Let’s talk about cesarean section

Cesarean section is one of the oldest operations. It is called cesarean section in English and kaiserschnitt in German. The reason for this is that it is related to Caesar the great, and the truth remains to be verified. At the beginning of the establishment of modern medicine, surgery has been basically mature. But at that time, there was no blood transfusion technology, no antibiotics and anesthesia, and the death rate of cesarean section was very high. At that time, dystocia was basically the use of forceps or fetal head suction. After the improvement of anesthesia, disinfection and blood transfusion technology, cesarean section and appendectomy are almost the same, becoming one of the most popular medical technologies. Some doctors in township hospitals also do this kind of operation. But if we want to grasp the evidence of cesarean section, it is not a day’s work.

for some obvious evidence, such as pelvic outlet stenosis, severe pelvic deformity, umbilical cord exposure or prolapse, college graduates have to master. This kind of evidence is called absolute evidence in clinic. Absolute evidence of placenta previa, placental abruption and so on. Especially placental abruption, even if the fetus has died, but also through cesarean section to take out the fetus, otherwise it will produce very serious complications, endanger maternal life. Sometimes many patients or their families can’t figure out, “when the children are gone, do they have to have an operation?” of course. There are also some cases such as conjoined twins, neglected occipital transverse position, chin anterior position and so on. If these patients choose vaginal delivery, it is also impossible.

in the fatal evidence, there is also pregnancy complicated with heart disease. In the past, it was suggested that all patients with heart disease should be ligated, or the pregnancy should be terminated in the early stage of pregnancy. But some patients secretly pregnant, do not do prenatal examination, in fact, very dangerous. I once met a mother who had been avoiding doctors because of her severe heart disease and the doctor’s advice to beat her child. I didn’t come to the hospital until I was in labor, but when I got to the hospital, I had severe acute left heart failure and died in our old director’s arms in a few minutes. In fact, pregnant women with heart disease need not be furtive.

under the close medical supervision, after the first dangerous period, we should take measures as soon as possible, and under the condition of full preparation, we can do cesarean section directly. Maybe there is a glimmer of hope. If you come to the hospital after labor, the doctor knows nothing about the patient’s heart, liver, kidney, lung and other organ functions, and there is no time to check after labor, it is very dangerous, seriously threatening the lives of mothers and infants. Of course, not all pregnant women with heart disease need cesarean section. Which conditions need cesarean section, which conditions need forceps midwifery, need obstetrics, anesthesia, ICU and heart disease experts to conduct a comprehensive evaluation of the patient’s situation. If the patient is not expected to have heart failure, the American College of Obstetricians and gynecologists recommends vaginal delivery, but use forceps. However, the doctor-patient relationship in China is too tense. Experts from China and the United States have different views on this issue.

cephalopelvic disproportion is a controversial evidence. What is head basin not to weigh? There is no strict medical definition, but in many cases, vaginal delivery is very difficult or even impossible. For example, persistent occipital transverse position, occipital posterior position, is it produced by vagina or cesarean section? It is difficult under natural conditions, but the use of forceps can also be vaginal delivery. Especially in the case of very strong productivity, some patients with occipital transverse position can turn to occipital anterior position, so it is not good for patients to decide the mode of delivery early, but it is also bad for people to decide the mode of delivery too late. Cut or raw? Sometimes it’s really hard to make decisions.

clinically, more evidence is not so absolute. In medicine, it is called “relative evidence”. These evidences indicate that vaginal delivery is possible under certain conditions, but cesarean section is better for the long-term or fetal benefit. For example, in breech delivery, cesarean section was recommended only when the fetus was more than 3500g, but now many people carry out cesarean section for breech pregnant women, regardless of the size of the fetus. The reason is for the safety of the fetus. This view has its rationality and one sidedness. There are umbilical cord around the neck, it was difficult to find before, now through ultrasound, the vast majority can be found in the preoperative examination. Is it raw or dissected? Self birth is not only very painful, but also prone to the situation that the uterine orifice has been opened completely but the fetal head does not go down, prone to neonatal asphyxia. Will family members agree to use forceps or attract labor at that time? But the problem is that not all umbilical cords around the neck don’t come out. When there was no cesarean section before, most people were not born? So in such cases, doctors will discuss with their families, many people will choose cesarean section.

in addition to the factors of mother and birth canal, there are more and more cesarean section due to fetal factors. For example, severe pregnancy induced hypertension, gestational diabetes mellitus, severe hypertension or systemic lupus erythematosus, etc. in the past, pregnant women with relatively small fetuses felt that they had no problem with birth, but now they tend to have cesarean section. An important reason is that under these conditions, the fetal development is not perfect. In the process of more than 8 hours of delivery, the fetal head can not bear such long-term pressure, and it is easy to merge with neonatal intracranial hemorrhage. Many doctors recommend cesarean section. Some family members have raised objection to this question. Can’t such a small hair be born? In fact, the essence of the problem does not lie in the birth, but in the survival rate and complications after birth. So the evidence of cesarean section is more and more complicated.

is cesarean section good or self birth good? Not only family members and pregnant women will ask this question, but also doctors often ask themselves. Previous studies have found that the mortality of patients with cesarean section, whether mother or fetus, is higher than that of vaginal delivery. Some people take this kind of thing out and talk about it. As a matter of fact, the basic diseases are basically ruled out for the mothers who give birth through vagina, and they belong to physiological obstetrics. For the mothers who give birth through abdominal surgery, either they have the mother’s reasons or the fetus’s reasons. The vast majority of them are pathological obstetrics. The prognosis of the latter is of course worse than the former. Due to the different constituent ratios, a simple comparison is actually unscientific.

although cesarean section is a routine operation, there are still risks. First of all, cesarean section is prone to postpartum hemorrhage, serious need to remove the uterus, and even some patients lost their lives due to postpartum hemorrhage; second, amniotic fluid embolism, rescue is very difficult, mortality is very high. Of course, there are not many such extreme cases. The most common problems are abdominal visceral adhesions, which lead to abdominal pain and reproductive difficulties; uterine incision scar pregnancy; endometriosis, which lead to dysmenorrhea; such as postoperative wound infection. Compared with these problems, they can only be considered as pediatrics.

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