PRIMARY CESAREAN SECTION IN THE MULTIPARA

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Abstract 1. Primary cesarean section performed in a municipal and in a voluntary hospital on 186 multiparous mothers with a pregnancy of 28 weeks or over were reviewed for the 10 year period between 1950 and 1960. 2. During this study period, 36,277 women were delivered. The cesarean section incidence was 3.3 per cent. The incidence among ward patients was 2.3 per cent, while that of the private patients was 4.4 per cent. The incidence of primary cesarean section in the multipara was 0.51 per cent or one in every 195 deliveries. 3. Hemorrhage stands out as the most frequent indication for primary cesarean section in the multigravida. 4. Fetopelvic disproportion was the second leading cause for abdominal delivery. The concept that multiparous patients rarely have fetopelvic disproportion has resulted in undue delay in performing cesarean section. A multigravida in labor, with an unengaged presenting part, should receive the same careful investigation as the primigravida. 5. The validity of our indications for primary cesarean section were critically reviewed. In 86.5 per cent of the patients, the operations were considered valid, 2.2 per cent were doubtful, and 11.3 per cent were not justified. Hemorrhage was responsible for 62 per cent of the nonvalid sections while fetal distress contributed 28.5 per cent. 6. A more conservative approach to antepartum bleeding in certain multiparous patients and the avoidance of oxytocin-induced fetal distress in others, should lower the incidence of cesarean sections in the multigravida. 7. The maternal mortality incidence was 0.53 per cent. 8. The gross perinatal mortality was 11.6 per cent. The causes of fetal deaths and the risks inherent in the indications for abdominal delivery are discussed.