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Data are presented on caesarean section rates during the first five-year period of the Bavarian Perinatal Study (BPE 1982-1986), comprising 450,000 births. In order to identify long-term trends, statistical studies from the Munich Perinatal Study (MPS) dating back to 1975 were continued in the same Munich hospitals through to 1982-1984. The results may be broken down as follows: 1. The overall rate of caesarean sections has been increasing, steadily, reaching 15% in the 1986 BPE. No clear levelling-off is evident yet. 2. The highest rates of caesarean sections and vaginal operative deliveries were found in university hospitals. Spontaneous deliveries occurred least often in university hospitals (about 70%), and most frequently in the larger country and private hospitals (77-79%). Smaller externally staffed private hospitals had about the same rate of vaginal-operative deliveries as university hospitals. 3. Following caesarean section, postoperative complications prompted a three- to sixfold higher rate of maternal transfer to other hospitals over that following spontaneous delivery. 4. As maternal age increases, so does the rate of caesarean section for primiparae. Nevertheless, recent years have witnessed a levelling-off for women over 34 years of age. No trend toward further increase is evident for this age group.(ABSTRACT TRUNCATED AT 250 WORDS)

From 1971 to 1980 20 patients at the first department of women of the university of Munich required a puerperal hysterectomy because of septicemia following caesarean section. During the same time a total of 2,726 caesarean sections were performed. 14 of the 20 women requiring hysterectomy had the caesarean section in the first department for women. Six women were referred with septicemia following caesarean section in another hospital. The causative relationship between caesarean section and septicemia was reviewed leading to the indication for hysterectomy. The indications for the caesarean section, risk factors for increased puerperal infection, the postoperative course, the indication for hysterectomy, the findings at operation the findings in the operative specimen and the course following hysterectomy were reviewed. Risk factors promoting an ascending infection postpartum were the type of labor, frequent vaginal examinations, previous attempts at vaginal delivery, and internal fetal monitoring by a scalp electrode. The recognition of incipient septicemia include severe pain in the abdomen and a subjective feeling of severe illness in the patient. The white blood count is increased, the body temperature is high and beginning respiratory insufficiency points to the severity of the illness. In these cases a repeat laparotomy with hysterectomy to eliminate the focus of infection is the treatment of choice for the septicemia. 19 of the patients who required hysterectomy for septicemia following caesarean section were discharged home after a mean hospital stay of 36 days. One of the patients died 41 days following caesarean section and 20 days following hysterectomy because of septicemia resistant to treatment.