Suture care after caesarean section algorithm. Performing specific exercises. Suture care after caesarean section

A caesarean section is an obstetric operation during which the fetus and placenta are removed from the uterus through an artificially created incision in its wall. A team of surgeons (an operator and 2 assistants), an anesthesiologist, an operating nurse, an anesthetist nurse, a midwife, and a neonatologist are involved in providing the operation.

Features of conducting childbirth through caesarean section

Currently, caesarean section is performed with a transverse incision in the lower label segment. This technique provides relatively little trauma to the uterus, creates conditions for healing and the formation of a full-fledged scar. During the operation, the following points are distinguished:

• ventiotomy,
• opening of the lower segment of the uterus,
• removal of the fetus and afterbirth,
• suturing of the uterine wall
• and layer-by-layer suturing of the abdominal wall.

Depending on the technique and complexity of the caesarean section during childbirth, its duration is on average 20-25 minutes.

After the operation, an ice pack is placed on the lower abdomen for 1.5–2 hours, which helps to contract the uterus.

Previously, the issue of the birth plan is decided in the antenatal clinic or medical center, where the patient is monitored during pregnancy. The examination is carried out not only by an obstetrician-gynecologist, but also by doctors of other specialties: therapist, oculist, endocrinologist, dentist, if necessary, neuropathologist, surgeon, orthopedist. In the presence of any diseases, these specialists give their recommendations on the management of pregnancy and a conclusion on the method of childbirth. The final decision on the method of delivery is made by the doctors of the maternity hospital.

Each maternity hospital has its own characteristics of the operation, anesthesia, management of the postoperative period. Therefore, it is better to choose a maternity hospital in advance. The patient herself, not possessing professional knowledge in this area, cannot make such decisions. As a rule, doctors of the antenatal clinic send to the maternity hospital 1-2 weeks before the expected date of birth.

Determination of the term of delivery by caesarean section

The due date can be determined in the following ways:

by the date of the last menstruation - subtract 3 months and add 7 days;

with a known date of conception - subtract 3 months and 7 days or add 266 days (38 weeks);

by fetal movement - in multi-pregnant women, movement is felt at about 18 weeks, and in primiparas - at 20 weeks;

according to ultrasound data.

If possible, the date of the operation is chosen as close as possible to the date of birth. At the same time, the wishes of the patient herself are taken into account. The patient certifies her consent to the surgical delivery and transfusion of blood components (only if necessary) in writing.

Preparing for a caesarean section

When preparing a pregnant woman for a planned caesarean section in a hospital, an additional examination of the pregnant woman is carried out, including

• study of biochemical parameters of blood,
• determination of blood group and Rh factor,
• examination of vaginal discharge smears for the presence of gonococci, Trichomonas,
• determining the degree of purity of the vagina,
• examination by a therapist and, according to indications, examination by other specialists.

If necessary, medical correction of the identified deviations in the state of health. Before and on the day of surgery, an anesthesiologist examination is necessary. In addition, in preparation for a planned operation, a comprehensive assessment of the condition of the fetus is necessarily carried out: fetomonitoring and ultrasound studies with dopplerometry in the vessels of the mother-placenta-blood system, amnioscopy.

In the case of a planned caesarean section, the patient or her relatives must donate 300 ml of plasma (the liquid part of the blood) in advance, since transfusion of blood products may be necessary during surgery. Autoplasma donation is carried out in those maternity hospitals that have their own blood transfusion department. This procedure does not adversely affect the health of the mother or the condition of the fetus, the lost plasma is restored in the body in 2-3 days. This eliminates the possibility of infection with various infections, including HIV, hepatitis C and B.

In the case of an emergency operation, it is necessary to collect a detailed history, including allergic and blood transfusion, conduct an objective examination of the pregnant woman and assess the condition of the fetus. In terms of prognosis, a planned caesarean section is better than an emergency one.

Before the caesarean section, a set of hygiene measures is carried out: pubic and abdominal hair is shaved, the pregnant woman should take a hygienic shower the day before. It is important to get a good night's sleep, so it is better to take something soothing at night (on the recommendation of a doctor), this will help to cope with understandable excitement. On the day of the operation, you can neither drink nor eat. A cleansing enema is performed 1-2 hours before the operation. Immediately before the operation, already on the operating table, a catheter is inserted into the bladder, which is removed a few hours after the operation. These measures help prevent complications from the kidneys.

Types of anesthesia for caesarean section

Surgical intervention on the abdominal organs should always be carried out so that the patient does not feel pain. Therefore, the surgeon with the anesthesiologist must carefully select the method of anesthesia. At the same time, they proceed from the safety and sufficiency of anesthesia for a pregnant woman, take into account the interests of an obstetrician-gynecologist, so that during anesthesia there are conditions for a comfortable and quick surgical intervention. When choosing a method of anesthesia, the capabilities and preferences of the anesthesiologist are also taken into account.

Anesthesia for caesarean section can be general and regional.

Indications for general anesthesia for caesarean section are:

• the desire of the patient
• physiological characteristics of a pregnant woman,
• impeding the implementation of a regional blockade,
• significant blood loss
• the need for immediate operative delivery.

