Features of an emergency caesarean section

Sometimes the need for a cesarean section arises suddenly, unexpectedly. Such an operation is called emergency, it is carried out without preliminary preparation, according to strict health indications. In this article, we will talk about the features of such delivery and consider its pros and cons.

What it is?

An emergency caesarean section in the official medical language is a delivery operation that is performed on an emergency basis. This means that there is no time to plan an operation and schedule additional examinations. The baby and mother need an urgent delivery, on which their lives depend.

Such an operation is done at any time, the main condition is the viability of the baby.

Such an operation really helps save lives, but, alas, it is associated with certain risks - the likelihood of complications after an emergency surgical delivery is always much higher than after a planned one.

If the operation is urgent, special techniques and methods may be chosen. The likelihood of complications for the child is also higher than with a caesarean section performed according to the planned schedule.

Indications

The need for an urgent operation can arise during pregnancy, as well as during natural childbirth, if insurmountable obstacles arise that interfere with normal physiological delivery. The operation may be required both according to the indications of the woman and in the interests of the fetus.

During the period of bearing a child, existing complications of pregnancy usually become the reason for the appointment of a planned operation. An emergency may arise when:

the threat of rupture of the uterus along the old scar or incipient rupture, as well as in the event of a ruptured uterus;
premature detachment of a normally located placenta, as well as detachment of a low-lying "child's place" with the development of bleeding;
sudden deterioration of the fetus - tight cord entanglement, signs of oxygen starvation, the development of hemolytic disease due to the Rh-conflict between the mother and the baby;
sudden premature discharge of amniotic fluid, after which contractions do not develop, despite stimulation with medications.

If labor has already begun, the need for an emergency caesarean section may arise at any time, especially if the woman in labor is at risk. The operating room is always at the ready if a woman gives birth with a scar on the uterus (second birth after the first cesarean section), if the birth is taken from a woman who is pregnant with twins or triplets, as well as in other situations. Generic indicators for an emergency caesarean section are:

premature placental abruption during childbirth, before the baby passes through the birth canal and is born;
a long period after the passage of water, if childbirth does not develop;
primary weakness of labor forces (contractions weakened, stopped, do not resume under the influence of medication, or are discoordinated, the cervix does not open);
secondary weakness of labor (attempts have weakened or stopped, the passage of the baby, the birth of his head slowed down or stopped);
the onset of acute fetal hypoxia (the most dangerous situation for the baby);
prolapse of the umbilical cord or parts of the child's body into the birth canal, for example, with intense discharge of amniotic fluid, with polyhydramnios;
rupture of the uterus along the old scar during childbirth;
high blood pressure in a woman in labor, a state of eclampsia.

In case of premature onset of labor, a woman who was scheduled to undergo a cesarean section for medical reasons in a planned manner also undergoes an emergency operation.

Important aspects

While a horizontal incision just above the pubis is considered preferable for a planned operation, surgeons often do not have time for such an incision in an emergency operation. Therefore, such delivery can be carried out by the corporal method. In this case, the dissection of the abdominal wall is carried out longitudinally, vertically from the navel, perpendicular to the line of the pubis downward.

The corporal incision provides wider and faster access for the surgical team to the uterus. The uterus itself can also be dissected longitudinally, transversely, in a lunar way - the choice of a specific tactic depends on the preferences of the surgeon conducting the operation, as well as on the location of the fetus in the uterus and other factors.

The disadvantage of this tactic is that the risk of developing profuse and heavy bleeding during corporal dissection increases significantly. But in situations where the count goes to minutes and the life of a woman or a child depends on them, such a risk is justified, especially since modern maternity hospitals and perinatal centers have reserves of donor blood and plasma to immediately replenish the amount of blood lost during bleeding.

An emergency caesarean section, if it takes place without complications, lasts less than the planned one, since it takes less time to dissect the abdominal wall by the corporal method. Sometimes doctors, after weighing the risks, perform an emergency operation with a low horizontal section, which is more preferable if the woman is still going to have children.

Vertical sutures on the abdomen take longer to heal than horizontal ones, they are not cosmetic, and therefore almost always spoil the appearance of the abdomen. Healing of sutures takes about 60 days. For comparison, the suture heals three times faster after a planned operation - about 20 days.

Often, after an emergency operation, a woman and a child need to stay in intensive care.

Anesthesia for urgent surgery

The choice of the type of anesthesia is another curious feature of emergency surgical delivery. If, before a planned operation, a woman is examined by an anesthesiologist in order to choose the type of anesthesia for the upcoming operation, then there is simply no time to identify contraindications before an emergency operation. Epidural anesthesia, which is popular today, has a fairly large list of contraindications, but general anesthesia, which until recently was the only type and had no alternatives, has no contraindications - it can be given to any person at any age and in any situation.

The only thing that will matter is the history indicated in the woman's card, her weight and the state of blood pressure at the moment. Based on these data, the anesthesiologist will quickly determine the necessary dosages of drugs that will immerse the woman in labor in a sound medication sleep, in which she will neither see nor hear anything. Of course, she will not be able to see her baby immediately after birth.

Epidural anesthesia requires not only preliminary preparation, but also a longer time to achieve the effect. From the moment of the introduction of drugs into the epidural space of the spine, it takes 15 to 25 minutes before the onset of the desired degree of anesthesia, while general anesthesia acts within a minute after the introduction of an intravenous injection. It takes the doctor another five minutes to install the tracheal tube and connect the patient to the ventilator. After that, the operation can begin.

If a woman is given an epidural at the beginning of labor and there is already a catheter in her spinal canal, there may be spinal anesthesia, in which case drugs for pain relief will be injected into the installed catheter. The woman will be conscious, but she will not feel pain, she will be able to see the moment of the birth of her child.

Possible consequences

Any cesarean always has a chance to get complicated. But with an emergency operation, the risk of negative consequences is much higher. What can be these consequences:

adhesions, suture suppuration, fistula formation in the area of the postoperative suture on the abdomen, scar discrepancy;
infectious complications, inflammation;
the likelihood of bleeding during or after surgery in the early recovery period;
inadequate reaction of the woman's body to anesthesia;
the impossibility of repeated childbirth through the natural birth canal;
development of respiratory failure, distress syndrome in a child;
the effect of drugs for anesthesia on the baby.

The recovery period after an emergency operation lasts almost a month longer than the same period after a planned operation.

A woman is introduced to serious restrictions on physical activity, on lifting weights, and a strict diet is also recommended to her to prevent bloating and constipation.

It is possible that after a corporal dissection, the postpartum woman will have to take painkillers longer. In almost all cases, after CS, an emergency course of antibiotic therapy is given to reduce the likelihood of infection. This factor sometimes leaves an imprint on the breastfeeding regime - it is possible that you will have to express and dispose of milk before the end of the antibiotic intake.