Modern aspects of cesarean section

Abstract

The increase in the frequency of cesarean section (CS) remains one of the actual problems of modern obstetrics and causes the concern to the world community. Today, it is believed that the abdominal delivery is a safer and more non-traumatic method of delivery for the benefit of the fetus than vaginal delivery. The relative number of cases of abdominal delivery, according to the WHO, should not exceed 10 % of the total number of births, which minimizes the occurrence of complications and prevents the development of bleeding and purulent-inflammatory diseases in the postpartum period. But the latest data demonstrate that this percentage is 18.6 % worldwide, that is one in five births ends in CS. The frequency of CS has been growing rapidly in recent years in most countries of the world, and in this context Ukraine is no exception (14.2 % in 2006, to 25.08 % in 2020). This increases the risk of maternal and perinatal morbidity and mortality. In the presented material for the distance learning about the operative delivery, doctors will find up-to-date information on indications, contraindications, methods of CS, as well as recommendations on counseling of pregnant women before surgery and preventive measures to minimize complications during obstetric surgery. According to the modern approach, the indications for the CS are divided into planned and urgent ones, which are clearly defined in this article. Considerable attention is paid to counseling of the patients before this operation and the obligatory acquaintance of the pregnant woman with the method of performing CS, anesthesia and potential perioperative complications and signing her the informed consent on the possible expansion of surgery. According to the standpoint of evidence-based medicine, the most optimal method of CS is presented, which significantly reduces the likelihood of hemorrhagic, purulent-inflammatory complications during surgery and in the postoperative period. The issues related to modern methods of anesthesia of CS with the use of multimodal analgesia, early mobilization of women in labor and prevention of thromboembolic complications, rehabilitation measures are also identified.