Indications for regional anesthesia for caesarean section include:

• mother's request
• improved communication between mother and fetus, as the patient is conscious until the moment of removal of the child and can see and hear her child immediately after birth.

However, both methods of anesthesia for caesarean section have their advantages and disadvantages. The choice of anesthesia during a caesarean section during childbirth should be approached comprehensively.

Indications for childbirth through caesarean section

The rate of caesarean sections is increasing every year. In the West, due to the development of insurance medicine, in Russia, due to the introduction of a monitoring system for the intrauterine state of the fetus. There are quite a few indications for performing a caesarean section. They are associated with the initial health of the mother, aggravated obstetric and gynecological history, intrauterine state of the fetus during pregnancy.

There are absolute indications for surgery, which are obstetric situations in which it is impossible to extract the fetus through the natural birth canal or poses a serious risk to the health of the mother and the life of the unborn child. Thus, absolute indications exclude vaginal delivery, i.e. caesarean section is the method of choice in these situations. The presence of absolute indications requires mandatory caesarean section, relative indications need their justification. The group of relative indications includes diseases and obstetric situations that can adversely affect the condition of the mother and fetus if delivery is carried out through the natural birth canal. At the same time, the question of the operation is unequivocally difficult to solve.

Absolute indications for caesarean section

Anatomically (narrowing of the pelvis III, IV degrees) or clinically narrow pelvis.

Threatened uterine rupture.

Detachment of a normally located placenta.

Incomplete placenta previa with inability to stop bleeding.

Inferiority of the scar on the uterus (scar on the uterus after corporal caesarean section, fresh or very old scar, signs of thinning of the scar on the basis of ultrasound).

Umbilical cord presentation as an indication for caesarean section.

Genitourinary fistulas, cancer of the cervix, vulva, rectum, bladder.

Breech presentation with a large fetus (in the case of an estimated fetal weight over 3500 g).

Exostoses, tumors in the small pelvis, cicatricial changes in the neck.

Transverse and stable oblique position of the fetus.

Incorrect insertion of a full-term fetus.

Malformations of the uterus and vagina.

Rhesus conflict.

Progressive intrauterine fetal hypoxia, impaired uteroplacental blood flow.

Relative indications for caesarean section

Anatomically narrow pelvis of I and II degrees of narrowing in the presence of other adverse factors (large fetus, breech presentation of the fetus, incorrect insertion of the head, post-term pregnancy, etc.).

Incorrect insertion of the head.

Breech presentation of the fetus.

Post-term pregnancy with unprepared birth canal of a pregnant woman for childbirth in combination with other obstetric complications.

Age primiparous (over 30 years old) in the presence of other unfavorable factors for natural delivery. Age itself is not an indication for surgery. The older the woman, the greater her baggage of chronic diseases. However, it all depends on the mood of the pregnant woman. It is up to you to deal with many of these factors.

Aggravated obstetric or gynecological history (stillbirth, miscarriage, prolonged infertility, etc.).

Large fetus as an indication for caesarean section.

Prolapse of the umbilical cord.

Complications in childbirth: weakness and discoordination of labor, rigidity (poor opening) of the cervix, insufficient elasticity of tissues, especially soft tissues of the birth canal, which can lead to their rupture, impaired contractile function of the uterus and poorly opening cervix - this can lead to labor child injury.

Indications for caesarean section due to the interests of the fetus

Most of the indications for operative delivery are due to the concern for maintaining the health of both the mother and the fetus, i.e. are combined. In some situations, indications from the mother or fetus prevail. Indications for caesarean section, due to the interests of the fetus, include:

• threatening fetal asphyxia,
• hemolytic disease of the fetus,
• multiple pregnancy,
• head insertion.

Some extragenital diseases (hypertension of the 2nd and 3rd degree, high myopia) require a caesarean section in the interests of the mother. Sometimes, already in the process of labor, it is necessary to change the birth plan in favor of operative delivery, although initially all the data were in favor of vaginal delivery.

Features of care after childbirth by caesarean section

The first three days after caesarean section, the patient is in the intensive care unit, where her condition is monitored around the clock: general well-being, pulse, blood pressure, respiratory rate, size and tone of the uterus, amount of discharge from the genital tract, bladder function. On the first day after surgery, if urination is disturbed, bladder catheterization is necessary every 6 hours.

As a rule, anesthesia is required in the first 2–3 days of the postoperative period, and then it is gradually abandoned. In the intensive care unit

• infusion metabolic therapy is carried out,
• physiological saline is injected to replace fluid loss,
• antibiotic therapy is prescribed to prevent possible complications, as well as drugs that promote uterine contraction and normalize the function of the gastrointestinal tract.

Rehabilitation after caesarean section in the postpartum department

After anesthesia for caesarean section for the first time, the patient is helped to rise 6 hours after the operation. Sitting in bed and getting up is allowed at the end of the first day, gradually increasing physical activity.

Transfer to the postpartum department, as a rule, is carried out for 2-3 days. The child at this time is in the children's department. After the transfer from the intensive care unit, a more active motor regimen begins. Now the woman herself can take care of the child, feed him and swaddle.

