Fetal mortality in cesarean section

Volume

66

SELECTED

Number 6

Carbone, R,alph, and Keating, Rague

Maternity

Hosp.

William: 6: March,

ABSTRACTS

Cesacean 1953.

1355

Section

Report

for 19X1, Bull.

Margaret

In 1951, 315 cesarean sections were done at the Margaret Hague Hospital. This was an incidence of 3.6 per cent. In private patients the incidence was 3.9 per cent while in clinic patients it was 3.1 per cent. The types of operation included 192, or 61 per cent, laparotrachelotomies, 119, or 38 per cent, extraperitoneal sections, and 3, or 1 per cent, cesarean hysterectomies. No classical operations were done. There was no maternal mortality. Of 176 patients who had had previous cesarean sections, 96 had repeat sections, while 80, or 95 per cent, were delivered vaginally. The perinatal mortality was 6.2 per cent, with 7 infants stillborn and 13 who died in the neonatal period, most of the latter being premature infants. In mature infants, the total. mortality was only 1.4 per cent. The chief indication was dystocia from various causes. The second most frequent indication. was hemorrhage (44, or 14.0 per cent, of the group) due to placenta previa or abrnptio placentae. The third most frequent indication was toxemia of pregnancy (31, or 9.9 per cent, of the total sections). Miscellaneous indications included 8 cases of fetal distress, 3 of maternal diabetes, 7 of prolapsed cord. Conduction anesthesia was usually employed, spinal anesthesia alone in 163 cases and spinal with various supplements in 140. Complications included hemorrhage in 12.4 per cent, shock in 2.5 per cent, bladder injury in 4 cases. KARL M. WILSON Litchfield, Harry R., Sternberg, S. David, Halperin, Mo,rtality in Cesarean Section, J. A. M. A. 151:

Jacob,

and

Turin,

Richard:

Fetal

783,1953.

The authors report 969 cesarean sections performed at the Beth-El Hospital from to 1951, inclusive. These sections were done by various members of the attending and house staffs. There were a total of 44 fetal and neonatal deaths, giving a gross mortality of 4.5 per cent. Among the 44 infants who died, 3 were considered nonviable at the time of section, 11 were stillborn (all in the viable stage), and 25 were associated with either placenta previa or ablatio placentae. There were only 5 fetal deaths in patients who had elective sections prior to the onset of labor. In those infants on whom postmortem examinations were done pulmonary atelectasis, aspiration pneumonia, and hyaline membrane were the commonest findings. The authors feel that the reduction in the fetal mo’rtality resulting from section for placenta previa was due to more conservative care of They are transfused repeatedly until the fetus the patients presenting this complication. becomes more mature and are kept under absolute bed pest. The authors call attention to the following points in their routine of cesarean section: (1) slow release of amniotic fluid when the uterus is opened; (2) after delivery placing of the infant below the level of the mother’s abdomen, which allows blood from the placenta to run into the circulation of the infant; (3) general suction of the oral pharynx and nasal passages; (4) laryngoscopic intratra,cheal suction or oxygen insufllation when necessary; (5) aspiration of gastric contents; (6) placing of infant in a heated incubator in TrendeIenburg position at an angIe of 10 degrees; (7) transporting of infant to nursery in incubator. WILLIAM BERMAN 1945

Endocrinology sturnick,

M.

I.,

and

Gargill, S. L.: Clinical Assay J. Med. 247: 829,1952.

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Synthetic

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Val-

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evaluation The drug

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