Parto cesareo
Il parto cesareo, anche detto taglio cesareo, è un vero e proprio intervento chirurgico, attraverso il quale il ginecologo procede all’estrazione del bambino dall’addome della mamma. Si può avere un parto cesareo programmato, quando viene stabilito prima dell’inizio del travaglio, oppure urgente, quanto per il bene della mamma e/o del bambino è necessario intervenire d’urgenza. Di solito, il taglio cesareo viene programmato quando la placenta è previa, il bambino è podalico oppure molto grande rispetto al bacino della mamma, oppure ancora in caso di parto gemellare. In caso di parto cesareo programmato, circa un mese prima della nascita viene fatto un pre-ricovero, durante il quale la futura mamma viene ricoverata per una mattinata in ospedale, per essere sottoposta ad esami del sangue, elettrocardiogramma, visita anestesiologica e visita ostetrica con ecografia. In base ai risultati, verrà fissata la data del parto cesareo, di solito un mese dopo. Prima dell’intervento, bisogna solo depilare il pube e arrivare in ospedale a digiuno dalla mezzanotte precedente, mentre non è necessario fare un clistere. Durante il ricovero, viene fatto un tracciato cardiotocografico per monitorare il bambino e poi la mamma viene portata in sala operatoria.
Parto cesareo: anestesia
Primo step del parto cesareo è, ovviamente, l’anestesia. Di solito viene fatta un’anestesia locale, spinale o epidurale, che provoca solo una perdita della sensibilità dolorosa dalla zona lombare in giù. Solo in caso di emergenza, viene praticata l’anestesia totale. Per evitare l’insorgere di infezioni, prima o all’inizio dell’intervento viene somministrato alla mamma un antibiotico a largo spettro. Fatta l’anestesia, il medico controlla che abbia fatto effetto prima di cominciare con l’intervento.
Parto cesareo: incisione
Un paio di centimetri sopra il pube, viene fatta un’incisione orizzontale, lunga circa 10 centimetri. Il taglio longitudinale, ovvero quello che va dall’ombelico al pube, viene fatto solo in caso d’urgenza oppure se in precedenza sono già stati fatti tagli cesarei o altri inteventi con taglio longitudinale. Dopo aver inciso la pelle, si passa allo strato di grasso addominale sottocutaneo e alla fascia muscolare che racchiude i muscoli, i quali non vengono tagliati, ma semplicemente separati. Infine, si incidono il peritoneo, una pellicola che racchiude gli organi addominali, e l’utero. Rompendo il sacco amniotico, il medico estrae il bambino. Il tutto avviene in circa 5-10 minuti.
Parto cesareo: nascita
Dopo essere stato mostrato alla mamma, il bambino viene dato all’ostetrica, che taglia il cordone ombelicale. Ultima fase del parto cesareo (e del parto naturale) è il secondamento, ovvero l’espulsione della placenta. L’utero viene ripulito dal chirurgo per rimuovere eventuali residui di sacco amniotico, di placenta o di coaguli di sangue, e infine tutti i tessuti vengono ricuciti. In totale, l’intervento dura tra i 30 e i 45 minuti. La mamma resta in osservazione per circa un’ora in una saletta vicino alla sala operatoria. Prima di riprendersi e potersi alzare in piedi, di solito dovrà aspettare circa 24 ore. Il ricovero dura di solito 3-4 giorni.
Parto cesareo: rischi
Bisogna ricordare che il parto cesareo è un vero e proprio intervento chirurgico e pertanto può presentare rischi e complicazioni, come un eccessivo il sanguinamento, con conseguente anemia, e infezioni delle ferita o della cavità uterina (endometrite). Rare ma possibili anche le lesioni alla vescica e all’intestino. Nei giorni immediatamente successivi al parto, è possibile che la mamma presenti febbre, stitichezza, problemi di cicatrizzazione della ferita. Infine, rispetto al parto naturale, è maggiore il rischio di placenta accreta e di placenta previa nelle successive gravidanze.
Parto cesareo programmato: a quante settimane?
Il parto cesareo programmato non andrebbe mai fatto prima della 39° settimana, per evitare che il bambino possa avere problematiche come difficoltà respiratorie, infezioni e bassi livelli di zucchero nel sangue, che necessitano di cure intensive. Ovviamente diverso è il caso di un taglio cesareo d’urgenza, dove è necessario intervenire prima possibile per evitare complicazioni.
Parto cesareo o naturale?
È meglio fare un parto cesareo o naturale? Sicuramente il parto naturale è preferibile, anche se, come abbiamo detto più sopra, in alcuni casi è necessario intervenire con un taglio cesareo. Questo soprattutto perché dopo il parto cesareo la mamma impiega più tempo per riprendersi e necessita di un ricovero di almeno 3 giorni. Inoltre, come tutti gli interventi, il cesareo presenta rischi e complicazioni, sia durante che dopo. Tra l’altro, quasi sempre dopo un primo parto cesareo, anche i parti successivi verranno eseguiti secondo questa modalità. Da non sottovalutare è il fatto che durante il parto cesareo la mamma è completamente anestetizzata dall’ombelico in giù, cosa che la può far sentire meno partecipe. Infine, quasi sempre i papà non sono ammessi in sala parto.
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