As far as diet is concerned,

• on the first day after a caesarean section, it is allowed to drink mineral water without gas.
• For 2-3 days, the diet expands - you can eat boiled beef meat, low-fat broth.
• From the third day, full nutrition is possible, with the exception of those products that are not recommended for breastfeeding.

If there are no special contraindications due to the condition of the mother and child and the woman does not receive antibiotics, then breastfeeding can be allowed on the third day after the operation. Usually on the fifth day after the operation, an ultrasound examination of the uterus is performed.

With a successful course of the postoperative period, the woman is discharged on the 6-7th day after the caesarean section. Care and help from family members is needed so that they take on part of the household chores.

Some time after the operation, a woman may feel weakness, increased fatigue, pain in the suture area.

Diet of a nursing mother after caesarean section

Particular attention should be paid to the nutrition of a woman after childbirth: it should be balanced, based on natural products. All fried foods are excluded, only boiled and stewed foods are eaten. From the diet of the mother must be excluded:

foods with high allergenicity (eggs, chocolate, peanuts, shrimp, crabs, caviar, salmon and chum fish, pickles and marinades, seasonings, strong coffee, canned food);

products that cause fermentation processes in the intestines, which disrupts the function of the gastrointestinal tract (grapes, etc.);

Eating after caesarean section should be 5-6 times a day, 30-40 minutes before feeding the baby, this contributes to a better secretion of milk. It is also necessary to use special foods for nursing mothers (cereals and dry dairy products), take vitamin-mineral complexes in the form of drugs or drinks.

The daily diet of a nursing mother after a caesarean section includes:

• meat (beef, lean pork, chicken, turkey);
• low-fat varieties of fish (cod, pike perch, carp);
• dairy and sour-milk products (kefir, cheese, cottage cheese, yogurt);
• cereals (oatmeal, buckwheat, wheat);
• fats (butter and vegetable oils, sunflower, olive, soybean);
• vegetables, fruits, dried fruits.

History of caesarean section

The history of caesarean section goes back to ancient times. There are conflicting opinions about the origin of the name of the operation. It is believed that the term "caesarean section" comes from the name of Gaius Julius Caesar, who was extracted by the abdominal route, for which he received the name Saevag. The beginning of the history of caesarean section can be considered the end of the XVII century. BC, when the Roman emperor Numa Pampilius issued a law prohibiting the burial of pregnant women without first extracting the child by means of abdominal dissection and incision of the uterus. Later, this rule was included in all laws of most European countries and has been preserved to this day.

The first reliable caesarean section on a living woman was performed in 1610. surgeon Trautmann of Wittenberg. In Russia, the first cesarean section operations were performed by I. Erasmus in Pernov, 1756, and V. M. Richter in Moscow, 1842. The beginning of the second stage is considered to be 1876, when G. N. Rein and, independently of him, Porro proposed to remove the uterus after removing the child, since it was a source of bleeding and infection.

The next stage in the development of caesarean section was marked by the use of a silver thread to suture the uterus in 1852. F. E. Polynomial. The introduction of the uterine suture abroad is associated with the name of F. Kehler, who performed the operation in a peasant house and put a three-row suture on the incision of the uterus, he is also considered the founder of the caesarean section in the lower segment of the uterus with a transverse incision.

Currently, much attention is paid to improving the technique of caesarean section, finding suture materials, new antibiotics for the prevention of purulent-septic complications, improving methods of anesthesia, as well as assessing the viability of the uterine scar after cesarean section.

Recovery after a caesarean section is quite long. This period takes place in several stages and includes several rules. Compliance with these rules will help a woman quickly return to shape. If the patient does not follow the rules of postoperative care, the risk of various unwanted complications increases.

To understand what difficulties await a woman after surgery, you should know its course. During surgery, several layers of tissue are cut. The operation consists in cutting the muscle layer, epidermal tissue and the uterine cavity. The method of incision depends on the reasons for the appointment of operative delivery.

For surgical intervention, the laparotomy method is often used. It involves cutting tissue over the top of the pubic bone. The wound is short. With one movement, the doctor opens access to the uterine cavity. The baby is quickly removed, the umbilical cord and placenta are removed last.

Sometimes more complex dissection is used. An incision is made from the pubis to the umbilical zone along the peritoneum. A longitudinal incision is accompanied by damage to the fat layer. This layer is difficult to restore. For this reason, such exposure is carried out only in emergency situations. A vertical incision is prescribed only in cases where natural labor activity threatens the life of the fetus or mother.

After the end of the surgical influence, the doctor puts stitches. The seam is applied to each fabric separately. The skin is tightened with cosmetic sutures. They avoid the formation of coarse scar tissue. The muscle layer is sutured with a self-dissolving thread. Such medical material is completely absorbed a few weeks after the operation.

Various materials are applied to the walls of the uterus. Its choice depends on the characteristics of the cut. If the edges fit well together, then a bioabsorbable material is used. If the edges of the wound are not pulled together with a regular thread, then the imposition of brackets is necessary. Staples are removed only after complete fusion of the walls of the uterine cavity.

