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Caesareansection
FromWikipedia,thefreeencyclopedia

ACaesareansection(oftenCsection,alsootherspellings)isa
surgicalprocedureinwhichoneormoreincisionsaremadethrougha
mother'sabdomen(laparotomy)anduterus(hysterotomy)todeliver
oneormorebabies.ThefirstmodernCaesareansectionwasperformed
byGermangynecologistFerdinandAdolfKehrerin1881.

Caesareansection
Intervention

ACaesareansectionisoftenperformedwhenavaginaldeliverywould
putthebaby'sormother'slifeorhealthatrisk.Somearealso
performeduponrequestwithoutamedicalreasontodoso,whichisa
practicehealthauthoritieswouldliketoreduce.[1][2][3]
Csectionsresultinasmalloverallincreaseinbadoutcomesinlow
riskpregnancies.[4]ThebadoutcomesthatoccurwithCsectiondiffer
fromthosethatoccurwithvaginaldelivery.Establishedguidelines
recommendthatcaesareansectionsnotbeusedbefore39weeks
withoutamedicalindicationtoperformthesurgery.[5]
Inmanycountries,caesareansectionproceduresareusedmore
frequentlythanisnecessary,andconsequentlygovernmentsandhealth
organizationspromoteprogramstoreducetheuseofcaesareansection
infavorofusingvaginaldelivery.Thecountrieswhichreportoveruse
ofthisprocedurearenotfindingwaystodecreaseuseoftheprocedure
asmuchastheywouldlike.

AteamofobstetriciansperformingaCaesareansectioninamodern
hospital.
ICD10
PCS

10D00Z0

ICD9CM

74(http://icd9cm.chrisendres.com/index.php?
srchtype=procs&srchtext=74&Submit=Search&action=search)

1.1Medicaluses

MeSH

D002585

1.2Prevention

MedlinePlus 002911

Contents
1Uses

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2Risks
2.1Riskstothemother
2.2Riskstothechild
3Classification
3.1Byurgency
3.2Bycharacteristicsofthemother
3.3Otherways,includingbysurgerytechnique
4Technique
4.1Anaesthesia
4.2Preventionofcomplications
5Recoveryperiod
6Usage
6.1Increasinguse
7History
8Societyandculture
8.1Etymology
8.2Orthography
9Specialpopulations
10References

Uses
Caesareansectionisrecommendedwhenvaginaldeliverymightposearisktothemotherorbaby.Csectionsarealsocarriedoutforpersonal
preferencebutthisisnotrecommended.Plannedcaesareansectionsalsoknownaselectivecaesareansectionsshouldnotbescheduledbefore
39weeksgestationalageunlessthereisamedicalreasontodoso.

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Somemedicalindicationsarebelow.Notallofthelistedconditionsrepresentamandatoryindication,andinmanycasestheobstetricianmust
usediscretiontodecidewhetheraCaesareanisnecessary.
Complicationsoflaborandfactorsimpedingvaginaldelivery,suchas:
abnormalpresentation(breechortransversepositions)
prolongedlabourorafailuretoprogress(dystocia)
fetaldistress
cordprolapse
uterineruptureoranelevatedriskthereof
increasedbloodpressure(hypertension)inthemotherorbabyafteramnioticrupture
increasedheartrate(tachycardia)inthemotherorbabyafteramnioticrupture
placentalproblems(placentapraevia,placentalabruptionorplacentaaccreta)
failedlabourinduction
failedinstrumentaldelivery(byforcepsorventouse(Sometimesatrialofforceps/ventouse
deliveryisattempted,andifunsuccessful,itwillbeswitchedtoaCaesareansection.)
largebabyweighing>4000g(macrosomia)
umbilicalcordabnormalities(vasaprevia,multilobateincludingbilobateandsuccenturiatelobed
placentas,velamentousinsertion)
Othercomplicationsofpregnancy,preexistingconditionsandconcomitantdisease,suchas:

A7weekoldCaesareansectionscar
andlineanigravisibleona31year
oldmother.

preeclampsia[6]
previous(highrisk)fetus
HIVinfectionofthemother
Sexuallytransmitteddiseases,suchasgenitalherpes(whichcanbefataltothebabyifthebabyisbornvaginally)
previousclassical(longitudinal)Caesareansection
previousuterinerupture
priorproblemswiththehealingoftheperineum(frompreviouschildbirthorCrohn'sdisease)
Bicornuateuterus
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Rarecasesofposthumousbirthafterthedeathofthemother
Other
Lackofobstetricskillobstetriciansnotbeingskilledinperformingbreechbirths,multiplebirths,etc.(Inmostsituationswomencan
birthvaginallyunderthesecircumstances,althoughplannedCsectionhasalowerriskofinfantdeathforbreechbirthsthanvaginal
delivery.[7]Obstetriciansarenotalwaystrainedinproperproceduresforsuchdeliveries,increasingtheriskstillfurther.)[8]
ImproperUseofTechnology(ElectricFetalMonitoring[EFM])[8][9]

Prevention
ItisgenerallyagreedthattheprevalenceofCsectionishigherthanneededinmanycountriesandphysiciansareencouragedtoactivelylower
therate.Someoftheseeffortsinclude:emphasizingthatalonglatentphaseoflaborisnotabnormalandthusnotajustificationforCsection
changingthestartofactivelaborfromacervicaldilationof4cmtoadilationof6cmandallowingatleast2hoursofpushingforwomen
whohavepreviouslygivenbirthand3hoursofpushingforwomenwhohavenotpreviouslygivenbirthbeforelaborarrestisconsidered.[4]
Physicalexerciseduringpregnancyalsodecreasestherisk.[10]

