CESAREAN SECTION. - This is the extraction of the fetus and its appendages through the uterine wall. The name seems to derive from the description that Pliny the Elder, in his Natural History, gave of the birth of Scipio Africanus: "a casu matris utero."
Certainly an extremely ancient practice, it was performed, until almost our own day, either on a dying woman as a last attempt to save the fetus, or in the decision to sacrifice the mother's life for the sake of the faith. This was because, given the primitive technique (the uterus was generally left unsutured in the abdominal cavity, thus provoking hemorrhage and infection) and the lack or insufficiency of asepsis and antisepsis, it was an operation of very great risk for the woman. Only in 1876 did Edoardo Porro succeed in greatly improving the maternal prognosis of the c. s.; this was due both to the establishment of antisepsis in surgery and, above all, to his surgical technique: after extracting the fetus from the uterus, which had been exposed by an incision in the abdominal wall, he amputated the uterus itself and the ovaries, thus greatly reducing the danger of hemorrhage and infection. But while maternal mortality thus fell to 15-20%, it remained an operation too mutilating for the woman. Only six years later, Kehrer and Sänger performed the "conservative" c. s., by which the woman, with the sutured uterus, retained the possibility of further pregnancies. Since then, successive refinements of this fundamental operation of modern obstetrics have reduced maternal and fetal mortality to negligible percentages, and the scar from the uterine incision scarcely prejudices subsequent pregnancies; indeed, today the obstetrician can perform repeated c. s. on patients who have already undergone the operation. Cases of women who have undergone the operation three or four times are now common.
The absolute indications for c. s. are all those clinical conditions in which delivery cannot occur through the natural passages. For example, a marked pelvic deformity, i.e., a constriction of the maternal pelvis in one or more of its diameters, to such a degree as to prevent the passage of the fetus through the pelvis itself; tumors that occlude the lower part of the maternal pelvis, etc. But the minimal mortality, and above all the fact that c. s. does not prejudice further pregnancies, have greatly extended the range of indications for the operation, and today it is performed even for clinical conditions in which, until a few years ago, recourse was had to other interventions that put the life of the mother and fetus at greater risk or prejudiced subsequent deliveries, or even placed the obstetrician in the dilemma of sacrificing the fetus in an attempt to save the mother, e.g., with embryotomy operations. It is therefore performed in cases of central placenta previa, sclerosis of the uterine cervix, fetal macrosomia, shoulder presentation, and pelvic deformities of an even more excessive degree, etc.
The destructive c. s. is performed today only in rare, special circumstances; in these cases, the primary exigency of saving both maternal and fetal lives takes precedence over the concern to preserve the woman's uterine function. Post-mortem c. s., i.e., after maternal death, is performed today only in the rarest cases in which it is permitted: indeed, the fetus may survive the mother by a few minutes; the abdomen and uterus are then rapidly opened, and an attempt is made to extract the still-living fetus, after which the woman's abdomen is sutured with a few stitches. Success is rare and generally occurs when the mother dies not from prolonged illnesses that would also harm the child, but from sudden, accidental death.