What is the danger of the operation for a woman

It should be borne in mind that recovery after a caesarean section does not always go smoothly. In some cases, a woman has a variety of complications. There are such possible negative processes as:

• rupture of seams;
• the formation of ligature fistulas;
• wound infection;
• consequences of introduction into anesthesia;
• the appearance of adhesions;
• opening of the hernial ring;
• improper formation of the uterine scar;
• problems with breastfeeding;
• changes in the structure of the endometrium;
• psychoemotional stress.

Often recovery after cesarean is accompanied by a violation of the rules. A woman begins to lead an active physical life a few days after the operation. Such an impact entails a divergence of the edges of the wound. In many patients, this complication is diagnosed on the 7th day of hospital stay. To eliminate the pathology, it is necessary to carry out additional suturing of the wound. Such a pathology during surgery - caesarean section increases recovery.

A dangerous disease is the formation of ligature fistulas. Pathology got its name because of the reasons for its appearance. Pathology develops slowly. Initially, a slight swelling forms on the seam area. Gradually, it increases in size. To the touch, it has a high temperature and a solid structure. A few days later, a small hole appears on the surface of the tumor. Pus accumulated in the tumor is brought to the surface. When the wound is cleaned, a ligature is found in the fistula cavity. These are the residual threads from the sutures placed on the muscle layer. The thread causes the death of the tissues surrounding it. The body tries to reject the dead cells. For this, the content of leukocyte cells in the blood increases. Leukocytes, dead tissue forms pus. He causes an abscess. The problem of ligature fistulas is associated with incomplete dissolution of the threads from the seams. Pathology is detected in 5% of operated women.

There is also a risk of infection of the postoperative surface. Infection is caused by a variety of pathogenic microorganisms. They enter the wound from the external environment. This entails tissue necrosis and its further suppuration. Inflammation and infection of the sutures is observed with improper wound care. Pollution and accumulation of blood exacerbates the development of the pathological process.

Keep in mind that a caesarean section is performed under general anesthesia. A drug is injected into a woman's body that puts her into a state of sleep. The number of full anesthesia during life should not exceed 4-5. Otherwise, the nervous system undergoes irreversible changes. After anesthesia, the woman has a hard time moving away. The first hours there is severe dizziness. Nausea and vomiting may also occur. For this reason, it is not recommended to move and sit abruptly.

There is also such a complication as adhesions. Adhesions form in areas of tissue that are sewn together. This complication can lead to the appearance of other pathologies. Against the background of adhesions, a woman cannot become pregnant. There are also problems with the intestines. Adhesions are removed by surgery. Spikes are not found immediately. The disease is diagnosed after a few months.

With a vertical caesarean section, patients may develop a hernial orifice. It was because of this complication that a laparoscopic section was introduced. It allows you to avoid this pathology. The gate is formed at the site of divergence of the diaphragmatic muscles. The hole allows the intestines to exit into a free cavity. The hernia must be repaired with surgery.

A complication is the incorrect formation of the uterine scar. It interferes with the patient in several ways. The woman does not have a normal sexual life. Also, the next possible delivery should be by caesarean section. The problem also occurs during menstruation. There is severe pain at the time of contraction of the uterine body. Pathology is not amenable to any method of treatment.

In many cases, there are problems with breastfeeding. Lactation after the section does not occur immediately. This is due to the introduction into anesthesia and hormonal disorders. Milk appears in the breast only with the growth of prolactin. This hormone rises under the influence of oxytocin. Oxytocin is formed in the body before the onset of labor. Caesarean section excludes the beginning of the natural preparation of the body for childbirth. Due to this feature, prolactin appears gradually. Lactation returns to normal on days 9–14. If this does not happen, the child is transferred to artificial nutrition.

Sometimes there is a change in the structure of the endometrium. Endometriosis affects the part of the uterus damaged during a caesarean section. This disease has no external manifestations. It is found when planning another pregnancy. After a long absence of conception, a woman turns to a gynecologist. The examination reveals a section of the endometrium with an uncharacteristic structure. Such a consequence of the operation is eliminated by drug therapy.

There are difficulties with the psycho-emotional background. In the process of natural childbirth, a relationship is established between a woman and a child. Cesarean section excludes its occurrence. Many patients are diagnosed with postpartum depression. To quickly eliminate it, you should seek the help of a psychologist.

Complications of surgery in a child

Caesarean section adversely affects the health of the child. Anesthesia, administered to the mother before the operation, enters the child's body through the umbilical cord. Against this background, the child develops a pathology of motor function. Within a few days after surgery, the child sleeps for a long time and refuses to eat. Lethargy is due to the presence of a drug in the blood.

There are also problems with the immune system. If in natural childbirth the child is being trained, then with a caesarean section it is absent. When a child passes through the birth canal, the lungs gradually empty of fluid. During the operation, the child does not clear the lungs on his own. The removal of fluid is carried out after the operation by obstetricians. Residual fluid often causes pneumonia. The disease adversely affects the state of the respiratory system. The child often begins to get sick with acute respiratory diseases.

