Uterus: A Colour Atlas of Caesarean Section (Volume 14) Narendra Malhotra, Arun Nagrath, Shikha Seth
Chapter Notes

Save Clear

IntroductionChapter 1

Caesarean section, a life-saving operation for both fetus and mother, accounts for approximately 15–20% of all deliveries. The purpose of the operation is to deliver the fetus through the abdomen in instances, where vaginal delivery would be either impossible or dangerous to the life or health of the mother and/or fetus.
It is not known exactly when and where the operation of caesarean section was first performed. Ancient Roman law describes the practice of postmortem caesarean section known as “Lex Regia” in which, it was forbidden to bury the pregnant woman before her baby had been cut out.
The term caesarean section was first used by James Guillimeau in his book of Midwifery in 1598. In the initial days, the mortality was very high, up to as much as 50% because the uterine wound was left open. Porro in 1876 introduced caesarean hysterectomy to decrease the mortality from haemorrhage, peritonitis and septicaemia. No wonder that at that time symphysiotomy and craniotomy were preferred alternatives to the caesarean section.
The revolution came with Sanger in 1882 who described the uterine suturing in two layers, which reduced the mortality significantly.
Changing Trends
Classical Caesarean Section
Originally caesarean was done by the vertical upper segment incision in the uterus.
Extraperitoneal Caesarean Section
Later in 1907, Frank, introduced an improved method especially for the infected cases by opening the uterus extraperitoneally, to prevent the spread of infection from the uterine wound into the peritoneal cavity. Technical difficulties, high chances of bladder injury and serious infection of the pelvic cellular tissue made this approach out.
Transperitoneal Lower Segment Caesarean Section
Kronig in 1912 described that the chief merit of Frank's operation was not so much in extraperitoneal approach as in the low position of the incision in the uterus. He described the technique of transperitoneal caesarean, which is the preferred approach till date. Initially lower segment vertical incision was used which was later modified to transverse incision in view of better outcomes.