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Outline. HistoryA public health perspectiveIndicationsIndividualizationConclusions. Cesarean delivery : History. A cross-cultural phenomenonJulius CesarLex CaesareaCaedere secoUsually a postmortem procedure. Cesarean delivery : History. Jacob Nufer (1500) first reported survivorBennet (1794
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1. VBAC: Friend or Foe Raphi Pollack, MDCM, FRCSC.,
Bikur Cholim Hospital,
Jerusalem, Israel.
2. Outline History
A public health perspective
Indications
Individualization
Conclusions
3. Cesarean delivery : History A cross-cultural phenomenon
Julius Cesar
Lex Caesarea
Caedere seco
Usually a postmortem procedure
4. Cesarean delivery : History Jacob Nufer (1500) first reported survivor
Bennet (1794) USA
Radford (1880) 131 Cesareans with mortality of 83%
5. Cesarean Delivery: Development Historically a post-mortem procedure.
Breakthroughs:
Anesthesia
Aseptic technique (Lister 1870)
Sutures (Sanger 1880)
Low transverse incision (Kerr 1926)
6. Low transverse incision Kerr 1926
Replaced the Classical incision
Decreased maternal mortality
Decreased hemorrhage
Decrease peritonitis
7. Conservatism in Obstetrics No matter how carefully the uterine incision is sutured, we can never be certain that the cicatrized uterine wall will stand a subsequent pregnancy and labor without rupture. This means that the usual rule is once a cesarean, always a cesarean
Edwin Craigin, 1916
8. CRAIGIN WAS RIGHT !! He was referring ONLY to classical cesarean scars
9. Mode of delivery vs. Risks LTCS
Mortality
Hemorrhage
Oper. Trauma
Infection
VTE
Accreta/ rupture
Bonding SVD
VTE
Pelvic floor injuries
Episiotomy complications
Sphincter injuries
10. Placenta Previa & Placenta accreta
11. Cesarean Delivery: The Epidemic
12. Cesarean Rates : Brazil