Caesarean Disproportion between maternal pelvis and fetal volume
Definition of cesarean
Caesarean section is a surgical procedure that involves removing the baby by cutting the abdomen and maternal uterus. The two main reasons for the practice are in order of frequency:
- The disproportion between the maternal pelvis and fetal volume;
- Abnormal position of the child at the time of delivery (see page Caesarean section for abnormal presentation of the child).
Depending on its cause, cesarean section may be performed in an emergency or be programmed in advance (usually 8-10 days before the theoretical date of term).
What is cephalopelvic disproportion?
30-35% of all caesarean sections are due to an imbalance between the maternal pelvis and the estimated volume of the child, in practice it is mainly the volume of the head, the most important part of the fetus and out (normally) first.
To the eighth month of pregnancy (33 to 36-37 weeks of gestation), the doctor checks the baby's presentation (part of the baby's body that penetrates the first in the maternal pelvis at the time of birth) and appreciates the dimensions maternal pelvis to assess the ease of a natural birth, vaginally.
In case of doubt, he prescribed a pelvimetry (X-ray examination of the pelvis of the patient). Even with these tests, it is difficult to conclude that formally; obstetricians try natural childbirth keeping in mind the possibility of failure therefore the need for a cesarean section. Such a situation can be reversed: a maternal pelvis normal child but particularly large (4 kg or more).
There are other indications of cesarean section, as multiple pregnancies where caesarean section is not compulsory but more frequent than in singleton pregnancies. It may also be a scar on the uterus (uterine scar), usually a result of a previous cesarean section. It may also be the need to terminate the pregnancy before the end when his extension poses major risks to the fetus or the mother, toxemia, diabetes, hypertension ... Or even an unforeseen complication occurring during childbirth itself: absence of cervical dilation, hemorrhage, abnormal fetal heart rate.
Course of Caesarean section
It takes place not in the delivery room but the operating theater and under anesthesia, mainly epidural. It is almost always preferable to general anesthesia: the woman remains conscious and can attend the birth and the postoperative course is much simpler. The pubis is then shaved, a urinary catheter is in place.
The incision in the vast majority is horizontal just above the pubic bone (called Pfannenstiel), as more aesthetically hidden by pubic hair. It is also stronger than the vertical incision (in the middle of the abdomen), now abandoned. The surgeon then incises abdominal muscles that are discarded. Finally, the incision of the uterine cavity allows the doctor to remove the baby.
Cut the umbilical cord, the placenta is removed by hand and then the uterus and the different layers (plans) are closed, the skin is sutured (staples or son). Most often a drain is placed to prevent hematoma under the scar removed two days later. Anesthetic intravenously over 24 hours can be injected at the request of the patient
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