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• W1544955382 abstract "In reviewing these articles I have endeavored to present all relevant material and the numbers and percentages without distortion. Articles were taken consecutively, over a fixed period of time, in a fixed reliable publication, and without consideration as to the belief of the authors. This, I believe, is the best approach if we are to solve such questions. The final results of this study are, more or less, two opposing rates of mortality. The results indicate that “once a section, always a section” does not give the superior results which its advocates believe, for they have not compared their results with present-day mortality rates in trial vaginal delivery, nor do they take into account a corrective factor which has been mentioned. Another point worthy of note is that the mortality rates for cesarean section used here are from cases since 1940, since the advent of penicillin and other antibiotics. The abrupt drop in mortality as we move into the decade 1940 to 1950 has been demonstrated in the statistics concerning cesarean section. At least one-half the ruptures in this series occurred in the decade 1930 to 1940, so there is every justification to believe that when series involving the truly modern medical era become available, the results will be still further in favor of trial vaginal delivery. The role of infection in the production of inferior scars is well known, and the widespread use of antibiotics should further decrease the incidence of rupture. Also the ever increasing use of the low cervical cesarean section over the classical cesarean section will steadily improve the outlook for vaginal delivery in acceptable cases. It is felt that the statistics from low cervical scars speak for themselves, and lend less room for debate. In the classical scars we note a situation in which one concept offers less risk to the mother, while the opposite concept favors the infant. It becomes a matter of which we desire to protect to the greatest degree. Most of us will choose the mother as our primary interest, thereby indicating, we believe, trial vaginal delivery as the choice. The question as to proper management will no doubt be studied for some years before the final answer is determined. The factor most accountable for such a delayed decision is the small incidence of ruptures and consequent delay in the collection of a large series of cases. We continue to practice trial vaginal delivery, and this review of literature indicates it to be the management of choice." @default.
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• W1544955382 date "1953-05-01" @default.
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• W1544955382 title "A study of the management of pregnancies subsequent to cesarean section" @default.
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• W1544955382 doi "https://doi.org/10.1016/0002-9378(53)90617-6" @default.
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