How long does a cesarean section take and what determines the duration of the operation?

Caesarean section refers to the category of operations that are quite laborious and serious, and therefore the operative delivery lasts not five or ten minutes in time. In this article, we will consider what is the average duration of surgery, whether it depends on the type of anesthesia, and what factors can influence the duration of surgery.

Duration

There are several methods for performing a delivery operation. And much in terms of its duration will depend on the method by which the surgeon will carry out the operative delivery. With any of the methods chosen, it takes time for the anesthesiologist to do his job: the operation cannot begin until the woman is deprived of sensitivity. It takes 10 to 20 minutes to give anesthesia, depending on the method of pain relief chosen.

Further, everything depends on the technique of surgical manipulations. The incision can be made horizontally on the lower abdomen, just above the pubis. Such an incision, about 10 centimeters long, is named after the German obstetrician, who was the first to propose to conduct operative childbirth in this way - the Pfannenstiel section. Today, up to 90% of caesarean section operations are performed using this technique. The child can be extracted within 20 minutes after the start of the operation.

If there is a need to make a vertical cut, then the section is called corporal. The time it takes to extract the baby with such a dissection is significantly reduced - up to 5 minutes, but surgeons will need more time in the second stage of the operation, in which they will suture, since the dissection area is more extensive.

Any traditional operation consists of several stages:

anesthesia;
access to the uterine cavity;
extraction of the fetus;
crossing the umbilical cord;
extraction of the placenta;
suturing.

The average duration of a traditional caesarean section, taking into account all stages, is 25 to 45 minutes. Much depends on the qualifications of the surgeon, the characteristics of this pregnancy, the presence or absence of complications during the operative delivery, preparation.

Planned and emergency operations last for different amounts of time. Therefore, no one will be able to say in advance how long a particular surgical intervention will last.

Scheduled and emergency COP

The more thorough preparation the doctors were able to carry out before the operation, the lower the risks of complications both in childbirth itself and in the postoperative period. The document of the Ministry of Health regulating the procedure for preparing for a planned operation (letter No. 15-4 / 10 / 2-3190) recommends that medical teams adhere to certain rules. So, the list of preparatory measures for carrying out a planned operation is as follows:

obligatory collection of anamnesis;
determining the state of the child (in what position the baby is located in the uterus, how much he presumably weighs, what is his heart rate) - perform ultrasound and CTG;
determination of the mother's condition (analysis of a vaginal smear, blood pressure, heart rate, skin condition);
blood test for HIV, syphilis, hepatitis, general blood tests, coagulogram (if there is reason to suspect problems with blood clotting), mandatory confirmation of the blood group and Rh factor before surgery;
consultation with an anesthesiologist (examination, identification of contraindications to certain types of anesthesia, choice of anesthesia method).

On the day of a planned operation, early in the morning, a woman is given an enema to cleanse the intestines; in the evening she should not eat, so as not to create a load on the digestive tract and it is easier to endure anesthesia. The night before, a woman receives sleeping pills or drugs from the group of barbiturates - the so-called premedication takes place.

Before entering the operating room, a woman's pubis is shaved. The Ministry of Health strongly recommends that all pregnant women, without exception, use compression stockings or bandaging the legs with an elastic bandage to prevent thromboembolism in the early postoperative period. By the appointed time, the woman ready for the operation is delivered to the operating room, where the anesthesiologist immediately begins to work.

Emergency surgery can be challenging. First of all, they are associated with the fact that the woman is not prepared for surgery.

If she ate not so long ago, then the doctors will need to empty the stomach with a probe and water before injecting anesthesia. Only then will anesthesia be administered.

Usually, with an emergency delivery, delay can pose a serious danger to the mother and the fetus, and therefore they will try to get the child out of the mother's womb as soon as possible, but the duration of the operation will become longer, because suturing a vertical incision (if it is allowed for quick extraction of the fetus) will require more time. In total, the operation can take up to an hour.

In addition to the longitudinal and transverse incision, surgeons may use other dissection techniques. It all depends on the features of the location of the fetus or fetuses in multiple pregnancies. Most of the following incision techniques lengthen the operation slightly:

low vertical incision (corporal, but in the lower abdomen);
T-shaped or J-shaped cuts;
bottom cross section.

The doctor, at his discretion, chooses the method of section, taking into account the location of the baby's head. This is necessary in order to more carefully remove the head from the incision and not injure the baby.

After incisions on the abdominal wall and uterus, both emergency and planned operations are carried out in approximately the same way. The surgeon inserts four fingers of the hand below the level of the head and helps it "cut" between the edges of the wound. The surgeon's assistant assists with pressure on the anterior abdominal wall. The front and back hangers of the crumbs are taken out alternately. Then the surgeon grabs the baby under the armpits and brings it into the light.

If childbirth occurs on time, the operation is planned, they try to open the fetal bladder before the baby is born. If the birth is premature, then it is recommended to get the baby right in the fetal bladder, so the risk of infection and severe stress for him will be less. After removing the fetus, the woman is injected intravenously with 10 ml of oxytocin, and the doctor proceeds to separate the placenta.

At the stage of suturing the uterus, the reproductive organ can remain in its place, or it can be removed outside the abdominal cavity. Doctors who prefer to sew the uterus in place say it may be more painful to pull the uterus outside the abdomen (with epidural anesthesia). Doctors who take out the uterus are confident that this shortens the duration of the surgery and reduces bleeding.

