History of caesarean hysterectomy

Abstract

Caesarean hysterectomy evolved as a life-saving procedure following caesarean delivery. The concept underlying caesarean hysterectomy dates back to the mid 1700s and with a description of the procedure performed on laboratory animals. Eduardo Porro of Milan performed the first planned caesarean hysterectomy in which both the infant and the mother survived. He documented his operation in a paper published in 1876. Porro advocated hysterectomy combined with caesarean section to control post partum haemorrhage and to prevent infection. The maternal death rate following the operation remained high, but was substantly below the rate prior to the introduction of the procedure. The Porro procedure contributed to more favourable outcome for both the mother and the infant, having sterility and premature menopause as its side effects. Fortunately, the need for the procedure was soon minimised following the proposal to close the uterine incision with sutures. Although elective caesarean hysterectomy is still a controversial issue, there is no doubt that emergency post partum hysterectomy in case of massive obstetric haemorrhage is potentially life-saving. Over the past decades, the availability of potent uterotonics and broad-spectrum antibiotics, the development of embolisation techniques, and new methods of vessel ligation, have markedly reduced the need for caesarean hysterectomy, which, however, remains an important procedure in modern obstetric practice.

Cezarean Hysterectomy, A lifesaving Procedure that Albanian Obstetricans Must Be Familiar With

“…14 In 1876, Eduardo Porro of Milan described the first cesarean hysterectomy in which both mother and baby survived, his patient was a primiparous dwarf, J. C., who was 25 years of age and was only 144cm in height. 15 In his procedure, the uterus was opened in situ and the child was removed alive. After removal of the placenta, an instrument called a cintrat's constrictor was passed over the neck of the uterus and the wire was sufficiently tightened to control hemorrhage and the uterus was then cut away.…”

Peritonealization in gynecology and obstetrics: Review of literature

“…Najčešći uzrok ileusa kod ženske populacije su postoperativne priraslice, koje su uglavnom posledica prethodne histerektomije ili carskog reza, kao najče-šćih ginekoloških operacija [6,7]. Period između inicijalne laparotomije i nastanka ileusa u retrospektivnoj studiji Al-Tooka i saradnika na 262 pacijentkinje iznosio je od mesec dana do 20 godina (prosečno 5,3 godine) [8].…”

“…Kao prednosti operativne tehnike koja savetuje napuštanje parijetalne i visceralne peritonizacije u toku carskog reza navode se i značajno manji utrošak šavnog materijala, manja učestalost postoperativnog febrilnog morbiditeta i neophodnosti upotrebe analgetika i antibiotika, brže uspostavljanje peristaltike, manja učestalost adhezija u predelu mokraćne bešike i kao posledica svega toga značajna materijalna ušteda [7,14].…”

Obstetric hysterectomy: a receding trend

“…The Porro procedure contributed to more favourable outcome for both the mother and the infant, having sterility and premature menopause as its side effects. 8 Since Porro time many improvements have been introduced to the management, the most recent trend is towards fertility retaining approaches.…”