It is usually suitable for pregnant women with narrow birth canal, serious abnormal fetal position, abnormal fetus, twins or multiple births, too large fetus, elderly women, difficult pregnancy, abnormal birth canal or premature water breakthrough.
For cesarean section, there are two ways: horizontal incision and vertical incision (that is, vertical incision).
2 Transverse cutting and longitudinal cutting In the history of medical cesarean section in China, longitudinal cutting actually existed before transverse cutting. However, when crosscutting was introduced, vertical cutting was gradually ignored, and crosscutting became the new favorite of hospitals all over the country.
Therefore, most hospitals now use horizontal incision for cesarean section, but because vertical incision also has certain advantages, it has recently been suggested to carry out vertical incision for cesarean section.
The difference between transverse cutting and vertical cutting: the stomach is cut by transverse cutting. The transverse incision is generally more than 2 cm above the pubic symphysis line, and the transverse cut is about 12- 15 cm.
Vertical incision: it is a longitudinal way, from the umbilicus to the pubic symphysis, the midline is cut from the side, and the vertical incision is about 12 cm.
Generally speaking, the form of the first knife cutting the skin in transverse cutting and longitudinal cutting is different, and the levels and steps of other cutting are the same:
They are all cut in the lower abdomen first, then the subcutaneous fat, muscle membrane, abdominal muscle, peritoneal layer and uterine muscle layer are cut in turn, and finally the amniotic cavity is cut to take out the fetus and placenta. Then, sew the above layers in turn, and finally sew the abdominal skin.
How to choose crosscutting or vertical cutting? From the aesthetic point of view, transverse cutting is better than vertical cutting.
Crosscutting: the transverse arc of the incision is just consistent with the skin texture, and it is more difficult to see whether there is a small belly. After healing, it will be well hidden under underwear, and the bikini can still be beautifully worn when playing on the beach in summer.
Vertical cutting: the abdominal wall has obvious scars, especially those with scar constitution. My stomach looks like a centipede, and it doesn't look good. Don't dare to wear anything with your stomach exposed.
From the degree of postoperative pain, transverse cutting is better than vertical cutting.
Cross-cutting: the traction of the wound after operation is light when it lies flat, so the degree of postoperative pain is light.
Vertical cutting: it is heavier to pull up and lie down, and the parturient feels more pain.
From the point of operation time, vertical cutting is better than horizontal cutting.
Cross: The operation takes a long time and requires high anesthesia, which is more suitable for elective surgery.
Vertical incision: the operation time is short, and when there is an emergency (such as umbilical cord prolapse and serious abnormality of fetal heart, the fetus needs to be delivered immediately), vertical incision is often used, even under local anesthesia.
From the difficulty of delivery, vertical cutting is better than cross cutting.
Transverse cutting: the delivery of fetal head is affected by the length of the injured mouth, and the delivery time is long, which is more difficult than vertical cutting.
Vertical cutting: the time from skin cutting to fetal delivery is shorter than that of transverse cutting, so it is easier to take out the fetal head without pressing the uterine bottom, and it is very difficult to take out the head.
In the field of vision exposed by surgery, vertical cutting is better than horizontal cutting.
Transverse incision: the extension of transverse incision is limited, and the exposure field during operation is limited, so it is impossible to explore widely.
Vertical incision: the surgical field of vision is fully exposed, and the incision can be extended according to the situation. Therefore, for those who are diagnosed as hysteromyoma, ovarian tumor or need surgical exploration before operation, vertical cesarean section should be performed.
The adhesion after vertical cutting is better than that after horizontal cutting.
Cross-cutting: After operation, the adhesion of each layer of incision is heavier than that of longitudinal incision, and the reoperation is more difficult than that of longitudinal incision.
Vertical incision: the probability of abdominal wall tissue adhesion is low, and it is better to choose vertical incision for those who have more reproductive requirements.
This shows that:
If you only want to be within two children, but also pay attention to beauty or thick and fat abdominal wall, then you can choose crosscutting;
But if you want to have more children and have gynecological or surgical complications, you should choose a vertical incision. In an emergency, the doctor decides to choose a longitudinal incision.
4 What exercises should I pay attention to after cesarean section? After operation, we should take a semi-supine position and do more turning movements, which can promote the peristalsis function of paralyzed intestinal muscles, promote the discharge of lochia and recover as soon as possible.
If you are healthy, you can get out of bed properly 24 hours after operation;
After 10 days or so, if you recover well, you can exercise properly:
For example, when lying on your back, your legs are alternately raised, first perpendicular to your body, and then slowly put down, doing it five times respectively;
In prone position, the legs are bent to the chest, the thighs are perpendicular to the bed, the hips are raised, and the chest is close to the bed. Do 1 time in the morning and evening, and gradually extend from 2 to 3 minutes to 10 minutes each time.
You must abstain from eating and drinking within 4 hours after operation; Drink a small amount of warm water 4 hours after operation; After the intestinal gas is exhausted, liquid food can be given 1 day, such as egg soup, rice soup, etc. (do not eat flatulence food such as milk, soybean milk and a lot of sucrose).
Then switch to semi-liquid food, such as porridge, noodle soup, wonton and so on. And then switch to a normal diet.
Hygiene should always keep the pudendal and abdominal incision clean. Within 2 weeks after operation, in order to prevent the incision from getting wet, it is best to take a bath. You can take a shower afterwards, but you must not take a shower before the lochia is discharged.
Wash vulva 1 ~ 2 times a day, and be careful not to let dirty water enter vagina; If the wound is red, swollen, hot and painful, you must seek medical attention in time to avoid wound infection.
Other aspects 1. Pay attention to urination after delivery.
For the convenience of operation, a catheter is usually placed before caesarean section. Therefore, as long as you have a feeling of urine after operation, you should try to urinate by yourself to avoid urinary tract bacterial infection caused by indwelling catheter for too long.
2. Use less painkillers.
Except that doctors can give some analgesic drugs on the day or night of operation, it is best not to use too many drugs to relieve pain afterwards, so as not to affect the recovery of intestinal peristalsis. Generally speaking, the pain of the wound will disappear by itself after 3 days.
3. No sexual intercourse
After three months of caesarean section, if the vagina no longer bleeds, the wound will heal well after examination by the doctor and sexual life can be resumed. However, strict contraceptive measures must be taken to avoid pregnancy (and the delivery interval of cesarean section is also recommended to be 18-24 months, that is, one and a half to two years).
Otherwise, the scarred uterus may rupture when pregnant again, especially at the end of pregnancy.