MD Milos Kupresak - Ostetrics - HISTORY OF CESAREAN DELIVERY

HISTORY OF CESAREAN DELIVERY

Terms

The origin of the term cesarean section is likely the product of two separate reports in 1581 and 1598, the former making reference to Cesarean and the second to Sections. The origin of the term cesarean is somewhat uncertain. The hypothesis that Julius Caesar was the product of a cesarean birth is unlikely to be true in view of the probability of fatality associated with the procedure in ancient times and the observation that his mother, Aurelia, corresponded with him during his campaigns in Europe many years later. The term may have as its origin in the Latin verb cadere, to cut; the children of such births were referred to as caesones. It is also possible that the term stems from the Roman law known as Lex Regis, which mandated postmortemoperative delivery so that the mother and child could be buried separately; the specific law is referred to historically as Lex Cesare.

In 1876, Eduardo Porro, an Italian professor, recommended hysterectomy combined with cesarean birth to control uterine hemorrhage and prevent systemic infection. The Porro procedure combined subtotal cesarean hysterectomy (see the section Peripartum Hysterectomy, below) with marsupialization of the cervical stump.[9] Fortunately, the need for such an extreme procedure was soon minimized by the proposal to close the uterine incision with sutures. The introduction of suture material, which enabled the surgeon to control bleeding, was of monumental importance in the evolution of the procedure. In 1882, Max Sänger from Leipzig published a monograph based largely on experience from surgeons in the United States who had used internal sutures, explaining the principles and technique of cesarean delivery, including aseptic preparation, with special emphasis on a two-step uterine closure using silver wire and silk and careful attention to hemostasis. The use of silver wire stitches were developed by 19th century gynecologist J. Marion Sims, who invented his sutures to repair vaginal tears (fistulas) that had resulted from traumatic childbirth. Sänger thought that this approach would obviate the growing tendency for cesarean hysterectomy caused by fear of hemorrhage and infection. It is interesting to note that Sänger attributed much of the early development of suture material to American frontier surgeons, including Frank Polin of Springfield, Kentucky, who in 1852 had reported the use of silver wire sutures in surviving patients who had undergone cesarean delivery.

The low transverse incision was trialed between 1880 and 1925 and was noted to reduce the risk of infection, as well as uterine rupture, in subsequent pregnancies.

Death from peritonitis remained a major threat. Approximately 30 years later, extraperitoneal cesarean delivery was first described by Frank (1907) and subsequently modified by Latzko (1909) as a technique to reduce the risk of peritonitis in high-risk patients. Subsequently, Krönig (1912) realized that extraperitoneal cesarean birth not only minimized the effects of peritonitis but also allowed access to the lower uterine segment through a vertical midline incision, which could then be covered with peritoneum, an approach that led to the modern-day low vertical procedure. Later, Beck (1919) and DeLee and Cornell (1922) modified the Krönig approach and popularized it in the United States. Finally, Kerr (1926) developed the low transverse incision, which is most commonly employed throughout the world today. The need for an extraperitoneal procedure was essentially eliminated by the development of modern antibiotics.

As the risk-versus-benefit considerations changed, obstetricians became more confident in the use of cesarean section and began to argue against delaying surgery. Surgeons such as Robert Harris of the United States, Thomas Radford of England, and Franz von Winckel of Germany recommended cesarean delivery as an early solution to labor disorders to improve outcome. In turn, maternal and perinatal mortality rates were reduced as cesarean birth became viewed as one of several approaches to improve perinatal outcome.