After surgery, the baby is not immediately given to the mother. A woman is recovering from surgery. She needs to recover from anesthesia and recover. The development of the sucking reflex is reduced. The baby may refuse to breastfeed. Such children are often bottle-fed.

Recovery after a caesarean section begins with suture care. During it, you need to consult a doctor. In the first days after the operation, the treatment is carried out by medical personnel.

The wound surface is initially cleaned with a special antiseptic solution. In medical centers, chlorhexidine or a sterile solution of furacilin is used. These medicines contribute to the complete cleansing of the wound from various bacteria and dead cells.

After antiseptic treatment, a drying solution is abundantly applied to the seams. For this, brilliant greens and fucorcin are used. Wound treatment is carried out 2 times a day. After all activities, a sterile postoperative bandage is glued to the wound. It is made from a bandage or bought ready-made.

Also, the period of stay in the hospital should be accompanied by a shower. The wound should be wetted with warm water. It is not allowed to treat the wound with a washcloth. It is recommended to apply the foam liberally and rinse it off with running water.

To avoid infection of the uterine suture, daily douching with an antiseptic liquid should be performed. Miramistin is used for douching with a special nozzle. It is administered vaginally. After injection, press the dispenser several times. The solution helps to cleanse the microflora of dead tissue and relieve the inflammatory process.

Rehabilitation after caesarean section should be carried out at home. During the recovery period, the woman must clean the wound on her own. The doctor prescribes all the necessary drugs in the prescription.

The sutures are removed only after the formation of dense scar tissue. Removal does not cause pain to the woman. Next, the wound is treated with other medicines.

In order for the scar to form faster, it is necessary to use drugs that enhance metabolic processes in tissues. This effect has levomikol, levosin and panthenol. The product is applied to the seam after washing with hydrogen peroxide.

Normalization of lactation

The recovery period includes the normalization of lactation. Many women have problems with breastfeeding. The rapid appearance of milk after the section is impossible. Normally, milk should come on the third day after childbirth. Against the background of anesthesia and surgical intervention, this process is restored much later.

The body prepares for lactation in the initial period of labor. Oxytocin is responsible for contraction. This hormone helps the walls of the uterus to move the fetus to the lower tract. Also, its release causes a decrease in progesterone. This results in a surge of prolactin. The hormone helps the glandular tissue of the breast to produce milk.

A cesarean section does not allow the body to begin preparatory activities for childbirth. Oxytocin is not detected in the blood. Prolactin does not affect the mammary glands. A woman cannot breastfeed her baby for the first few days after a caesarean section.

• frequent expression of milk;
• putting the baby to the breast;
• taking special drugs.

Frequent expression of milk helps to recover lactation faster. It can be expressed manually or use a breast pump for this. The device shows great efficiency. Especially high-quality excretion of milk shows an electric apparatus. It is connected to an outlet and applied to the mammary gland. Under its influence, a vacuum is formed between the breast and the apparatus. Milk under pressure begins to flow into the milk receiver. In the early days, it is necessary to express no more than 20 ml of milk. The resulting liquid can be taken to the child or left to be stored in the refrigerator.

It also helps to increase the volume of milk by putting the baby to the nipple. Nature designed it so that the child makes sucking movements at the sight of the breast. This helps the hormonal system of a woman to rebuild faster. Prolactin increases. Milk begins to flow in the right amount.

Recovery of the body during lactation can be carried out with the help of various medications. Apilac and Mlekoin allow to increase the volume of milk production. The first drug is made from royal jelly. This substance allows you to normalize breastfeeding and accelerate the healing of the postoperative suture. Also, apilac is necessary to strengthen the bone skeleton of the child.

Some patients ask doctors how to quickly recover from a caesarean section and increase lactation. Experts advise using special nutrition. It contains no allergic substances. All components are made from natural substances. Food is diluted with boiled water and taken in the form of a milkshake.

Power control

In order to understand how to get in shape after a cesarean, you need to control nutrition. The diet of women in labor excludes a number of products. Avoid food such as:

• salty dishes;
• alcoholic drinks;
• fried food;
• fatty food;
• fruits containing acids.

Recovery after childbirth involves avoiding the use of salt and spices. Salt in the body contributes to the accumulation of fluid. Excess water helps to reduce metabolic processes. This leads to a slowdown in wound healing and a decrease in the contractile function of the uterus. For this reason, the use of salt should be avoided.

Any alcohol is also prohibited. Alcohol-containing drinks adversely affect the functioning of the vascular system and hormonal levels. Vessels cease to supply the tissues with the required number of oxygen molecules. Cells stop actively multiplying. Tissues begin to restore their function more slowly. It should also be borne in mind that alcohol adversely affects the child. During lactation, it is forbidden to drink even light alcohol.

Fried and fatty foods negatively affect the functioning of the gastrointestinal tract. It is dangerous in the first days after the operation. These foods can cause constipation. A decrease in the contractile function of the intestine is accompanied by increased gas formation and abdominal pain. You can eliminate the pathology with special absorbent preparations or by reducing the consumption of fried foods. If the problem persists for a long time, you need to contact a specialist.

