Cesarean section: Progressive trends

1. 1. A survey of 852 cesarean sections performed during the 9 year period from Jan. 1, 1943, through Dec. 31, 1951, is presented. 2. 2. An increase in incidence from 2.5 per cent to 5.1 per cent during the time surveyed is noted, with an average incidence of 3.5 per cent. 3. 3. The most frequently noted indications were previous cesarean section, cephalopelvic disproportion, and hemorrhage. There has been a liberalization of indications for fetal causes, for elderly primigravidas, and for bad obstetrical history. 4. 4. There has been a steady, marked increase in the low cervical two-flap cesarean section with a constant decrease in the classical type. 5. 5. There has been a steady rise in the use of regional rather than inhalation anesthesia, from 42.7 per cent of cases during the first 3 years of the survey, to 76.2 per cent of the cases during the last 3 years. 6. 6. The morbidity rate was 49.2 per cent. The use of antibiotics as a prophylactic measure in all cesarean sections has lowered the rate constantly. It is believed that penicillin should be given prophylactically to all patients in labor or with ruptured membranes for 12 hours. A plea is entered to change the obstetrical standard for the determination of morbidity following cesarean sections. 7. 7. The chief postoperative complications encountered were ileus, wound infection, and thrombophlebitis. 8. 8. The corrected maternal mortality rate was 0.47 per cent. One death was due to anesthesia, 1 death was due to postoperative pneumonia, 1 death was due to hemorrhage, and 1 death was due to paralytic ileus. 9. 9. A gross fetal mortality rate of 6.92 per cent is reported. The corrected fetal mortality rate, eliminating those cases in which the fetal heartbeat was nor heard prior to surgery and cases of fetal abnormalities not compatible with life, was 3.05 per cent.