CAESARIAN SECTION THAT MUST BE ELECTIVE

J D BLOOM
1909 Southern medical journal (Birmingham, Ala. Print)  
Provisioned upon the fact, potent in point to much that must make us assumedly confi¬ dent, and that implies unmistakable hope in the effort of doing, is Caesarian section to be un¬ derstood and appreciated. In its performance, either first before labor has begun or at its beginning, offers practically the only chance of life and health to both and a viable child that the conservative operative procedures have never recorded. Truthfully, there is no risk to the child's life, and in any
more » ... and in any condition of contracted pelvis, be the child's condition as it may, an aseptic uteropomy happily adds to the security and health of both. This is a chief argument and essential to its recom¬ mendation sustained, as it is, by every ob¬ server of note. In primaparae with contracted pelvis this procedure should replace the "obstetric oper¬ ations," and is with a showing in a statis¬ tical way that leaves no doubt as to its hu¬ manity and satisfactory benefit. Whilst the condition of placenta praevia of central im¬ plantation with viable child or in eclampsia occurring in first pregnancy near term with a roomv pelvis, an advised intelligence should outline our efforts, as no definite rule can be given in guidance. Even with modern asepticism the limit of operative work should be measured by trauma. Verily, resistance limits and encourages our efforts and the minimiz¬ ing of life's expenditure secures the goal of success. The "obstetric operations," particu¬ larly in the last named conditions, must be worthily considered if healthy results are to be made responsive and some life is to exist as a result. In the doing of or indications for, from a mere standpoint of pelvic measurement, it must be remembered that this is only one-half of the problem, as in the instance of a conju¬ gate of but two inches, the warrant for oper¬ ation would be absolute, but between two and one-half and three it would be difficult to clas¬ sify the indications. Learning the relative proportions existing between foetal and pelvic calibre is the method alone of determining the dimension indications for the operation. Symphsiotomy at best has a limited possibil¬ ity, and it is said that a separation of at most, of the pubic bones, not more than two and three-fourths inches is permissable. Beyond this a separation involves risk to the bladder, vaginal walls and sacre-iliac joints as to make the procedure extremely dangerous. In truth, it is cjuestionablewhether symphsiotomy should ever be performed, in that the disaster, if it occurs, is unseen and unremediable amidst lym¬ phatics and vessels, the parent trunk of which does not present. The provisions of symph¬ siotomy have no place here; enough it is that we know the effects that have resulted from this procedure. We know it as an inhuman doing in that the procedure gets beyond the operator's control. By whatever verbiage man may express methods, the one word "Asepais" expresses the success in the well-timed and purposed Caesarian Section Succinctly. It allows of perfect aseptis, minimum trauma and the life of both. The Sanger, Bar and Fritsch uterine incis¬ ion, in addition to bringing the uterus out of the abdominal cavity previous to the incision, the anterior or Robb method of deal¬ ing with the omentum are practically the es¬ sentials to the perfect detail and low mortality rate. The deaths that have been reported were of operative sepsis and did not exceed five per
doi:10.1097/00007611-190905000-00009 fatcat:cpsfulhzezbr5gdydmo5uujaem