It is recommended to exclude fruits containing a large amount of acids. Acids cause problems for the child. There is increased gas formation. The baby becomes restless, does not sleep well. Allergic rashes also appear. Children's diathesis largely depends on the nutrition of the mother in the recovery phase after cesarean section.

Cosmetic care

Modern pharmacy kiosks offer a wide range of cosmetics for women after a caesarean section. Means help get rid of nipple cracks and postpartum stretch marks.

There are also drugs that eliminate the scar after surgery. Contractubex has an effective action. It is made from herbal ingredients. The tool does not cause allergies in women. It also gradually reduces the density of scar tissue. The scar becomes less visible.

Nipple cream should be used. Such substances help soften halos and nipples. This helps to avoid the appearance of cracks during breastfeeding.

You can also visit a special massage aimed at eliminating stretch marks and increasing metabolic processes in the body. Massage enhances blood circulation, restores vascular nutrition.

Physical activity after surgery

In the first days after surgery, a woman is prohibited from high physical activity. Increased activity can adversely affect the healing of the postoperative suture. It is also dangerous for the normalization of the uterine cavity. If a woman begins to move actively, the risk of wound divergence increases.

A month later, you can resort to a special technique - yoga for moms. These exercises exclude sudden movements. Yoga helps to stretch the muscular frame and normalize the psycho-emotional state. Also, such exercises help to strengthen the contraction of smooth muscles. Thanks to this, the uterus quickly takes on its size, the shape of the body returns to normal.

Doctors also recommend long walks with a child from 2 years old. You should lay a route with a rise up the hill. Lifting with a load helps the leg muscles to strengthen. The lungs are in place. The respiratory system is restored. How long you can walk, you should check with your doctor.

Women in labor ask how to recover after a caesarean section. To do this, you must follow all of the above rules. They will help a woman quickly bring her figure back to normal and increase lactation. Also, following the rules allows the child to quickly adapt to the environment.

Everyone knows that after giving birth by caesarean section, a scar remains on the abdomen, because during this operation, doctors make an incision in the soft tissues of the abdominal cavity and the wall of the uterus. In this case, the incision is quite large so that the baby can be easily pulled out into the light and not injure him.

Seams after caesarean section: types

Types of incisions for caesarean section directly depend on the course of childbirth, for example, in case of acute fetal hypoxia or heavy bleeding in a future mother, the doctor may decide to conduct corporal caesarean section. This means that the incision on the abdomen will pass vertically from the navel to the pubic area.

And the wall of the uterus is opened with a longitudinal incision. However, this type of caesarean section is quite rare, since such a suture after a caesarean section is not particularly beautiful - it is very noticeable, tends to become thicker over time, and increases in size.

Usually, caesarean section is performed laparotomy according to Pfannenstiel. This is an incision in the skin and subcutaneous fat transversely passing through the suprapubic fold. In this case, there is no opening of the abdominal cavity, and due to the transverse direction of the incision and the fact that it is located inside the natural skin fold, the scar from the caesarean section will subsequently become almost invisible.

cosmetic seam after a caesarean section, they are usually applied precisely with a Pfannenstiel incision. With a corporal incision, the strength of the tissue connection must be very high, which requires interrupted sutures, and a cosmetic suture after such a caesarean section is categorically not suitable.

Internal seams, which are superimposed on the wall of the uterus, have a large number of options, for example, you can use the hardware technique for applying ligatures. The main thing here is to achieve better conditions for the healing of the uterus and reduce blood loss, since the outcome of subsequent pregnancies depends on the strength of the sutures.

Pain relief after caesarean section

As a rule, so that the seam after a cesarean section does not hurt much, the woman in labor is prescribed painkillers. They are usually used only in the first days, and then they are gradually abandoned. In addition to painkillers, antibiotics may also be prescribed to avoid complications caused by the infection.

Also, after a cesarean, they can not do without drugs that will help reduce the uterus and help normalize the functions of the gastrointestinal tract. After the third day, almost all women in labor refuse to use drugs, and already six days after the cesarean section, the stitches are removed, unless, of course, they are self-absorbable.

After the suture has healed, it will become almost invisible, and will not cause unnecessary trouble for the mother. Of course, if she follows the recommendations of the doctor and properly care for him.

How to care for caesarean section stitches?

While you are in the hospital, daily dressings and antiseptic treatment of the suture after cesarean will be carried out by the medical staff, and after discharge, the doctor will tell you how to care for the postoperative suture yourself at home.

The main thing to remember is that doctors will allow you to pamper yourself with a shower only a day after the stitches are removed, and rub the stitch with a washcloth a week later. If the postoperative period will pass with complications, then the doctor may prescribe you special ointments that will help the suture heal as soon as possible.

What complications can occur in the postoperative period?

These may be early complications or those that appear after some time. Usually early complications manifest themselves even before the removal of stitches after caesarean section - in the hospital. These include small hematomas and bleeding.

You will easily notice them - the bandage on the seam will get wet with blood. If this happens, inform the medical staff immediately so that the wound does not fester.

