Guillimeau was the first to use the term cesarean section CS in , but this name became universal only in the 20th century. The many theories of the origin of this name will be discussed. This surgery has been reported to be performed in all cultures dating to ancient times. Many heroes are reported to have been delivered this way. Old Jewish sacred books have made references to abdominal delivery. It was especially encouraged and often mandated in Catholicism.

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Guillimeau was the first to use the term cesarean section CS in , but this name became universal only in the 20th century. The many theories of the origin of this name will be discussed. This surgery has been reported to be performed in all cultures dating to ancient times. Many heroes are reported to have been delivered this way.

Old Jewish sacred books have made references to abdominal delivery. It was especially encouraged and often mandated in Catholicism. There is evidence that the operation was done in Muslim countries in the middle ages. Islamic rulings support the performance of PMCS. Now that most maternal deaths occur in the hospital, perimortem CS PRMCS is recommended for the delivery of a fetus after 24 weeks from a pregnant woman with cardiac arrest. It is believed that emergent delivery within four minutes of initiation of cardiopulmonary resuscitation CPR improves the chances of success of maternal resuscitation and survival and increases the chance of delivering a neurologically intact neonate.

The ethical aspects of these operations are also discussed including a discussion about PMCS for the delivery of women who have been declared brain dead. Cesarean section is a surgical operation of particular interest medically and historically. The operation is unique in that it concerns two lives simultaneously and brings forth a new life. The origin of the name cesarean section is still uncertain. The notion that the name was derived from the fact that Julius Caesar was delivered by this means is almost certainly erroneous, as his mother, Aurelia, was still alive when the emperor undertook the invasion of Britain.

She actually buried him when he was 55 years old. It forbade burial of a pregnant woman until the child had been removed from her abdomen, even when there was but little chance of its survival, so that the child and mother could be buried separately. When ancient Rome became the Roman Empire, the Lex Regia turned into Lex Caesarea under the rule of the emperors, and the theory goes that the operation became called cesarean operation. While the antiquity of the operation is definitely established, it is impossible, or at least very difficult, to ascertain when it was first performed and whether the women on whom it was performed in old times were dead or alive at the time of the operation.

According to Greek mythology and poetry, both Aesculapius, the god of physic, and Bacchus, the god of wine, were delivered by this operation. The first was delivered by his father Apollo. The Persian hero Rustum, son of King Sol, was also reported to have been delivered this way. Gods and heroes tend to avoid the dark confines of the natural channels of birth. Indra, the Indian supreme Vedic god, refused to be born by the old, well-proven way.

Also, Buddha Gautama is reported to have emerged pure and immaculate from the right side of his mother, Maya. Abdominal delivery probably on dead women was also performed in other cultures as described in Thompson index of mythology and folklore.

Mythology aside, cesarean section during earlier times was performed not on living subjects, but only on the dead if there was hope of rescuing a term child, especially if it is felt that this child may be of value to the community, an heir to the throne for example!

According to Boley, the oldest authentic record of a living child born by means of this operation is Gorgias, a celebrated orator of Sicily in BCE. Gallen, and Gebhard, Bishop of Constance, were born this way in and , respectively. Her obstetrician told the king that either craniotomy or abdominal delivery is required to terminate the protracted labor. A lot of controversy exists about the validity of these reports.

There are also reports of women in labor performing cesarean operations on themselves and of husbands performing the operation on their wives. Jacob Nufer, a Swiss pork butcher, is said to have performed the operation in on his wife with a razor while she was lying on the kitchen table. It is said that is the first record of maternal survival following cesarean section. The authenticity of this tale is doubted.

The first documented such case occurred in Zaandam, Holland, in The child survived, but the mother died 36 hours later. Notwithstanding all these reports, there is no agreement among historians on when and where the first cesarean section was performed on a live woman for the purpose of delivering a live child.

The Roman Catholic church encouraged the use of abdominal deliveries for pregnant women who died to offer the souls of unborn children the chance of salvation through baptism. At the same time, the church banned the use of abortion, craniotomy, and fetal dismemberment as techniques to deliver the child in order to save the mother.

The Senate of the Republic of Venice in laid down severe penalties for any doctor who failed to make an attempt to save the child in this way. He integrated surgical debates with theological discussions about the nature of the soul and original sin.

He argued that original sin will condemn the fetus to an afterlife in hell if left unbaptized. He proposed that all Andean priests should be trained in the art of cesarean section. Furthermore, in the absence of a qualified expert, they should be obliged to perform it on women in their parishes who died during childbirth.

The obsession with baptism of infants was especially seen in France. Peu, in his Practique des Accouchements , described in great detail how baptism was to be accomplished in operative deliveries. If baptism was of such paramount importance, should the imminent death of the mother be hastened to save her otherwise doomed child? Saint Thomas Aquinas — clearly stated that the mother should not be killed in order to baptize the child.

