Cesarean section

　　Cesarean section is performed when it is absolutely impossible to deliver vaginally due to some reason, and it can save the lives of both the mother and the child. Common indications for cesarean section include:

　　First, difficult labor
　　1. Pelvic inlet malpresentation: It refers to a narrow pelvic inlet plane. In plain language, it means that the fetus is too large for the maternal pelvic inlet. Among them, 'absolute pelvic inlet malpresentation' occurs in pregnant women with明显 narrow or malformed pelvis or in those with a significantly large fetus. For these pregnant women, the full-term live fetus cannot 'enter the pelvis', cannot be delivered vaginally, and cesarean section is required during term pregnancy, the indication is clear, and the decision is easy to make.
　　2. Abnormal birth canal or soft birth canal: Abnormal birth canal, such as a pregnant woman with a fractured coccyx, may have the tip of the coccyx elevated, narrowing the effective birth canal; abnormal soft birth canal, such as severe vaginal developmental畸形, scar stenosis, or pregnant women with benign or malignant tumors in the rectum or pelvis that obstruct the birth canal. In these cases, even if an episiotomy is performed, it is estimated that a full-term fetus cannot pass through the birth canal, and cesarean section is preferable.
　　3. Abnormal fetal position: For example, some breech, transverse, and abnormal cephalic positions (high-lying, frontal, occipital posterior, etc.) are not suitable for vaginal delivery. There are also some situations in twins or multiple pregnancies (such as the first twin in breech or transverse position, or conjoined twins), which are also not suitable for vaginal delivery. In addition, some correctable fetal abnormalities, where the fetus cannot tolerate the labor process, or where a part of the fetus is abnormal and cannot pass through the birth canal, cesarean section should be performed.
　　4. Cord prolapse: In some cases where the amniotic membrane has ruptured, the umbilical cord passes over the presenting part of the fetus and prolapses into the cervical os and into the vagina, even outside the vagina, which is called cord prolapse. At this time, the cervix and the presenting part of the fetus compress the umbilical cord, and the fetus may rapidly develop intrauterine distress, even fetal death. Therefore, once cord prolapse is detected and the fetal heart rate is still present, the fetus should be delivered within a few minutes.
　　5. Fetal distress: refers to fetal hypoxia in utero, leading to acidosis in the fetus, causing damage to the nervous system. In severe cases, sequelae may remain, even fetal death in utero, which is a common complication in obstetrics. In this situation, if vaginal delivery cannot be achieved within a short period, an immediate cesarean section should be performed.
　　6. Cesarean section history: prone to uterine rupture or threatened uterine rupture.

　　Two, pregnancy complications
　　For example, severe preeclampsia, eclampsia, placenta previa, placental abruption, etc.

　　Three, pregnancy complications
　　For example, some uterine fibroids, ovarian tumors; some internal and external diseases, such as heart disease, diabetes, kidney disease, etc.; some infectious diseases, such as gestational condyloma acuminatum or gonorrhea, etc.

　　Four, precious child
　　This is a relative indication for cesarean section. The mother is older, has been infertile for many years, has had multiple failed pregnancies, the fetus is valuable, and so on.

　　The main complications after cesarean section are:
　　1. Respiratory and pulmonary infection Encourage and assist the mother to turn over within 2 hours after the operation, and turn over once every 2 hours. Assist the mother to cough out sputum in time if she has sputum.
　　2. Bedsores Keep the bed clean, dry, and flat, and do a good job of skin care in a timely manner. Change clothes and pants frequently;督促并协助产妇翻身，especially for edema patients, whose skin resistance is low, and pressure on limbs is prone to bedsores, which should be paid special attention to.
　　3. Urinary tract infection During the catheterization, strict aseptic operation should be performed, and good perineal care should be done to keep the perineum clean during the period of indwelling catheter. Do not let the urine bag and drainage tube be higher than the buttocks to prevent retrograde infection. Encourage the mother to drink more water and urinate as soon as possible after the catheter is removed, generally not exceeding 4 hours.
　　4. Intestinal adhesion and lower limb venous thrombosis Encourage and assist the mother to turn over within 2 hours after the operation, and督促并协助产妇下床活动 after the urinary catheter is removed.

　　From the perspective of the mother, cesarean section surgery increases the chance of massive hemorrhage and infection, and the possibility of postpartum complications is 10 to 30 times higher than that of natural childbirth. The pain after cesarean section lasts longer, and the recovery time is also longer. Urinary catheters need to be left in place, and there is a period of time when the mother cannot eat, which obviously affects breastfeeding. If the baby has congenital defects or dies unexpectedly, the mother needs to wait for 3 years before getting pregnant again to avoid uterine rupture and affect the safety of both mother and child. In addition, the cesarean section incision is large, and the mother is prone to amniotic fluid embolism, where amniotic fluid enters the blood, posing great harm to the mother's life safety.
　　From the perspective of the newborn, since the child has not been squeezed through the birth canal, one-third of the fetal lung fluid cannot be expelled. Some may not be able to breathe independently after birth, which is known as 'wet lung', and it is easy to have complications such as neonatal asphyxia and hyaline membrane disease. At the same time, cesarean section may also cause iatrogenic preterm labor due to not truly reaching fetal maturity, leading to a series of complications in premature infants, such as intracranial hemorrhage, retinopathy, or even disability or death. In addition, there are also numerous cases where some doctors operate carelessly, causing harm to both the mother and the fetus.

