George Schaefer

Changing indications for cesarean section: Analysis of fifteen years' experience at flushing hospital

Abstract Although the trend in the recent literature is toward an increase in the incidence of cesarean section, mainly due to the addition of new indications, we have found a slight decrease in our section incidence in the last 5 years. Such indications as contracted pelvis, cephalopelvic disproportion, toxemia, and intercurrent disease showed a total decrease of 18 per cent in the past 5 years. We believe that this has resulted from more careful evaluation of our indications and from compulsory consultation by 2 qualified obstetricians before section is done. A thorough discussion of the indications for each section at the weekly staff conferences has further tended to reduce sections done for tenuous indications. Operations performed for the indication previous section were increased by 17 per cent in the past 5 years. It may be that the increasing number of low cervical sections may be a factor in permitting more patients to deliver vaginally rather than performing repeat sections. Such indications as dystocia due to faulty presentation or tumors, hemorrhage, and miscellaneous indications have shown no change in their incidence of section over the past 15 years. It is our belief that the judicious use of intravenous Pitocin has resulted in vaginal deliveries in many patients who previously might have come to section. We have found it extremely useful in patients with uterine inertia and in patients with hemorrhage where conditions for vaginal delivery exist but where delivery must be brought about rapidly. We have also noted a tendency to attempt induction with Pitocin in toxemic patients in whom we previously might have thought that labor could not be induced. Even when the Pitocin induction was not successful on the first attempt it usually resulted in vaginal delivery on a subsequent attempt the following day. We have also used Pitocin in patients in whom the question of slight cephalopelvic disproportion existed and in whom we felt an adequate trial of labor was indicated. With the more forceful uterine contractions produced by Pitocin, we have been able to evaluate such a patient within one to two hours as to the possibility of vaginal delivery. We have noted no untoward effects from this procedure and have frequently saved the patient from an unnecessary section.

A re-evaluation of the management of pregnancy and tuberculosis.

EARLY in 1956 it was estimated that 2,000,000 persons in the United States were ill or had previously been ill with tuberculosis. Of these 250,000 wcrc active cases, 550,000 inactive cascs, and 1,200,000 had previously had the disease (Natioiial Tuberculosis Association, 1957). Of the approximately 4,000,000 births a year in the United States, at least 40,000 occur in women with tuberculosis, and, despite recent advances with antimicrobial agcnts and rescctional surgery, tuberculosis complicating pregnancy is still a formidable problem. Many new concepts in the care of the pregnant woman have been developed in recent years, and because of these changes both in phthisiology and in obstetrics, it is dcsirable to reassess the management of pregnancy in the tuberculous woman.