In recent years, the interest of researchers in the Caesarean section has been explained by the change in obstetric strategy and the expansion of indications for surgical delivery, as well as an increase in the number of pregnant women with a scar on the uterus. In Russia there is an annual increase in the cesarean section by approximately 1%. So, in 1997, according to the Ministry of Health of the Russian Federation, this indicator was 10.1%, in 2006 - 18.4%.

One of the important factors in the growth of the cesarean section in the last two decades is the operation in the interest of the fetus. There is some correlation between an increase in the cesarean section and a decrease in perinatal mortality from 15.8% in 1985 to 12.08% in 2002 and 11.27% in 2006. At present, no one doubts the role of Caesarean section in reducing perinatal mortality and slightly less - the infant morbidity. However, it is clear that increasing the cesarean section can not solve the problem.

Special attention should be paid to the issue of cesarean section in case of premature pregnancy. At a gestation period of up to 34 weeks, a cesarean section is not an operation of choice, and it is produced mainly on urgent indications from the mother. In these terms of pregnancy there is an inadequate deployment of the lower segment of the uterus. For the fetus at the gestation period of 26-32 weeks and the weight of the fetus to 1500 g, when careful delivery is extremely important, the nature of the incision on the uterus. Today, there are new indications for surgery, the frequency of which is quite high (10.6%), is an induced pregnancy after in vitro fertilization.

An increase in the frequency of abdominal delivery creates a new problem - the management of pregnancy and childbirth in women with a scar on the uterus. The issues of independent births through natural birth canals after cesarean section are discussed in our country since the 60s. According to modern data, from 30 to 60% of pregnant women who have had a cesarean section can give birth alone with a favorable outcome for the mother and fetus.

Despite widespread use, the cesarean section is classified as a complex operation with a high incidence of postoperative complications - 3.3% -54.4%, which are related, inter alia, to the technique of intervention.

At present, various modifications of the caesarean section are known, which differ in the way they access the uterus, the features of the incision and the suturing of the wound. The choice of this or that technique is defined as objective prerequisites to which the term of pregnancy, the presentation and size of the fetus, the presence of a scar and the accompanying pathology of the uterus (myoma of the uterus, infectious processes and t. ), and the preferences of the surgeon, depending on the traditional medical school and their own experience.

medicus. en Key words:.