Wondering about cesarean delivery
In recent years, due to different reasons more preferred caesarean section after the birth and follow-up rules carefully and carefully, the risk of postoperative complications can occur significantly reduces.
Cesarean section is defined as the delivery of the fetus older than 20 weeks from the incision to the uterine wall through the abdomen. Although it is not a recommended method today, it is seen that the number of caesarean sections has increased significantly due to the career of women, late marriages and older pregnancies. The World Health Organization recommends that the cesarean rate 15% - 20 Although, according to Ministry of Health data on cesarean delivery rate in Turkey is taking place approximately 40%.
Anadolu Health Center Obstetrics and Gynecology Specialists Op. Dr. Nuri Ceydeli and Op. Dr. We talked to Ebru Füsun Işık.
How can we explain the increase in the birth rate especially in recent years by cesarean section?
Women's career choices make the gestational age progress. With late births, cesarean rates are increasing. In addition, with the technological developments, the baby is now closely monitored. Thus, in case of any problems that may occur during normal birth, normal birth is terminated by cesarean section. The decrease in the use of assistive techniques in normal birth due to the risks on the baby and mother is another factor that increases the frequency of returning to cesarean section in the last stage of normal birth. Some patients may choose to have a cesarean section to reduce the risk of normal birth.
What are the complications during cesarean delivery?
The frequency of the problems that can be seen in caesarean delivery is affected by the urgency of the caesarean section, the environment in which it is performed and the conditions. During emergency cesarean sections, the possibility of having problems due to inappropriate hygienic environment and insufficient tools increases. Most of the complications seen in the caesarean section are similar to those seen during normal birth. However, after the birth of the baby, the uterine muscles can not sufficiently contract severe and intense bleeding. The incision in the uterus during the birth of the baby may expand due to excessive stretching and ruptures may occur. The bladder can also be injured.
Complication rates decrease due to infections What are the complications after cesarean delivery?
# Intrauterine inflammation after cesarean section is found in the average of 35-40%. This situation is most often seen in cases where the labor is prolonged and the period between the delivery of water and delivery is prolonged and the delivery takes place by cesarean section.
# Urinary tract infection may occur due to catheter insertion. However, due to the presence of antibiotics, complications related to life-threatening infections after birth are less than 2%.
# Painkillers used for pain control during anesthesia and after cesarean section can also affect bowel function. In the first 24 hours after surgery, patients may have nausea and abdominal tension. Rarely, bowel functions may be delayed.
During pregnancy and postpartum period, the possibility of blood clotting in the blood of the patient's body increases and the risk of vascular blockage increases. This risk, which is seen in 0.24% of all births, is higher after cesarean delivery.
Obesity, an obesity problem, limitation of movement, maternal age and an increase in the number of births are among the other factors that increase the risk of vascular obstruction. Deep vein thrombosis, that is, if the blood accumulated in the veins is left untreated, it may cause a clot to be thrown into the vessels leading to the lungs with a 15-25% chance.
Blood clots within the vein and vascular obstruction due to this condition, usually manifests itself as unilateral tenderness, redness and swelling.
What can be done to make the post-cesarean section more comfortable?
In general, removing the patient from the bed within the first eight to 12 hours after surgery helps to breathe the lungs, prevent vascular obstruction, and regulate bladder and bowel functions. After caesarean section, patients can usually stand up, walk around and take a shower on the second day. After the first six hours after the process, before the mouth liquid, then solid food intake can be started. To minimize the risk of infection, a catheter is inserted into the patient, preferably within the first 12 hours after cesarean section. The dressing at the caesarean section is opened 24 hours after the surgery and there is no need to have another dressing instead.
Can a woman who gives birth by caesarean section give birth later?
Once a caesarean section was performed, it was always thought that caesarean section would be done. Now that opinion has changed. If the woman does not have a problem that prevents her from having a normal birth, if the reason for the previous cesarean section is not permanent, vaginal birth can be tried at the next birth. Previous classical caesarean section, severe pelvic stenosis, trauma or rupture at birth and lack of preparedness for emergency conditions make normal post-cesarean delivery impossible. Vaginal delivery should not be tried in cases who have had more than one cesarean section. However, the risk of uterine rupture is between 1% and 4% in patients who have two cesarean sections. The risk of uterine rupture is five times higher in patients who have had two caesarean sections. The risk of uterine rupture in vaginal delivery after total caesarean section is 6%. If this risk is explained to the patient in detail and the patient confirms it, normal birth can be tried.
Which anesthesia method should be used in cesarean section?
The anesthesia methods applied during cesarean section are divided into two as general and regional. The physician must decide which of the anesthesia methods is suitable for the expectant mother.
Anadolu Medical Center Anesthesia Department Director Sahil Barlas says that pregnancy-related maternal mortality rates range from 6.1 to 12 per 100,000 live births, while only 2 to 3% of these rates occur due to anesthesia.
Dr. According to Barlas, different anesthesia methods are used for mothers who will deliver by cesarean section. The choice of anesthesia is determined by many factors such as urgency of surgery, preference of patient - surgeon and anesthesiologist. Methods of anesthesia; general anesthesia and regional anesthesia.
Regional anesthesia is also in itself; spinal, epidural, combined spinal - epidural.
Advantages and disadvantages of anesthesia methods
Dr. Sahil Barlas gives the following information about the advantages and disadvantages of anesthesia methods used in cesarean section:
Advantages of general anesthesia: It provides a very fast and reliable start to the operation. Therefore, it is generally preferred for emergency cases. In general anesthesia, airway and respiratory control of the patient is performed more safely and blood pressure changes are more controlled.
Disadvantages of general anesthesia: The risk of escaping the mother's stomach contents to the lungs and the difficulty in providing airway are among the disadvantages of general anesthesia. In addition, the mother may delay the baby's breastfeeding after surgery, albeit briefly. In addition, the transfer of anesthetic drugs to the baby through the mother's circulation, even in very small amounts, can lead to early laziness in the baby.
Advantages of regional anesthesia: In regional anesthesia, maternal mortality rates are much lower than in general anesthesia and the infant is exposed to anesthetic drugs at a very low rate. The risk of gastric contents, which can be seen at the beginning of anesthesia, escapes into the lungs is much lower in regional anesthesia. In addition, postoperative pain treatment gives better results in regional anesthesia.
Disadvantages of regional anesthesia: The main disadvantage of this technique is that it is a difficult and experience requiring technique and application. It is applied in a relatively compelling position for the mother, which in some cases leads to general anesthesia. Blood pressure control can be more difficult, among other disadvantages. Regional anesthesia methods are preferred because of the low maternal mortality rate in 80% of cesarean sections performed in the USA. In Turkey, these rates are much higher compared to general anesthesia is happening due to lack of experience in the regional process. Dr. Las Our goal is to apply regional anesthesia in all cases without a health barrier, Bar Barlas says.