　　How to avoid unnecessary cesarean sections? If the labor process is not as smooth as expected, what should the mother and her family do?
　　1. Do not be anxious and maintain full confidence in a normal delivery. Insufficient confidence can lead to weak labor power, making the original adverse factors even stronger, increasing the possibility of difficult labor.
　　2. Communicate with the doctor to understand the adverse factors and whether they can be corrected and how to correct them. For example, uterine contraction weakness can be corrected with oxytocin.
　　3. Discuss the mode of delivery with the doctor. Do not insist on cesarean section, listen to the doctor's opinion, weigh the pros and cons, and then decide on the mode of delivery.
　　4. The role of the husband cannot be ignored; he must remain calm and actively encourage his wife. When the contractions of the wife become strong and the delivery of the fetus is approaching, it is also the most painful time in her delivery process. At this time, the husband must remain calm and actively encourage her, and should not mistakenly think that cesarean section is a good way to relieve the pain of his wife and ensure the safety of both mother and child. He should trust the doctor's judgment.

　　A series of examinations should be conducted before cesarean section, including the mother's body temperature, pulse, respiration, blood pressure, medical history, blood type, liver function, HIV virus, hepatitis C, syphilis, to determine the health status of the mother and fetus.

　　Generally speaking, it is necessary to fast for 6 hours after cesarean section surgery. Because the normal function of the gastrointestinal tract is suppressed after surgery, intestinal peristalsis is relatively slow. If too much food is eaten, the burden on the intestines will increase, which not only causes constipation but also increases gas production, which is not conducive to recovery.
　　After 6 hours of surgery, there are certain considerations for eating. After 6 hours, you can eat congee, egg flower soup, and other liquid foods. On the first day after surgery, the main food should be thin congee and fish soup, given 6-8 times. On the second day after surgery, the mother can eat some soft, porridge-like semi-liquid foods such as mashed noodles and rice, given 4-5 times. After the third day, the mother can eat ordinary food, and should supplement high-quality protein, various vitamins, and trace elements. Foods that produce a lot of gas, such as soybeans, soy products, and sweet potatoes, should not be eaten. Foods that produce a lot of gas will ferment in the abdomen and produce a large amount of gas in the intestines, causing bloating.

　　Cesarean section surgery is mainly divided into seven steps, the whole process is as follows:

　　1. Cut the abdominal wall
　　After the site of surgery is determined, the operator should follow the routine procedures of cleaning, shaving, disinfecting, and anesthetizing. The first step is to make an arched incision, then successively incise the skin, muscle, external oblique muscle, internal oblique muscle, transversus abdominis muscle, and their fascia. If there are blood vessels, they should be avoided or doubly ligated. Then, incise the peritoneum, and when cutting the abdominal wall, it is necessary to use forceps to lift a small incision and then the operator inserts the middle finger or index finger of the left hand into the incision, guiding the incision of the peritoneum to an appropriate length, and exposing the rumen.

　　2. Pull out the uterus
　　After the peritoneum is incised, the operator's arm should be re-disinfected and rinsed with normal saline, then inserted into the abdominal cavity to examine the uterus, fetus, and adjacent organs, to determine if there are any ruptures or adhesions. Subsequently, an assistant should move the rumen forward to expose the uterus, and pull the uterus out to the outside of the incision. The movement should be slow and at a certain angle; excessive force can easily tear the uterus. After the uterus is pulled out, a large piece of multi-layer sterile gauze should be stuffed between the uterus and the incision edge to prevent the fluid inside the uterus from flowing into the abdominal cavity and causing infection.

　　3、切开子宫
　　After determining the large curve of the uterine horn, avoid the uterine papillae, and cut through the uterine wall with one incision. After fully ligating the bleeding points at the uterine wall incision, carefully separate the amnion near the incision. If the amniotic fluid inside the membrane is full, make a small incision first to release the amniotic fluid, choosing an appropriate position and direction for release. After some of the amniotic fluid is released, use scissors to extend the amnion incision and flip and fix the two incision edges towards the uterine incision on both sides, so that the cut edge of the amnion inversion forms a biological wound dressing. When the amniotic fluid flows out, it will not leak into the abdominal cavity and cause contamination.

　　4、拉出胎儿
　　When taking the fetus out, grab the fetus by the tarsus or wrist of the forelimb along the uterine incision and slowly pull it out in the most suitable direction and angle. If the incision is too small, it can be expanded. After the fetus is pulled out, the assistant should fix the uterus so that it does not shrink back into the abdominal cavity.

　　5、剥离胎衣
　　The principle of treatment is to remove all that can be removed, and if it cannot be removed, cut off the part that has already fallen off, leaving the rest inside the uterus to be spontaneously shed and expelled. However, the amnion near the incision edges must be removed to prevent obstruction of the suture.

　　6、缝合子宫
　　Before suturing the uterus, the uterus should be evenly sprinkled with antiseptic powder. The closure of the uterus is usually performed in two sutures, the first being a full-thickness continuous suture, and the second being a serous muscle layer buried suture. To accelerate uterine recovery and hemostasis, and to facilitate the expulsion of lochia, 5 to 10 units of pituitary posterior lobe hormone can be injected into the uterine cavity before suturing.

　　7、缝合腹壁
　　Before缝合腹壁, the abdominal cavity should be carefully cleaned. After the abdominal wall incision is tidied up, the peritoneum should be sutured first, usually with continuous suture using catgut. Before the peritoneum is sutured, antibiotics should be injected into the peritoneum through the incision to prevent infection and adhesion. Then, suture the muscles layer by layer, continuously. Finally, apply knot sutures to the skin, and when suturing the skin, turn the edge inward to prevent it from affecting the wound healing and extending the treatment period. After the suture is completed, apply iodine tincture or antiseptic ointment to the surgical site, then release the restraint and help the patient stand up.