CESAREAN SECTION

cesarean also spelled Caesarian, surgical removal of a fetus, at or before full term, from the uterus through an abdominal incision. Little is known of either the origin of the term or the history of the procedure. According to ancient sources, the procedure takes its name from a branch of the ancient Roman family of the Julii, whose cognomen Caesar (Latin caedere, to cut) originated from a birth by this means; some modern historians doubt that this is true. The first documented cesarean section on a living woman was performed in 1610; she died 25 days after the surgery. Abdominal delivery was subsequently tried in many ways and under many conditions, but it almost invariably resulted in the death of the mother from sepsis or hemorrhage. Even in the first half of the 19th century, the recorded mortality was about 75 percent, and fetal craniotomyin which the life of the child is sacrificed to save that of the motherwas usually preferred. Eventually, however, improvements in surgical techniques, antibiotics, and blood transfusion and antiseptic procedures so reduced the mortality that cesarean section came to be frequently performed as an alternative to normal childbirth. In modern obstetrical care, cesarean section usually is performed when the life of either the mother or the child would be endangered by attempting normal delivery. The medical decision is based on physical examination, special tests, and patient history. The examination includes consideration of any diseases the mother may have had in the past and disorders that may have arisen because of pregnancy. Special tests that might be performed include fetal scalp blood analysis and fetal heart-rate monitoring. Common indications for cesarean section include obstructed labour, failure of labour to progress, placenta praevia (development of the placenta in an abnormally low position near the cervix), fetal distress, diabetes, and improper positioning of the fetus for delivery. In addition, cesarean section is often used if the birth canal is too small for normal delivery. Sometimes when a woman has had a child by cesarean section, any children born after the first cesarean section are also delivered by that method; but vaginal delivery is often possible. The risks of cesarean section are low but real. The operation constitutes major surgery, and, compared to the risks of normal vaginal delivery, it is more dangerous for the mother. The risk of other complicationssuch as infection, hemorrhage, blood clots, and injury to the bladder or intestinesis also greater. If the baby is delivered by cesarean section planned in advance of labour, the infant can be premature. It has also been suggested that elective cesarean section may rob the infant of hormones and other substances released by the mother during labour. By the late 20th century, the incidence of cesarean sections in the United States had risen dramatically, largely as a result of an increase in the number of malpractice suits brought against obstetricians for failing to operate if there was the slightest indication of trouble in delivery.