Cesarean section in modern obstetrics: problems and ways to overcome them

A review of published scientific papers on the problem of cesarean section (CS) has been conducted. In modern obstetrics, the frequency of CS in individual obstetric institutions reaches 40—50%. The expansion of indications for surgery is not always justified. There is no correlation between an increase in the frequency of CS and the indicators of perinatal mortality (PM), since it is not the method of delivery that can change the PS index, but the antenatal protection of the fetus based on the use of modern diagnostic technologies. The result of the operational activity is a change in the doctor’s mentality, an increase in the number of women of reproductive age with an operated uterus, as well as a decrease in obstetric professionalism and qualifications of obstetricians in the art of childbirth through the natural birth canal. In addition, CS is economically costly, which increases the cost of obstetric care. The article provides up-to-date data on the causal relationships between the expansion of indications for abdominal childbirth and the development of complications. The article presents the current view of researchers on alternative methods of delivery, options for preparing a woman’s body for childbirth in the presence of a scar on the uterus, the possibility of conducting echographic and hysteroscopic assessments of the condition of the scar at the stage of pre-pregnancy preparation for the next pregnancy. The importance of instrumental diagnosis of fetal distress during delivery through the natural birth canal in pregnant women of this group is noted, and methods for differential diagnosis of hypoxia severity are presented. Much attention is paid to the formation of an insolvent scar on the uterus and data on the surgical treatment of such complications before conception are presented.