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Rana po cesarskim cięciu – pielęgnacja i możliwe powikłania

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Podczas operacji cesarskiego cięcia przerywana jest ciągłość tkanki skórnej i podskórnej, a także rozcinana jest powięź poprzeczna brzucha i macica. W czasie rekonwalescencji po porodzie bardzo istotna jest zatem odpowiednia pielęgnacja rany – pozwoli to przyspieszyć proces gojenia, a także uniknąć poważnych powikłań.

Cesarskie cięcie jest jedną z najczęściej wykonywanych operacji położniczych. W praktyce klinicznej zwykle wykonuje się cięcie poprzeczne, nad linią owłosienia. Taki zabieg wymaga precyzji od osoby operującej, jednak niewielkie nacięcie wpływa na zmniejszenie utraty krwi, a także lepsze gojenie się rany pooperacyjnej w macicy. Rzadziej spotykane jest cięcie podłużne – wykonuje się je zazwyczaj, gdy warunki anatomiczne wykluczają wykonanie cięcia poprzecznego, np. u kobiet otyłych. Takie cięcie pozostawia po sobie dosyć duży ślad w postaci blizny przebiegającej od pępka do spojenia łonowego.

Po narodzinach dziecka, w trakcie zabiegu, lekarz zszywa naciętą macicę, powięź i tkankę podskórną szwami rozpuszczalnymi, natomiast na skórze zazwyczaj stosowane są szwy nierozpuszczalne, które usuwa się między 7 a 8 dobą połogu. Szwy wewnętrzne rozpuszczają się około 3-6 miesięcy.

Podstawowe zasady pielęgnacji rany po cesarskim cięciu

Do momentu zdjęcia szwów na ranie pozostawiany jest jałowy opatrunek. W tym czasie należy szczególnie uważać, by nie zmoczyć opatrywanego miejsca, a jeżeli stanie się to przez przypadek, należy poprosić położną o zmianę opatrunku. Przy każdej zmianie opatrunku zalecane jest przemycie rany, np. środkiem antyseptycznym. Po 2-3 dniach od zdjęcia szwów zaleca się rezygnacje z opatrunku.

Po zdjęciu opatrunku rana po cesarskim cięciu powinna być przede wszystkim utrzymana w czystości i odpowiedniej suchości. Należy ją przemywać (2-3 razy dziennie) pod prysznicem z użyciem mydła antyalergicznego. Wskazane jest mycie rany ręką, ponieważ gąbki i myjki mogą podrażnić skórę.  Następnie ranę należy osuszyć papierowym ręcznikiem. 2-3 razy dziennie rana powinna być również dezynfekowana z pomocą środków antyseptycznych, przeznaczonych do pielęgnacji ran.

Pacjentkom odradzane jest stosowanie depilacji, golenia wzgórka łonowego przez okres około 3-4 tygodni po operacji. Kobiety nie mogą również używać pasów poporodowych. Wskazane jest noszenie przewiewnej, bawełnianej bielizny oraz odzieży, która nie uciska i nie podrażnia skóry. Można również skorzystać z dostępnych na rynku majtek poporodowych. W procesie gojenia się rany zaleca się stosowanie zbilansowanej diety bogatej w białko, witaminę C, cynk oraz kolagen, które wspierają gojenie się ran.

Powikłania rany po cesarskim cięciu

Najczęstsze powikłania rany po cięciu cesarskim to zakażanie, ropień, krwiak czy rozejście się rany. Do rozwoju tych powikłań może dojść na skutek nieprawidłowej pielęgnacji rany, a także otyłości, palenia papierosów, cukrzycy, mocznicy czy zespołu niedoborów odporności. Powikłania mogą również rozwinąć się u kobiet, u których w czasie ciąży występowały infekcje bakteryjne, nie zastosowano profilaktyki antybiotykowej okołooperacyjnej lub na skutek przedłużania się czasu operacji.