The Ministry of Health does not give clear recommendations and the question of whether to get the uterus before suturing or not is left entirely to the discretion of the surgeon. At this stage, the rotation of the placenta can increase the operation time. If the "child" place has grown into the tissue of the uterus, excision of the myometrium in the ingrowth zone or removal of the uterus will be required, if excision is not possible.

If the uterus is sutured with a single-row continuous suture, then the operation time is reduced by almost 10-15 minutes. But recent studies by Canadian scientists have shown that the risk of suture divergence during subsequent pregnancy and during childbirth (if a woman decides to give birth herself) is reduced if a more laborious two-row suture is applied.

Then the surgeons restore the peritoneum, if necessary, suture the muscle tissue and aponeurosis. For this, threads are used, which dissolve more slowly than the material on the uterus. Drainage has rarely been installed recently, since it causes a lot of inconvenience, and there are few visible positive effects from it. The external suture, if carried out with stapling, shortens the operation time. A cosmetic subcutaneous continuous suture is more time-consuming, but then looks more aesthetically pleasing.

After the external sutures are applied, the operation is completed. Doctors record the total time of surgery.

Epidural and general anesthesia

Spinal anesthesia is recommended as the first choice. In spinal anesthesia, drugs are injected into the subarachnoid space of the spine with a long and very thin game, washing not only the nerve roots, but also the spinal cord, as a result of which it is possible to achieve a fairly rapid and persistent analgesic effect. After a puncture, a woman begins to experience numbness in the lower part of the body within 5-7 minutes, and doctors can start an operation.

If spinal anesthesia for some reason is contraindicated for a woman or the woman in labor herself refused it, general anesthesia is administered. It takes a little longer than the spinal one. The woman will first receive an intravenous injection of anesthetic. After she falls asleep, a tracheal tube will be inserted into the trachea and connected to a ventilator.

This process is more laborious, depending on the skill of the anesthesiologist and the patient's vital signs - her pressure, pulse. If there are no complications at this stage, surgeons can start the operation about 10 minutes after the start of the anesthesiologist's work.

Epidural anesthesia involves the introduction of drugs into the eponymous (epidural) space of the spinal column. The time required to achieve an analgesic effect is higher than with other types of anesthesia - up to 25 minutes. An emergency caesarean section is performed under general anesthesia, and there are options for elective surgery.

Stark section

Today, in a number of perinatal centers, the method of caesarean section is becoming popular, proposed more than 20 years ago by the Israeli doctor Michael Stark. Such an operation differs from the classical one in less trauma and less time for performing surgical procedures. The doctor makes only two incisions - on the skin of the peritoneum and on the uterus, he spreads the rest with his hands, pushes them back, and then returns them to their proper place. There is no need to suture muscle tissue separately.

The Stark operation lasts no more than 20 minutes. This reduces harm to the mother and fetus due to the action of anesthetics, drugs used for pain relief. The risk of bleeding after a Stark section is lower since there are no unnecessary cuts and cuts. The rehabilitation period after such an operation is also easier and shorter, the woman gets up faster.

An operation that takes less time, alas, can not be done by everyone. There is a list of contraindications, which include fibroids, nodes, large veins in the area of expansion. In this case, the doctor will stop manual breeding and will carry out the operative delivery using the classical method. Disputes about the Stark section in the professional medical environment do not subside; the method has its admirers and opponents.

Reoperation

Does the duration of the operation change with a second cesarean section? The answer is obvious: the operation takes a little longer (in the absence of complications - by 5-7 minutes). This time is necessary for the surgical team at the second cesarean in order to excise the old scar that remained after the first surgical delivery and form a new one. Thus, a second scar will not appear on the woman's abdomen, as well as an additional second scar will not appear on the uterus - the operation is performed on the old scar.

There are exceptions when the situation calls for a cut along a new trajectory. But such situations are more rare than the rule.

What affects the duration?

Thus, the duration of the caesarean section depends on a variety of factors. It can be shorter if the doctor is well trained, the woman is examined in advance and the operation is performed as planned. The following factors can make the operative labor longer:

any complications during the operation (injury to internal organs, ureters and intestines, bladder, dissection of large vessels, bleeding);
the number of fetuses (surgery for singleton pregnancies is done faster than for twin pregnancies);
pathology in a child or in children, for example, in the case of conjoined twins, they operate only vertically, which increases the duration of the intervention;
the complexion of a woman (in obese puerperas it takes more time to suture the subcutaneous tissue);
the need for extended surgical intervention (in addition to cesarean, it is necessary to tighten the tubes, remove fibroids, tumors on the uterus, as well as the need to restore the injured bladder or intestines, if this happens);
the need for additional measures (for example, blood transfusion to the postpartum woman)

Reviews of women

Accurate information about the duration of delivery surgery from thematic forums on the Internet, where women leave their comments, is quite difficult to get. The reason is that women usually do not track how much time has passed, even if the entire operation is awake (with spinal or epidural anesthesia). Perception of time changes, and this is quite natural, because a woman is experiencing severe stress. Under general anesthesia, a woman is generally unable to monitor anything, because she is in a state of deep sleep.

According to the mothers, the cesarean lasted on average about 30-40 minutes. Some are sure they were in the operating room for about an hour.