There is no direct evidence that postmortem abdominal deliveries were done in the Middle Ages in Islamic countries.

This book was the leading textbook of surgery in Europe for about years. However, it is historically clear that the operation was performed during the Islamic era. To derive a ruling on any matter, Muslims have to rely on the primary sources of Islamic jurisprudence, i. The only possible reason for objection to the procedure is that it entails desecration of a dead body. To open the belly of a woman who just died with the aim and intention of delivering a live baby who may survive appears to be quite acceptable.

Intention in Islam is the basis of acceptance or rejection by God of any action. In old fiqh Islamic jurisprudence books are rulings that apply both indirectly and directly to this subject. Opening the grave and violating the sanctity of the dead are prohibited sins.

That is because correcting these problems are more beneficial than the harm of violating the sanctity of the grave. In another fiqh book, it is stated that if a pregnant woman dies and her baby is alive, it is permissible to open her belly from the left side and deliver the baby. Moreover, if the opposite condition occurs, i. Unfortunately, the same erroneous information has been restated in a more recent article quoting that source without any effort to investigate its accuracy.

First, save the mother, even if the child has to be sacrificed, only once hope has been abandoned for the mother should an attempt be made to save the child by postmortem cesarean section.

PMCS is meant to deliver a live baby. However, its results until recently were very poor. Only three infants survived. However, these authors cautioned that because of probable underreporting of unsuccessful cases, the true percentage of survivors is impossible to ascertain.

In their review of cases from to there were 61 cases with neonatal survival and known time interval. Seventy percent of the survivors were born within five minutes. Follow-up of the infant at 18 months of age demonstrated no evidence of neurologic damage. The occasion to perform PMCS is now very rare as the great majority of maternal deaths occur in the hospital. The pregnant woman is being treated for a serious medical or obstetric complication or brought to the hospital while still alive but in extremis because of a grave medical emergency or a major trauma, usually a car accident or gunshot wounds.

The proximate cause of death in these circumstances is usually cardiac arrest. CPR is less successful in late pregnancy because of compression of the inferior vena cava by the gravid uterus, the difficulty in chest compression, etc.

Once the fetus is delivered, autotransfusion of the blood in the uterus and the relief of the pressure on the pelvic veins and the inferior vena cava will increase the venous return and hence the cardiac output. Also chest compression will be easier to perform, and the pulmonary functional residual capacity will be increased, improving oxygenation.

All these factors tend to increase the success of CPR and maternal survival. It is believed that neonatal survival is best if CPR is initiated within four minutes of cardiac arrest and the delivery accomplished within five minutes. There were 35 women, 20 of whom had potentially resuscitable causes. Of these, 13 survived.

In 22 cases, information was provided regarding the effects of PRMCS on the maternal hemodynamic status. Twelve women had sudden and often profound improvement once the uterus was emptied. In eight women there was no significant change.

In no case was there deterioration of the maternal condition with the cesarean delivery. These operations resulted in 34 surviving infants including three sets of twins and one set of triplets.

Theoretically one can be criminally sued for performing PMCS. An operation performed to save an infant cannot be wrongful as there is no criminal intent. Also operating without consent may be construed as battery.

The unanimous consensus of the literature and of legal authorities is that a civil suit against a physician for performing a PMCS or PRMCS, regardless of the outcome, would not result in judgment against the physician.

The physician may feel hesitant to perform a PMCS, especially if some time has passed since death. The physician may be reluctant to perform PRMCS if there has been a relatively long interval since cardiac arrest before initiation of CPR as there is a possibility of leaving the husband with a neurologically damaged baby in addition to his dead wife.

This should not be the case. A review of the outcome of PMCS as reported in Confidential Enquiries over the past 25 years showed that there were no reported cases where survival beyond the early neonatal period was accompanied by neurological disability. This judgment should not be based only on the gestational age and the time interval involved but also on the maternal health status before death. The prognosis of the newborn will be better in case cardiac arrest or death was due to an acute cause, for example a car accident, than if it was due to chronic maternal disease like chronic hypertension, diabetes, lupus, etc.

In the latter cases, the fetal status probably already had been compromised by being subjected to poor intrauterine environment, hypoxemia, medications, etc. The hesitancy to perform these procedures can be overcome partly by special training or education. In their study of the rate of performance of PRMCS over a year period from to , they reported a significant increase from 0. Of these, two mothers and five neonates survived.


Postmortem and Perimortem Cesarean Section: Historical, Religious and Ethical Considerations

Perimortem cesarean delivery. Obstet Gynecol ; After hours office. Cesarean delivery: a reconsideration of the terminology. Obstet Gynecol ; 86 1 : Perimortem cesarean delivery: were our assumptions correct?.


2006, Número 4


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