  1. Zakażenie rany po cesarskim cięciu

Prawidłowe gojenie się rany może cechować się lekkim zaczerwienieniem w okolicach rany, lekką opuchlizną, wrażliwością czy niewielkim bólem. Z rany może również wypływać nieznaczna ilość przezroczystego wysięku. Gdy w ranie rozwija się zakażenie, dochodzi do zwiększenia się obszaru zaczerwienienia, obrzęku, silnych dolegliwości bólowych i wrażliwości rany. Obserwowana jest także zwiększona ilość wysięku oraz zmiany w jego kolorze i towarzyszący mu nieprzyjemny zapach. Ponadto objawem zakażenia jest rosnąca temperatura ciała, ogólne złe samopoczucie i uczucie gorąca w okolicach rany.

  1. Ropień

Do powstania ropnia w ranie może prowadzić infekcja bakteryjna. Lekarz nacina wówczas ranę w celu ewakuacji i drenażu oraz zapobieganiu gromadzenia się ropy.

  1. Krwiak

Krwiak w ranie pooperacyjnej tworzy się w wyniku zaburzeń krzepnięcia krwi, niedostatecznej homeostazy, na skutek przyjmowania niesteroidowych leków przeciwzapalnych, z powodu nadciśnienia bądź napinania okolicy rany. Krwiak może wchłonąć się samoistnie bądź zostać opróżniony przez lekarza poprzez nakłucie i niewielkie rozwarcie brzegów rany. Krwawiące naczynie powinno zostać odpowiednio zaopatrzone.

  1. Rozejście się rany

Rozejście się rany może być spowodowane osłabieniem żywotności tkanek, np. w wyniku zakażenia, krwiaka czy obfitego wysięku z rany. Niekiedy przyczyną jest również zła technika szycia albo za wczesne zdjęcie szwów. Rozejściu się rany towarzyszą dolegliwości bólowe oraz obecność treści surowiczo-krwistej.

W przypadku zaobserwowania niepokojących objawów w obrębie rany pooperacyjnej należy niezwłocznie zgłosić się do lekarza, by uniknąć poważniejszych powikłań.

Ryzyko komplikacji w związku z blizną

Całkowite zagojenie się rany pooperacyjnej może trwać nawet 6 miesięcy. Cesarskie cięcie pozostawia po sobie bliznę o długości około 10-15 cm. Blizna zazwyczaj nie jest w widocznym miejscu i można łatwo zakryć ją bielizną.

Higiena blizny jest bardzo ważnym elementem rekonwalescencji po porodzie. W procesie kształtowania się blizny po cesarskim cięciu kobiety mogą doświadczać bólu i ciągnięcia, zmian w postawie ciała, bólu kręgosłupa, dyskomfortu podczas aktywności fizycznej, a także zgrubień i zrostów w okolicy blizny. Bolesne zrosty to częsta dolegliwość pooperacyjna, która może prowadzić do poważnych konsekwencji, takich jak przewlekłe bóle miednicy mniejszej, bolesne miesiączki, niedrożność jelita cienkiego, niepłodność, dolegliwości przewodu pokarmowego, układu rozrodczego i moczowego.

Mobilizacja blizny po cesarskim cięciu

Ryzyko pojawienia się zrostów oraz poprawę elastyczności skóry zapewnia odpowiednia rehabilitacja blizny polegająca na jej mobilizacji prowadzona przez fizjoterapeutę. Polega ona na odpowiednich masażach i ćwiczeniach z blizną, które zwiększają ruchomość tkanek.

Nie należy jednak przeprowadzać jej w pierwszej fazie gojenia się rany (2-7 dni po operacji), ponieważ może to skutkować rozejściem się rany.  W tym czasie wykonywana jest jedynie praca manualna z okolicznymi tkankami. W drugiej fazie gojenia, około 4-5 tygodni po operacji, rozpoczyna się bezpośrednia praca z blizną w celu jej uelastycznienia i przywrócenia ruchomości okolicznym tkankom. Pacjentki są również instruowane przez fizjoterapeutów, by przeprowadzać mobilizację blizny samodzielnie. W fazie modelowania (6 miesięcy do 2 lat po operacji) można kontynuować pracę z blizną, jeżeli tego wymaga. Rozpoczęcie terapii blizny możliwe jest nawet, gdy minęło dużo czasu od cesarskiego cięcia.

Źródła: fizjomed.com.pl, szpital.szpital.zelazna.pl

 

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