An analysis of 874 cervical cesarean sections performed at the Chicago lying-in hospital

Abstract In this paper information is given concerning 1059 cesarean sections of all types which were performed at the Chicago Lying-In Hospital from July 1, 1915, to July 1, 1929. Since there were 51,323 deliveries at this hospital and its dispensary services, the incidence of abdominal delivery for the last fourteen years was 2.06 per cent, or one cesarean section for every 48.5 cases. The maternal mortality for the 874 cervical operations was 1.26 per cent. If the 21 Porro operations which were performed after a laparotrachelotomy are added, the death rate is 1.23 per cent. For the 147 classic cesarean sections, the mortality was 4.76 per cent and this is reduced to 4.27 per cent if the 17 Porro operations, which were done after a classic cesarean section, are added. All of the figures quoted in this paper are gross figures. None of the statistics was “corrected.” The following information is based only upon the 874 cervical operations. The chief indications for the laparotrachelotomies were cephalopelvic disproportion 42.1 per cent, previous cesarean section with test of labor 11.3 per cent, previous cesarean section without test of labor 6.5 per cent, toxemia without convulsions 9.7 per cent, eclampsia 1.8 per cent, placenta previa 4.8 per cent, abruptio placentae 3.2 per cent, dystocia dystrophia syndrome 4.9 per cent, a number of previous still-births 4.2 per cent, and cardiac disease 3.3 per cent. Only 50 per cent of the patients were in labor at the time of operation, and of these 38.1 per cent had labor pains between 1 and 25 hours, 9.3 per cent had pains between 25 and 50 hours, and 2.6 per cent had been in labor from two to four days. In 21.4 per cent of the cases, the membranes were ruptured when the cesarean section was performed, and the interval between the rupture of the membranes and the time of operation varied from one hour to eight days. Ether was the anesthetic employed in 35.8 per cent of the cases, novocaine alone in 55.1 per cent, novocaine with ether or gas in 6.1 per cent, ethylene in 2.6 per cent and nitrous oxide in 0.4 per cent. During the past year 92 per cent of all the cesarean sections were performed under local anesthesia. Sterilization by means of operations on the fallopian tubes was performed in 9.6 per cent of all the cases. If the Porro operations are included, the incidence of sterilization was 11.7 per cent. The cause of death in the 11 fatal cases was as follows: peritonitis 3, pneumonia (after ether) 2, sepsis 1, gangrenous appendicitis 1, pulmonary embolism 1, antepartum eclampsia 1, postpartum eclampsia 1, and tuberculous meningitis 1. The maternal mortality according to the indications was as follows: cephalopelvic disproportion 0.8 per cent, repeated laparotrachelotomy 1.6 per cent, toxemia without convulsions 1.2 per cent, eclampsia 6.3 per cent, placenta previa no deaths, abruptio placentae 7.1 per cent, cardiac disease 3.4 per cent, and tuberculous meningitis 100 per cent. Fever after operation was present in 43.4 per cent of the cases. The main causes of pyrexia in the 196 cases where the etiology was known, were infected wounds 6.1 per cent, pyelitis and cystitis 4.8 per cent, bronchitis 2.1 per cent, pneumonia 1.3 per cent, grip 1.0 per cent, endometritis 0.9 per cent and lochiometra 0.9 per cent. In 46.7 per cent of the cases the patients left the hospital within fourteen days after operation and in 84.6 per cent they went home within eighteen days. The fetal mortality according to the indications for the operation was as follows: cephalopelvic disproportion 3.3 per cent, repeated laparotrachelotomy no deaths, toxemia without convulsions 7.5 per cent, eclampsia no deaths, placenta previa 23.8 per cent, abruptio placentae 35.7 per cent, and psychosis 100 per cent. The chief causes of death among the 40 infants were as follows: dead before operation 22.5 per cent, prematurity 25 per cent, atelectasis 20 per cent, monsters 10 per cent, and congenital heart disease 5 per cent. Among the 21 patients who had Porro operations there were no maternal deaths and two fetal deaths (9.5 per cent).