It may also occur seam divergence. Such a complication is dangerous for 1-2 days after removing the ligatures, that is, for 7-10 days after cesarean. To prevent this from happening, avoid stress and exercise.

If you notice a divergence of the seam even in a small area, do not try to treat it yourself, but immediately seek qualified help.

Still possible suppuration of the seam. In order to prevent this, you undergo antibiotic therapy in the maternity hospital, but despite this, in some cases, the suture still begins to fester.

First, swelling and redness appear, pain is possible, and the skin around the seam left after the caesarean section is tense, then the medical staff makes dressings with a special antibacterial solution, and if the condition of the woman in labor worsens, the temperature rises, the general condition worsens, then doctors can prescribe antibiotics and send you to the gynecological department for treatment.

Late Complications

Such complications do not appear immediately, it may take more than one month. The most common complication among them is ligature fistulas. This complication after caesarean section occurs in many women in labor. It occurs due to the rejection of the suture material by the body.

The process of occurrence of ligature fistulas is quite long: first there is swelling, then redness, pain, and then pus erupts. If you carefully consider the wound, then in it you can consider the culprit of all troubles - the remaining ligature.

Treating yourself - smearing with antiseptic solutions and creams - is useless, the fistula will then close, then boil again. Therefore, you need to contact a specialist to remove the thread.

Scar correction methods after caesarean section

Usually, when performing a caesarean section, doctors try to make the seam as neat as possible so that after eight to twelve months it becomes almost invisible.

However, an operation is an operation, and in any case, after it, a scar will remain for someone less, for someone more noticeable. Therefore, a few months after the operation, you will begin to think about how to remove a scar remaining after caesarean section.

Today, special clinics of aesthetic surgery cope with such a problem very effectively, where in a few sessions with the help of a laser you will be relieved of scar tissue.

Before you go for laser correction, you should consult with your doctor so that he can determine the best time for the procedure based on the condition of the suture.

Answers

A caesarean section is an obstetric operation performed when a woman is unable to give birth naturally. It takes a little longer for women in labor to recover from a caesarean section. In order for a woman to gain strength faster, you need to follow some recommendations.

Postoperative period

If the operation went without complications and the child is healthy, after 2 hours the woman and the baby are transferred to the cohabitation ward. In order to prevent the development of complications, it is necessary to constantly monitor the condition of vital organs. To do this, the medical staff measures the pulse, blood pressure, temperature of the woman in labor, assesses the tone of the uterus, the nature of the discharge. The doctor also assesses the state of the urinary function and, if it is impossible to urinate, a urinary catheter is installed for the woman.

The first day after caesarean section requires active medical treatment. The operation is inevitably associated with blood loss. To restore the volume of circulating blood and increase the rheological properties of the woman in labor, rheopolyglucin, solutions of sodium chloride and glucose are administered. In case of massive blood loss, blood components are administered.

After the operation, the woman may be prescribed painkillers, which are administered within one to three days. When carrying out any surgical intervention on the abdominal organs, there is a risk of developing intestinal paresis. To prevent this from happening to a woman, she is prescribed prozerin. To prevent infectious complications, it is prescribed (in some cases, an antibiotic is administered intramuscularly or intravenously before surgery).

A woman stays in the hospital for 4-5 days or more in case of complications.

Nutrition of the woman in labor

On the first day after childbirth, a woman in labor should not eat anything, you can only drink non-carbonated water. But do not worry, the woman will not be hungry. All the necessary nutrients will be replenished with droppers.

On the second or fourth day, a woman in labor should follow a sparing diet, because her intestines are still not able to work to the fullest. You can eat boiled, pureed food. It is allowed to add hatred meat broth, steamed cutlets, low-fat cottage cheese and cheese, mashed potatoes to the diet. Under the ban are products that increase gas formation (legumes, flour products, grapes, etc.). If a woman is worried, you need to stroke your stomach clockwise for a minute.

Already on the fifth day, the menu is gradually expanding. But this does not mean that you can eat absolutely everything. Now a woman needs to constantly remember that everything eaten can affect the condition of the baby. Therefore, during the period of breastfeeding, you should not eat certain foods that can harm the crumbs.

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About the importance of movement after surgery

The first day after a caesarean section, a woman will feel weak, feel pain in her stomach, which is why the woman in labor does not want to move again. In addition, with active movements, a divergence of the seams may occur. However, already 6 hours after the operation, doctors advise starting to roll over from side to side, slightly pulling the legs up to the stomach, performing simple physical exercises right in bed (rotation of the feet, hands, flexion and extension of the legs at the knee joint, etc.), and then - and get up (strictly under the supervision of medical staff).

Important: you can sit down and get up only after the woman puts on a special postpartum bandage (in many maternity hospitals, women in labor are first wrapped tightly with a folded sheet).

You need to get out of bed carefully, without straining your abdominal muscles. You need to slightly pull your knees towards you, roll over on your side, and then, leaning on your hands, take a sitting position. By the end of the first day, a woman can already get out of bed and walk a little.

