Cesarean sections at St. Louis Maternity Hospital from 1948 through 1952

Abstract

The cesarean section rate at this hospital from 1948 to 1952 was 2.3 per cent. This is identical with the cesarean section rate from 1932 to 1937. There have been marked changes in indications for cesarean section. Medical indications, postmaturity, and toxemia of pregnancy have occurred less frequently as indications and cephalopelvic disproportion, previous cesarean section, premature separation of the placenta, and placenta previa have increased in frequency. Comparison of currently accepted indications for cesarean section at this hospital with indications prevalent in other hospitals with cesarean section rates of 6 to 10 per cent reveals that the latter institutions have a greatly increased incidence of previous cesarean section and elderly nullipara as reasons for cesarean section. Cephalopelvic disproportion as a primary indication for cesarean section occurs more frequently in the current St. Louis Maternity Hospital statistics than in statistics reported in the previously mentioned papers.Despite the relatively low cesarean section rate at this hospital, the maternal mortality rate was 2.4 per 10,000 vaginal deliveries and none in the cesarean section deliveries. The maternal mortality in the 1932–1937 series at this hospital was 30 deaths per 10,000 vaginal deliveries. The cesarean section maternal mortality was 57 deaths per 10,000 cesarean sections. The perinatal fetal mortality has decreased from 4.6 per cent in the 1932–1937 series to 3.6 per cent in the current series. The perinatal mortality following cesarean section in the 1948–1952 series was 9.6 per cent as compared to the 5.8 per cent reported in the 1932–1937 series. This is the result of the change in indications for cesarean section in the current series, with many infants dead or compromised prior to the cesarean section.Despite the use of various operative techniques and prophylactic antibiotics the maternal morbidity in cesarean section patients is about five times that in deliveries of all types. There was no demonstrable decrease in maternal morbidity when the low transverse cervical cesarean section was used as compared to the morbidity following the use of the classical cesarean section. Maternal morbidity in cesarean sections preceded by labor was about twice that of cesarean sections not preceded by labor.The neonatal fetal mortality in elective cesarean section because of previous cesarean section was 2.9 per cent as compared to the neonatal mortality in deliveries of all types of 1.5 per cent. Analysis of the fetal deaths that occurred in all types of deliveries indicates that cesarean section was indicated but not done in 2 per cent of the cases of fetal death. If cesarean section had been accomplished in these instances the cesarean section rate would have been increased from 2.3 to 2.4 per cent.