Cesarean section is a surgical procedure in which an incision is made in the mother’s abdomen and uterus to remove the baby . It is indicated when it is believed that a vaginal delivery could pose a risk to the mother or the fetus. In certain situations, cesarean delivery is the only solution for the birth of a healthy baby, and therefore it should only be performed when necessary, always assessing the risks and benefits in each case, and avoiding unnecessary cesarean sections.
There are different types of cesarean section depending on when it is performed and / or the type of cut that is made. We explain in detail all the cases and what characteristics the scar presents in each one of them.
Types of caesarean section according to the moment in which it is practiced
Depending on the case, the decision to perform a cesarean section may be made before delivery based on known alterations, such as, for example, abnormal fetal presentation or maternal illnesses; during labor, due to lack of adequate progression; or in an emergency situation that arises during childbirth, such as fetal distress.
Elective or scheduled cesarean
This cesarean section is performed before the mother has gone into labor , and obeys medical criteria that advise against vaginal delivery, whether due to maternal or fetal pathology. With exceptions, it should not be scheduled before week 39.
A scheduled cesarean section may be indicated in the following cases:
- Fetal presentation that makes vaginal delivery difficult
- Fetal macrosomia
- History of two or more previous cesarean sections
- Having had a uterine rupture in a previous pregnancy, due to the risk of recurrence
- Previous placenta
- Maternal diseases or infections, such as condylomata, HIV positive patients, active genital herpes lesions, or medical conditions of the mother that advise against vaginal delivery such as severe heart disease, risk of stroke, pre-eclampsia, eclampsia …
- In some cases of prematurity and multiple gestations
Cesarean section during the course of labor
Once labor has started, situations may arise that require a cesarean section during labor, such as:
- Failed induction of labor
- Parking for labor due to lack of dilation or descent of the baby
- Cephalopelvic disproportion (PCD)
Urgent cesarean section and emergent cesarean section
An urgent cesarean section is performed when a complication arises that requires the baby to be extracted quickly to avoid serious consequences that could compromise his life or that of the mother. It can be done before labor begins or during delivery. The safe time from when the problem is diagnosed until the urgent cesarean section is performed should not exceed 30 minutes.
For its part, emergent cesarean section is indicated when there is a vital risk to the mother or the baby . In these cases, fetal extraction should not exceed 15 minutes.
Urgent and emergent cesarean section is indicated in the following cases:
- Fetal suffering
- Suspicion of uterine rupture or uterine rupture
- Umbilical cord prolapse
- Placental abruption
- Maternal hemodynamic instability (problems in the functionality of the organs that control cerebral and cardiac oxygenation and cerebral pressure)
Types of cesarean section based on your incision
Cesarean section can also be classified based on the type of incision made . This can vary depending on several factors such as the position and size of the baby, the location of the placenta or the presence of uterine fibroids, among others.
The most common incision is the segmental one , which is made in the lower segment of the uterus. This type of incision can be horizontal (low transverse caesarean section), vertical (low vertical caesarean section) or T-shaped, the horizontal being the most used. In very specific cases, it may be necessary to perform a corporal or classic caesarean section.
We analyze all of them in detail:
Low transverse caesarean section
It is the technique of choice in most cases . The incision is made between three and five centimeters above the pubis, just below the bikini line or at the bikini line. This incision entails a shorter recovery time and fewer maternal complications. The scar that remains is resistant and very discreet.
Low vertical caesarean section
This incision is made vertically, two fingers below the navel and up to the pubic symphysis. It is simpler to perform than the horizontal one and also allows quick access to the uterus and an excellent surgical field, but it is aesthetically very attractive and carries a greater risk of bleeding.
That is why it is only indicated in cases of maternal-fetal emergency, such as cord prolapse, placenta previa, hemorrhage, polymyomatous uterus (uterus with fibroids), coagulation disorders with a high risk of bleeding or HELLP syndrome, among others.
Inverted T-shaped caesarean section
This type of cesarean section involves a double cut; horizontal and vertical. It is performed when it is necessary to have more space to be able to extract the baby , such as in cases of prematurity, when the baby has a health problem, macrosomic babies, or if the baby has a position that makes it difficult to extract through a horizontal incision only.
Corporal or classic caesarean section
Currently it is a very little used technique , as it is associated with a greater risk of uterine rupture in a future pregnancy, greater post-operative complications and a greater risk of bleeding. It consists of a vertical incision in the anterior aspect of the uterus, just along the rectus abdominis muscles.
It is used only in cases where access to the uterus is difficult due to anterior placenta previa, large cervical fibroids, tumors in the uterus, or significant adhesions. It could also be indicated in preterm deliveries below 26 weeks, and in case of perimortem cesarean section.
Although many factors can influence when recovering from a cesarean section, without a doubt the type of incision made is one of them. The doctor will tell you how to proceed to heal your wound, as well as other aspects to consider in order to have a future pregnancy.
Photos | iStock
Via | Hospital Sant Joan de Deu – Protocol for caesarean sections, Web Consultations, Assisted Reproduction ORG
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