Cesarean section is a common operation to solve dystocia or terminate pregnancy in time due to medical indications. The time from hysterectomy to fetal delivery during cesarean section should not exceed 150s. When the uterus ruptures, the external air and the operator's operation of delivering the fetus can cause the fetal breathing amplitude to increase. The longer the operation time, the more amniotic fluid will be inhaled, which will seriously lead to neonatal asphyxia. Prolonged intrauterine operation time, compression of abdominal aorta and inferior vena cava, and decreased uterine blood perfusion have adverse effects on fetal blood circulation. Therefore, in order to reduce the damage of fetal delivery difficulties to newborns, it is necessary to shorten the operation time of fetal head delivery.
At present, more and more parturients choose transverse abdominal incision for cesarean section, which makes it more difficult to deliver the fetal head. When transverse abdominal incision is used, rectus abdominis muscle is not cut off, and the relaxation degree of incision is not as good as that of longitudinal abdominal incision. If the fetal head floats high or is embedded too deeply, especially if the fetus is too large, it is often very difficult to take the fetal head by hand. If the fetal head cannot be delivered in time, it often causes amniotic fluid inhalation and neonatal asphyxia; If the force is too strong, it will often cause uterine incision tearing and postpartum hemorrhage. At this time, it is often necessary to use auxiliary devices to deliver the fetus as soon as possible.
Cesarean forceps is an important auxiliary instrument to solve the difficulty of head delivery, which is made by imitating vaginal forceps. Its basic characteristics are short forceps diameter, portability and flexible operation, which can shorten the delivery time of fetal head, reduce the occurrence of neonatal asphyxia, not increase the laceration of uterine incision and neonatal birth injury, and the neonatal head is free from forceps depression, so it is a safe surgical instrument that is harmless to mother and baby. When delivering the fetal head by hand in cesarean section, it is necessary to put pressure on the abdomen of the parturient, and the increased abdominal pressure is directly proportional to the difficulty of assisting the delivery of the fetal head. In the case of severe pregnancy-induced hypertension, heart disease, threatened uterine rupture, etc., the parturient should not increase abdominal pressure. And there is no need to use cesarean section forceps to assist the delivery of fetal head.
During the operation, the size of the uterine incision is appropriate, the movement is gentle, and the fetal head extends in time. Through the uterine incision with the smallest diameter line, the laceration of the uterine incision can be avoided. The rate of uterine incision laceration in cesarean section with forceps for the first delivery is higher than that in unarmed delivery, but the rate of uterine incision laceration in forceps delivery after unarmed delivery failed is higher than that in unarmed delivery, which may be related to the difficulty and long operation time of the former.
There are many reasons why it is difficult to deliver the head in cephalic cesarean section. In addition to the specific way of delivering the head, we should also comprehensively consider the specific situation of the parturient, such as the thickness of the abdominal wall, whether it is in labor, the degree of expansion of the lower uterine segment, whether the fetal head is connected, the size of the fetus and the intrauterine situation, and the choice of anesthesia, so as to select a reliable incision before operation and reserve corresponding instruments, so as to make full use of the advantages and avoid disadvantages. In any hospital with cesarean section conditions, there must be an auxiliary instrument for cephalic delivery in the surgical instrument set as a backup. Timely use of cesarean section forceps and appropriate relaxation of indications are of great significance to reduce the occurrence of neonatal malformation.