Many mothers are worried about being overweight and wonder when they can start physical activity. In the postpartum period, only simple physical exercises are allowed. More active loads can be started after a month and a half. It can be fitness, yoga, body flex. With exercises for swinging the press, you should wait for six months.

After discharge from the maternity hospital, the woman in labor will be warned that in the near future she cannot lift weights over three or four kilograms, that is, no more than the weight of the child.

Healing of sutures after caesarean section

During the stay of the woman in labor at the maternity hospital, the nurse regularly treats the seam with antiseptics (brilliant green, potassium permanganate solution), changes the bandage. The sutures are removed approximately on the seventh or tenth day. Skin healing usually occurs quickly. The seam is very noticeable at first, red or purple. As time goes by, it will become less and less noticeable. For the speedy resorption of the scar, you can take special ointments, for example, contractubex.

Do not take a shower until the stitches are removed. But you can wash separately parts of the body. It will be possible to take a full shower only after the stitches are removed, but, of course, you should not actively rub the scar. But visiting the bathhouse and bathing in the bath should be postponed for two months, until the seam on the uterus is completely tightened.

intimate life

The uterus after caesarean section is a large wound surface. Therefore, until it heals, and this happens within one and a half to two months, one should refrain from sexual intercourse.

The uterine suture heals completely within two to three years. If a woman plans to become pregnant in the future, she should become pregnant no earlier than after the specified period. That is why you need to use . And, of course, you should not hope that it is impossible to get pregnant during lactation - this is a myth.

The restoration of menstruation depends on whether the mother is breastfeeding the child. So, if a woman does not breastfeed, the menstrual cycle resumes after two months, if she feeds - after six months or more.

Grigorova Valeria, medical commentator

A caesarean section may be performed for a variety of reasons. It happens to be planned when there are serious indications for this related to the health of the mother or child in the womb.

It happens that you have to do a caesarean on an emergency basis, if, for example, something went wrong during physiological childbirth. Be that as it may, proper care after a cesarean section is very important, both for the postoperative suture and associated with proper nutrition and minimizing physical activity.

On the first day after operative delivery, the patient remains in the intensive care unit under the close supervision of obstetricians and an anesthesiologist. Here they monitor her general condition and how the bladder and intestines work.

You can sometimes get out of bed on the first, and sometimes only on the second day after a cesarean section. It all depends on the type of anesthesia used during the operation. General anesthesia takes longer to leave the body, and epidural - faster. The woman in labor herself cannot rise, you need to ask the medical staff or one of the relatives present nearby for help. Only on the second day, the young mother is transferred to the postpartum ward, where she can stay with her baby.

What to eat after a caesarean section?

For the fastest recovery of the body, the right approach to nutrition is very important. On the first day after operative delivery, it is only allowed to drink mineral water acidified with lemon. But the woman in labor receives food through droppers with the necessary vitamins and microelements.

Regarding what to eat after a cesarean section on the second day, then the diet is already more extensive. Low-fat chicken broths, cereals, boiled meat and fish, previously ground through a meat grinder or blender, sweet tea, fruit drinks are allowed. Starting from the third day, a full-fledged diet is gradually introduced, but taking into account the diet for nursing mothers, which excludes allergenic and difficult for the digestive tract foods that cause bloating and colic in both the mother and the newborn. A very important step is the first independent chair after the operation. Often, to normalize bowel function, an enema is prescribed.

Medical support

Immediately after the operation, the patient receives painkillers, which after a few days will have to be abandoned. Means are also prescribed that stimulate uterine contractions and normalize the work of the digestive organs. After the operation, especially if it was an emergency, antibiotic therapy is performed to avoid infectious complications.

How to care for a seam

Proper care after a caesarean section after a suture is very important. The medical staff changes dressings daily, monitoring the condition of the scar. The scar after a caesarean section should not be wetted during the first week. Only after discharge can you take a shower completely, but in no case do not rub the area of ​​\u200b\u200bthe seam with a washcloth. Bath is allowed only two months after cesarean. To reduce the load on the scar, you need to wear a special postoperative bandage.

On the seventh day after operative delivery, the patient's sutures are removed, unless, of course, self-absorbable sutures were used. Sometimes it happens that a woman, for inexplicable reasons, has a fever after a cesarean in the region of 38 degrees. Practice shows that subfebrile temperature can be a manifestation of an allergic reaction to the threads used to suture the incision. Usually the temperature drops immediately after the stitches are removed. After the scar has healed, the cesarean scar will be almost invisible, especially if a transverse incision was made. But for high-quality healing, it is important to follow all medical recommendations.

If you find a seal after a cesarean section in the suture area, you need to urgently consult a doctor. The cause of this phenomenon may be a hernia or keloid scar.

Exercise after caesarean section

In the first weeks after operative delivery, try to avoid physical exertion, especially on the suture area. If you are worried about extra pounds after pregnancy, then you can do special exercises after a cesarean to lose weight and clean your stomach only after one and a half to two months. In this case, you must first consult with your doctor.

Simple physical exercises after cesarean should be done for the legs, breathing exercises, retraction and relaxation of the navel are recommended. All this can be performed only if there is no pain.