Cesarean section in the Philippine General Hospital

ABSTRACT

An analysis of the cesarean sections and hysterectomies in the obstetrical department of the Philippine General Hospital during the two years following liberation is presented.The incidence of cesarean section among 3,749 viable births is 123 cases or 3.28 per cent.The complication that caused the greatest number of cesarean sections is placenta previa. None of the mothers died; but, out of 48 infants, 18 or 37.5 per cent either were stillborn (9) or died after birth. Sixteen infants or 88.88 per cent were premature.Dystocia, because of disproportion or malpresentation, was the next outstanding indication for cesarean section. There was no maternal mortality; but 3 out of 36 infants died, and 2 were stillborn. Two of the infant deaths were caused by hydrocephalus which were not diagnosed before the operation. One infant died of bronchopneumonia. Of the two stillbirths, one was a case of anencephalus with a large body, and the other was a severed after-coming head which could not be extracted below. The corrected fetal mortality of this complication is 1 death or 2.76 per cent.Cesarean section was performed in 7 cases of severe preeclampsia that failed to improve with conservative treatment, and in 91 cases of severe eclampsia where the fetus was alive and the cervix was either closed or dilated 1-2 cm. The maternal mortality of preeclampsia was 14.28 per cent, and that of eclampsia 22.22 per cent. We agree with those who believe that the best treatment for eclampsia, next to prevention, is the conservative treatment.Traumatic rupture of the uterus was caused by neglected transverse presentation in 41.5 per cent, and by pituitrin and salag or by pituitrin alone in 33.33 per cent. The high incidence of these causes calls for greater attention to, and proper management of, malpresentations and fetopelvic disproportion; and for more efficient instruction to those dealing in midwifery on the danger, limitation, and contraindications of pituitrin and salag.Rupture of the uterus through the cesarean section scar has been found in 4 cases (2.5 per cent), all of which were of the classical type. Because of the fibrotic condition of the scar and its lessened blood supply, the morbidity of such a type of rupture is relatively lower than when the rupture occurs in a noncesareanized uterus. Though all the babies were stillborn, all the mothers recovered; whereas from the traumatic rupture the maternal mortality was 41.66 per cent.The relative morbidity of the mothers exposed to infection operated on by extraperitoneal cesarean section and those operated on by laparotrachelotomy in conjunction with penicillin and the sulfa drugs is discussed.From 15 to 30 years dystocia was the most frequent indication for cesarean section, its incidence being 30%. But, after 31 years, placenta previa was the most frequent complication, its incidence being 46.87 per cent.Beginning from Para II to Para V, placenta previa was the highest indication for cesarean section, its incidence being 36.8 per cent. But from Para VI onwards, the incidence of placenta previa as indication for cesarean section is as high as 66.66 per cent. (Summary and Conclusion)