Sanxiang Metropolitan Daily, September 19 (Correspondent Yang Hua) With the opening of the mainland's two-child and three-child policies, scarred uteruses and elderly women have increased significantly, and the rate of cesarean section has also increased. When is a cesarean section performed? How to care after surgery? Will there be insufficient breastfeeding after surgery? Can I deliver vaginally in my next pregnancy after a cesarean section? Recently, in response to the hot issues that many women and their families are more concerned about, Yang Hua, deputy chief physician of Daoxian Maternal and Child Health Care Hospital, answered the questions.
1. In which cases should a cesarean section be performed?
Some pregnant mothers asked for a cesarean section, but the doctor said that there was no indication for surgery, and some pregnant mothers wanted to have a vaginal trial delivery, but the doctor recommended that she have a cesarean section. So when do you need a cesarean section? This question is actually what doctors often say about the indications for cesarean section. Any pathological or physiological condition in which vaginal delivery is not possible or unsuitable for vaginal delivery is an indication for cesarean section, and once these conditions occur, cesarean section should be performed on the advice of the doctor. These situations include, inter alia:
1. Fetal distress: when acute or chronic hypoxia of the fetus occurs in the third trimester of pregnancy or during delivery, and vaginal delivery is impossible in a short period of time.
2. Cephalopelvic disproportion: When the absolute cephalopelvic disproportion, the fetus cannot be delivered smoothly vaginally, or the relative cephalopelvic disproportionality fails through a full vaginal trial delivery.
3. Ccatricial uterus: If you have had 2 or more cesarean sections in the past, or have had surgical penetration into the uterine cavity during previous myomectomy.
4. Abnormal fetal position: fetal transverse position, when the first full-term pregnancy is a single breech position, the estimated fetal weight is greater than 3500 grams or foot exposure.
5. Placenta previa and vascular previa: When the placenta partially or completely covers the internal cervical orifice or vascular previa, vaginal delivery may cause blood loss from the mother or baby, endangering the life safety of the mother and baby.
6. Twin or multiple pregnancies: If the first fetus is not in the cephalic position, or if there is a complicated twin pregnancy, such as a conjoined twin, or a multiple pregnancy of three or more.
7. Umbilical cord prolapse: Once umbilical cord prolapse occurs, the fetus can die due to acute hypoxia, so it is estimated that the fetus may survive, and when the assessment results are that rapid vaginal delivery is not possible, emergency cesarean section should be performed to save the fetus as soon as possible.
8. Placental abruption: Placental abruption refers to the removal of the placenta in the normal position after 20 weeks of pregnancy before the delivery of the fetus, which is a serious complication in the third trimester. During placental abruption, if the fetus is likely to survive, fetal heart rate should be monitored and delivered by emergency cesarean section. If severe placental abruption occurs, emergency caesarean section should also be performed to save the woman's life, even though the fetus is dead.
9. Pregnant women with serious comorbidities and complications: such as pregnant women with heart disease, severe preeclampsia, acute fatty liver during pregnancy, etc., can not bear vaginal delivery.
10. Fetal macrosomia: fetal estimated to be greater than 4250 grams.
In addition to the above 10 conditions, cesarean section is also required to terminate pregnancy if there are genital tract infections, birth canal malformations, pregnancy combined with tumors, etc. In the absence of any indications for surgery, the doctor has the right to refuse a caesarean section when a simple pregnant woman requests a cesarean section, but the request of the pregnant woman should be respected and should be an alternative option.
2. After cesarean section, what should I pay attention to when nursing a mother?
1. Postoperative observation: When returning to the ward after surgery, attention should be paid to whether the wound dressing has bleeding, whether the urine volume and color of the urine bag are normal, and whether there is much vaginal bleeding. Pay attention to keeping warm, and prevent hot water bottles and other facilities from scalding the mother. Observe whether the mother's complexion and mental state are normal, and contact the doctor in time if there is any abnormality.
2. Postoperative medication: Before cesarean section and 2 days after cesarean section, the doctor will prophylactically use antibiotics and oxytocin for women to prevent wound infection and promote uterine contractions. If severe contractions occur, it is normal. If the pain is significant, you can tell your doctor about symptomatic treatment.
3. Abdominal wound: At present, most cesarean sections choose the transverse incision of the lower abdomen, the wound is beautiful, the healing is fast, and the stitches are generally removed 5 days after surgery. If it is a longitudinal incision in the lower abdomen, the stitches are removed 7 days after surgery. The wound heals well and can be discharged after stitches are removed. If you choose cosmetic thread to close the wound, you do not need to remove the stitches, and you can usually be discharged from the hospital 4 days after surgery.
4. Diet and exercise: Generally, after 6 hours of cesarean section, you can enter a liquid diet (water and rice soup), and after exhaust, you can enter semi-liquid (porridge and noodles), slowly transition to general food, pay attention to eating less and more meals. Turning over after surgery and getting out of bed as soon as possible is conducive to uterine rejuvenation, promote intestinal function recovery, reduce intestinal adhesions, and avoid and reduce the formation of venous thrombosis.
5. Treatment of the ureters after surgery During the retention of the catheter, the perineum is wiped and washed twice a day to keep the vulva clean and prevent infection. Generally, the catheter is removed 24 hours after cesarean section, at which time the woman should be helped to urinate on her own and reduce the occurrence of urinary retention.
3. Will cesarean section affect breastfeeding?
Some pregnant women and their families are worried that anesthesia and anti-inflammatory drugs after cesarean section will not affect milk, and will surgery lead to insufficient milk? In fact, mothers can rest assured that when the cesarean section is awake, the anesthetic has been basically metabolized, so it will not affect the milk. Doctors usually choose anti-inflammatory drugs that have no effect on breast milk, taking into account the need to breastfeed after childbirth. There is also no milk depletion after caesarean section. The mother's mood and the baby's sucking are the main reasons for affecting milk secretion, as long as you maintain a good mood every day, let the baby suck the nipple frequently, and the breast milk will be as adequate after cesarean section as usual.
4. How long after cesarean section is it appropriate to get pregnant?
After cesarean section, the second pregnancy should be no less than 18 months, and the best time is 2 to 5 years after cesarean section. During this time, the scar is soft and elastic. If the interval is too short, the uterine wall does not necessarily heal well, and uterine rupture is prone to occur. If the interval is too long, the scar will be fibrotic, the elasticity will be weakened, and the uterus will also be prone to rupture.
5. Can I deliver vaginally in my next pregnancy after cesarean section?
Many mothers who have had a one-child caesarean section have a vaginal birth. So what conditions must be met to "one child and two children shun"?
1. Only one cesarean section of the lower uterine transverse incision was performed, and the previous cesarean section was successful, the incision was not depleted, the wound healed well, and there was no late postpartum hemorrhage, postpartum infection, etc.; There are no surgical scars in the uterus other than the cesarean section.
2. The fetal position of this pregnancy is normal, the fetus is in the head position, the baby is not large, and the estimated fetus weight is less than 4000 grams.
3. There is no indication for a previous caesarean section, and no new indication for caesarean section has emerged.
4. The interval between 2 deliveries is greater than 18 months, and the time from the last caesarean section is generally 2 to 5 years later.
5. Ultrasound examination of the lower muscle layer of the anterior wall of the uterus is continuous, and the uterus is recovering well.
The pregnant mother who has a cesarean section for the first child and wants to have a vaginal birth for the second child must meet the above 5 conditions at the same time. Therefore, it is recommended that everyone should do a good job of preconception and pregnancy health care, reasonable diet, weight control, and full assessment before delivery, so that the second child can still complete the dream of a vaginal birth!