CESAREAN DELIVERY SURGERY

A cesarean section is an operation that allows babies who are not able to be born by vaginal delivery, that is, to be delivered by cutting the anterior abdominal wall and womb.
Names such as abdominal birth, Cesarean section are also given.
The incision is made from the abdomen just above the groin. The uterus opens and the amniotic fluid is drained and the baby is delivered. The baby's mouth and nose are cleaned from fluids and the umbilical cord is clamped and cut.
How long does cesarean surgery last?
Cesarean section is an operation that takes approximately half an hour (20-40 minutes). Due to the mother's preparation in the operating room, anesthesia procedures, entry and exit time may take longer. However, the surgery itself takes approximately half an hour. The operation is carried out by obstetricians and gynecologists. There is a team of anesthesiologists, anesthesiologists, and surgery nurses during the surgery.
What kind of anesthesia can be given in cesarean section?
Anesthesia is mandatory in cesarean operations. The anesthesia given may be general anesthesia or spinal or epidural anesthesia that only numb the lower part of the expectant mother. Candidate mothers who received spinal or epidural anesthesia; they do not feel pain during surgery. But they can see the baby as soon as they get out of the womb, they can hear the cry. They can also take care of their babies in a shorter period of time after surgery.
How is cesarean surgery performed?
Before starting the surgery, the patient is taken to the operating room and the interview is made first with the anesthesiologist. An anesthesiologist gives information about the anesthesia method to be applied to the patient and general or local anesthesia is applied. The skin area of ​​the patient is cleaned and covered. As with most abdominal surgeries, a urinary catheter is usually inserted during cesarean section. This probe is removed a few hours after surgery. In the operation, the skin, subcutaneous, fascia, and uterine layers are cut one by one and the inside of the uterus is reached. Meanwhile, the baby's water sac (amnion membrane) is cut and the water is discharged while the baby is taken out of the uterus. The uterus, peritoneum, fascia, subcutaneous tissue and the last skin layers are sutured one by one and closed again. The skin part is usually sewn with self-melting stitches, but different closure methods are also available.
In what cases is cesarean performed? When is it preferred?
- If there is a discrepancy between the baby's head and the birth canal; Normal delivery is not possible if the head is too large to pass through the birth canal or the birth canal is narrower than normal.
 - If the patient has previously had cesarean or uterine (myomectomy) surgeries, the uterus may tear from the old surgery site during normal delivery. In these cases, cesarean delivery is generally preferred.
- Normally delivery is impossible if the baby, who normally comes with a head-down, comes with an arm, shoulder or face for any reason.
- In cesarean delivery is generally preferred in babies advancing in the birth canal with the breech lead.
- If the placenta is placed in the lower part of the uterus in a way to close the birth canal, cesarean is absolutely required. The location of the placenta is determined by ultrasanography.
- The detachment of the placenta before the baby's birth is called detachment placenta. In this case, there may be serious bleeding and cesarean is urgently needed.
- If the baby is distressed during birth pains, heart rate is impaired or NST is bad, cesarean may be required.
- In multiple pregnancies such as twin and triplet, cesarean delivery is frequently applied.
- Excessive prolongation of labor, very slow progression
- Active HSV (herpes), HPV (wart, condyloma), HIV (Aids) infections in the mother
Is cesarean preferred in early births?
There is no rule that caesarean section will always be required in pregnancies that are at risk of preterm labor or pregnancies for any reason. Such pregnancies can sometimes be terminated with normal birth.
Sometimes pregnant with birth starts with artificial pain and normal birth may be possible. Sometimes it may be necessary to terminate pregnancy by cesarean section; Cesarean is not always necessary.
Risks of cesarean section:
Like any surgery, cesarean has a number of risks. These risks may be related to anesthesia, as well as some complications that may occur during or after surgery. During surgery, very rarely due to adhesion or other reasons, injuries to the abdominal organs (bladder, urinary tract, intestine) may occur. Excessive bleeding may occur. Rarely, bleeding or other reasons may require a complete removal of the uterus. Risks such as bleeding and infection continue after surgery.
Can those who have cesarean section give birth in later pregnancy?
Approximately 2/3 of the mothers giving birth with cesarean can give vaginal delivery afterwards. However, there is a small risk of uterine rupture (tearing in the uterus) in vaginal delivery procedures. This risk can be very dangerous for mother and baby. For this reason, women who have had a cesarean are not delivered normally in their next pregnancy.
Prophylactic antibiotic use in cesarean section:
- Prophylactic antibiotics are recommended in all cesarean surgeries. It is appropriate to perform antibiotics 60 minutes before the skin incision.
- First-generation cephalosporin antibiotics are the first choice if there is no allergy. If penicillin and cephalosporin have a history of allergy, clidamycin + gentamicin may be the appropriate option. Erythromycin can also be used
- If the laparotomy period exceeds 3 hours and blood loss of more than 1500 cc occurs, the re-dose is recommended 3 hours after the first dose.

Recovery after cesarean:
The average length of stay in the hospital after cesarean varies from 1 to 3 days. Healing takes longer than normal birth. Usually the mother becomes active enough to be able to do her job within 1-2 weeks.
When can sexual intercourse start after cesarean?
Sexual intercourse is permitted if there is no obstacle to the doctor's control, usually 6 weeks after surgery. This period is called the "forty-out" period among the public for 6 weeks, and it is the period when the mother's body heals in many respects and returns to normal.


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