Parto cesáarea: step by step, when é indicated and possibleícomplicable complicationsções

Cesarean delivery, or cesarean section, is a type of delivery in which the obstetrician makes a cut in the abdominal region, under anesthesia applied to the woman's spine by the anesthesiologist, to allow the birth of the baby.

This type of delivery can be scheduled by the obstetrician in advance if the woman wishes or if there is a risk of complications for the woman or the baby, such as in cases of gestational diabetes or prolonged labor without complete dilation, but it can also be done in emergency situations such as uterine rupture or placental infection, for example.

It is important to have prenatal care during pregnancy, so that the obstetrician can assess the he alth status of the woman and baby, and, if necessary, indicate a cesarean section.

C-section step by step

The first step of a cesarean section is the anesthesia that is given in the pregnant woman's spine, with the woman being seated for the administration of anesthesia. Next, a catheter is placed in the epidural space to facilitate drug administration, and a catheter is placed to contain the urine.

After the onset of anesthesia, the doctor will make a cut approximately 10 to 12 cm wide in the abdominal region, close to the "bikini line", and will cut 6 more layers of tissue until reaching to the baby. Then the baby is taken out.

When the baby is removed from the belly, the pediatric neonatologist must assess whether the baby is breathing properly and then the nurse can show the baby to the mother, while the doctor also removes the placenta. The baby will be properly cleaned, weighed and measured and only then can it be given to the mother for breastfeeding.

The final part of the surgery is the closing of the cut. At this point the doctor will sew up all the layers of fabric cut for delivery, which can take an average of 30 minutes.

It is normal for a scar to form after the cesarean section, however, after removing the stitches and reducing swelling in the region, the woman can resort to massages and creams that must be applied on the spot, so that it is possible to leave the most uniform scar. See how to care for a cesarean scar.

When cesarean section is indicated

The cesarean section should be discussed together with the doctor, so that it is possible to make a general assessment of the general he alth status of the woman and the baby. In addition, performing routine exams with the doctor are important to check he alth throughout pregnancy and the development of complications, such as eclampsia, gestational diabetes and changes in the placenta, for example.

Although it is often indicated when there are risks to the mother or baby associated with a normal delivery, cesarean section can be performed regardless of the presence of complications, as long as the woman wishes. See more about cesarean section indications.

1. Absolute indication

The absolute indications for cesarean section refer to situations in which cesarean section is fully recommended, and include:

• Eclampsia or preeclampsia;
• HELLP Syndrome;
• Uterine rupture, as it can endanger the life of the woman and the fetus, requiring immediate delivery;
• Infection of the placenta and possibly the fetus, requiring immediate delivery;
• Fetal asphyxia or fetal acidosis, which are situations that can lead to fetal hypoxia, which is the decrease or absence of oxygen, and endanger the life of the fetus;
• Prolapse of the umbilical cord, which is the exit of the umbilical cord through the vaginal opening, before the fetus, which can lead to fetal asphyxia;
• Placenta previa, which occurs when the placenta is positioned on or near the internal os of the cervix, preventing vaginal delivery;
• Abnormalities in the position of the fetus, which make vaginal delivery impossible;
• Small maternal pelvis, making vaginal delivery impossible;
• Deformity of the maternal pelvis, due to congenital malformations, which make normal delivery impossible;
• Twin pregnancy, if one of the babies is not in the upside-down birth position;
• Active herpes simplex virus infection;
• Maternal HIV infection, without antiretroviral treatment and/or unknown viral load or greater than 1000.
• Fetal distress, in the presence of signs and symptoms such as decreased or altered fetal heartbeat, decreased fetal movements and decreased volume of amniotic fluid.

In addition, other situations that have absolute indications for cesarean delivery are diabetes mellitus, chronic kidney disease or lung disease.

In these cases, even if the parents want a normal delivery, cesarean section is the safest option, being recommended by doctors.

2. Relative indication

The relative indications for cesarean section refer to situations in which the doctor may or may not indicate cesarean section, and include:

• Having performed two or more cesarean sections previously;
• Gestational diabetes, in cases where the estimated weight of the fetus on ultrasound is greater than 4.5 kg;
• Fetus with estimated weight, by ultrasound, greater than 5 kg;
• Failure to progress in normal labor, being stationary, prolonged and not fully dilated.

In these cases, the obstetrician must evaluate the pregnancy and the he alth conditions of the mother and baby and, if necessary, indicate a cesarean section.

Possible risks

C-section is considered a safe procedure, however due to the use of anesthesia and the fact that it is an invasive procedure, there is a greater risk of complications, especially when compared to normal delivery, the main ones being:

• Development of infection;
• Bleeding;
• Thrombosis;
• Baby injury during surgery;
• Poor healing or difficulty healing, especially in overweight women;
• Keloid formation;
• Difficulty breastfeeding;
• Placenta accreta, which is when the placenta is attached to the uterus after delivery;
• Placenta previous;
• Endometriosis.

These complications are more frequent in women who have had 2 or more cesarean sections, as the repetition of the procedure increases the chances of complications in childbirth and fertility problems.

Also, it is important to keep in mind that the cesarean section only increases the risk, which does not mean that these problems happen, as cesarean deliveries are normally without complications.