery, the incision is not dry, so obstetrician and gynecologist and the maternity will take care of the maternity and clean the incision.

Your doctor will give you painkillers, antibiotics, or uterus shrinkage medications to avoid complications such as infections. It is perfectly normal to take painkillers after cesarean section, as it does not affect the quality of milk at all, so if the pain has exceeded the threshold of tolerance, then the maternity should ask the doctor for painkillers.

3.2. On the mother's side

Nutrition:

  • Women are not allowed to eat anything within 6 hours after cesareansection, because at this time your bowel movements are very low, the intestinal tract is stagnant with a lot of gas, the stomach is weakly functioning, so it will be difficult to digest, making the body more tired, longer to recover. Therefore, mothers should only drink filtered water, sugar water, eat diluted porridge until deflated.
  • In the following days, mothers eat as usual, strengthen protein and calcium-rich foods, and drink plenty of water to have more lactation milk and avoid constipation;
  • Do not use foods that are prone to diarrhea or allergies, causing keloid scars (chicken, beef, seafood, vegetables …). It is recommended to eat nutritious foods such as: sugar protein, iron, freshly cooked vegetables.

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Post-birth maternity strengthens protein and calcium-rich foods, while drinking plenty of water

Body hygiene:

  • During this time, the mother should wipe the person with warm water or bathe quickly, avoiding soaking the body in the bath causing the incision to get wet.
  • When bathing, women should use clean cotton to dry the incision, so that the open incision does not need a closed bandage, keeping the incision dry. It is possible to clean the incision with a 10% solution of betadin or povidine, which helps the incision to quickly scar and avoid infection. Do not apply antibiotics, apply betel leaves, crushed garlic on the incision.

Body movement:

  • As soon as the cathethe tube was removed, the maternity was able to step down on the bed and practice walking again. Before that, mothers should move their limbs gently or sit up.
  • For women who have gone through too difficult labor before deciding to have a cesarean section or a difficult cesarean section that takes a lot of blood, it is necessary to rest to restore energy before moving.
  • Exercise is very good and accelerates the recovery process after birth, but if the caesarean section is still needed 4-6 weeks after birth to be trained again.

At Share99 International Health Hub, obstetrics and gynecology at Share99 is pain relief on the first day after surgery by lumbar square muscle anesthesia, helping mothers take care of their baby and recover better health. This is an analgesic technique performed by Share99 to help prevent pain signals before it is transmitted to the spine and to the brain, causing postoperative pain for women.

In addition to the technique of lumbar square muscle anesthesia under ultrasound instructions, in obstetrics and gynecology, Share99 also implements the technique of neurosychism to relieve perinac pain / hypothetic, helping women experience life in the most pleasant way, whether it is normal birth or cesarean section. Thanks to these measures, maternity and childbirth at Share99 are fully pain relief, quick recovery, bowel movements soon work again, exercise – walk early, do not cause chronic pain. The results of the most recent aneges anegesy showed that: '' All cesarean sections do not haveto use morphine,post-birth pain during movement and living is almost no longer recorded ''

For direct advice, please click hotline number or register online HERE. In addition, you can register for remote consultation HERE

SEE MORE:

  • Why does the incision heal, the patient still hurts?
  • Diary of taking mother for 4th caesarean section in Share99 Hai Phong
  • Features of uterus contractions in labor

About: John Smith

b1ffdb54307529964874ff53a5c5de33?s=90&r=gI am the author of Share99.net. I had been working in Vinmec International General Hospital for over 10 years. I dedicate my passion on every post in this site.

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