DEFINITION

The Cesarean section is the surgical intervention that allows the exit or birth of a fetus by means of an abdominal incision.

DESCRIPTION

A Cesarean section is realized when the vaginal childbearing is not possible or bears some risk for the mother or the fetus.

The surgery is realized normally with the awake mother but without pain by means of anesthesia from the breast to the legs (it anesthetizes epidural or spinal anesthesia).

An incision is realized over the pubis in the low abdomen.

On having remained exposed, the womb (counterfoil) is opened by means of another incision and the amniotic liquid is liberated, then the baby is extracted.

The mouth of the baby and the nose they are cleaned of fluids and the umbilical cord unites (ties) and is cut. Later the newborn baby (RN) surrenders to the pediatrician or nurse who will make sure that he breathes appropriately and will realize the test of Apgar (evaluation of the RN from 0 to 10) to the minute and to 5 minutes.

The Cesarean sections are quite frequent (up to 20 % of all the births in U.S.A). because the doctors can have more safety for the mother and the baby, by means of this procedure than with the vaginal childbearing.  
Some obstetricians believe that the Cesarean section is of election in case of buttocks presentation, presentació previously, ancient mother, etc...

In a Hospital with correct welfare quality the Cesarean sections index between the whole of newborn babies must not be major than 15 %, according to the tendencies of the Welfare Quality in the Hospitals.

The mother, on having been awake, can hear and see the baby.

INDICATIONS

Some of the reasons of indication of the Cesarean section are:

Fetal indications

• Sharp fetal suffering (SFA) for diminished oxygen contribution to the fetus.
• Tachycardia or bradicardia fetal (the heart beats with excessive or insufficient rapidity).

Maternal indications

Relative to the womb

• too small, cicatrized, or deformed womb.
• Multiple gestation.

Relative to the cérvix (neck of the womb)

• Too relaxed Cérvix (cervical incompetence).
• Presence of infection activates for genital herpes in the mother.

Relative to the afterbirth and umbilical cord

• Afterbirth that ocluye the cérvix (previous afterbirth), or of low insertion.
• Premature afterbirth detachment (afterbirth abruptio).
• Drawstring prolapse (exit of the drawstring for the vaginal channel).

I am in danger for the mother (maternal anxiety)

• The head of the fetus is too big to happen across the pelvis of the mother (disparity cefalopélvica).
• Work of very long childbearing.
• Abnormal position of the baby

• Of buttocks and first-time mother (presentation of buttocks).
• Transverse presentation.
• Face presentation.

• Mother of (ancient) advanced age, more than 40 years
• Presence of an associate important illness (toxemia, preeclampsia, eclampsia, hypertension)

EXPECTATIONS AFTER THE SURGERY

Most of the mothers and the children recover well, with few problems.

CONVALESCENCE

The stay in the hospital is 2 to 4 days.

The recovery is usually more long than for a vaginal childbearing. It is recommended to walk from the first day

of the intervention to improve and to shorten the recovery.

For the pain of the incision they usually recommend analgesics

RISKS

• The risks of any intervention under anesthesia:
• Reactions to the medication.
• Respiratory problems.
• Hemorrhages.
• Infections.
• The additional risks include:
• Infection of the womb

COST

The cost of any surgery changes significantly between surgeons, medical facilities, and regions of the country.

The costs can be ordained for groups:

• Surgeon: 901,52 to 1.502,53 euros.
• Anesthetist: 180,30 to 300,51 euros.
• Hospital expenses, including taken care of infirmary and operating theater: 601,00 to 1.803,00 euros.
• Medicines: 90,15 to 240,40 euros.
• Other additional expenses, if complications exist (transfusions, etc...) or analysis or Rx are realized: 60,10 to 601,00 euros.

The changeability of every case is a fact being able to be considering to be a basic cost for 2.103,54 euros by intervention without complications.

TO SEE ALSO

• Test of Apgar

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