Risks
Adverseoutcomesinlowriskpregnanciesoccurin8.6%ofvaginaldeliveriesand9.2%ofCsectiondeliveries.[4]

Riskstothemother
InthosewhoarelowrisktheriskofdeathforCaesariansectionsis13per100,000andforvaginalbirth3.5per100,000inthedeveloped
world.[4]TheUKNationalHealthServicegivestheriskofdeathforthemotherasthreetimesthatofavaginalbirth.[11]
InCanadathedifferenceinbadoutcomeinthemother(e.g.cardiacarrest,woundhematoma,orhysterectomy)was1.8additionalcasesper
100orthreetimestherisk.[12]
Aswithalltypesofabdominalsurgeries,aCaesareansectionisassociatedwithrisksofpostoperativeadhesions,incisionalhernias(which
mayrequiresurgicalcorrection)andwoundinfections.[13]IfaCaesareanisperformedunderemergencysituations,theriskofthesurgerymay
beincreasedduetoanumberoffactors.Thepatient'sstomachmaynotbeempty,increasingtheanaesthesiarisk.[14]Otherrisksincludesevere
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bloodloss(whichmayrequireabloodtransfusion)andpostduralpuncturespinalheadaches.[13]
WomenwhohadCaesareansectionsweremorelikelytohaveproblemswithlaterpregnancies,anditisrecommendedthatwomenwhowant
largerfamiliesshouldnotseekanelectiveCaesarean.Theriskofplacentaaccreta,apotentiallylifethreateningcondition,is0.13%aftertwo
Caesareansections,butincreasesto2.13%afterfourandthento6.74%aftersixormore.Alongwith
thisisasimilarriseintheriskofemergencyhysterectomiesatdelivery.[15]
Motherscanexperienceincreasedincidenceofpostnataldepression,andcanexperiencesignificant
psychologicalbirthtraumaandongoingbirthrelatedposttraumaticstressdisorderafterobstetric
interventionduringthebirthingprocess.[16]Factorslikepaininfirststageoflabor,feelingsof
powerlessness,intrusiveemergencyobstetricinterventionareimportantinthedevelopmentofbirth
trauma.[16]
Subsequentpregnancies

Transvaginalultrasonographyofa
uterusyearsafteraCaesareansection,
showingthecharacteristicscar
formationinitsanteriorpart.

WomenwhohavehadaCaesareanforanyreasonaresomewhatlesslikelytobecomepregnantorgive
birthagainascomparedtowomenwhohavepreviouslyonlydeliveredvaginally.[17]
WomenwhohadjustonepreviousCaesareansectionaremorelikelytohaveproblemswiththeirsecondbirth.[4]Deliveryafterprevious
Caesareansectionisbyeitheroftwomainoptions:
VaginalbirthafterCaesareansection(VBAC)
ElectiverepeatCaesareansection(ERCS)
BothhavehigherrisksthanavaginalbirthwithnopreviousCaesareansection.CriteriaformakingVBACincludethatthepreviousCaesarean
sectionshouldbealowtransverseone.VBAC(comparedtoERCS)confersahigherriskformainlyuterineruptureandperinataldeathofthe
child.[18]Furthermore,optingforVBACresultsin2040%oftimesinthatCaesareansectionisperformedeventuallyanyway,withgreater
risksofcomplicationsinanemergentrepeatCaesareansectionthaninanERCS.[19][20]Ontheotherhand,VBACconferslessmaternal
morbidityandadecreasedriskofcomplicationsinfuturepregnanciesthanERCS.[21]
Adhesions
Therearenumberofstepsthatcanbetakenduringabdominalorpelvicsurgerytominimizepostoperativecomplications,suchasthe
formationofadhesions.Suchtechniquesandprinciplesmayinclude:
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Handlingalltissuewithabsolutecare
Usingpowderfreesurgicalgloves
Controllingbleeding
Choosingsuturesandimplantscarefully
Keepingtissuemoist
Preventinginfection
However,despitetheseproactivemeasures,abdominalorpelvicsurgerycanresultintraumathatcan
leadtoadhesions.Inordertopreventadhesionsfromformingfollowingapelvic(gynecologic)surgery,
suchashysterectomy,myomectomyorcaesareansection,adhesionbarriercanbeplacedduring
surgerytominimizetheriskofadhesionsbetweentheuterusandovaries,thesmallbowel,andalmost
anytissueintheabdomenorpelvis.

Suturingoftheuterusafter
extraction.

Adhesionscancausecomplications,suchas:
Infertility,whichmayresultwhenadhesionstwistthetissuesoftheovariesandtubes,blocking
thenormalpassageoftheegg(ovum)fromtheovarytotheuterus.Oneinfiveinfertilitycasesis
estimatedtobeadhesionrelated(stoval)
Chronicpelvicpain,whichmayresultwhenadhesionsarepresentinthepelvis.Almost50
percentofchronicpelvicpaincasesareestimatedtobeadhesionrelated(stoval)
Smallbowelobstructionthedisruptionofnormalbowelflow,whichcanresultwhen

ClosedIncisionforlowtransverse
abdominalincisionafterstaplinghas
beencompleted.

adhesionstwistorpullthesmallbowel.

Riskstothechild
Nonmedicallyindicated(elective)childbirthbefore39weeksgestation"carrysignificantrisksforthebabywithnoknownbenefittothe
mother."Complicationsfromelectivecaesareanbefore39weeksinclude:newbornmortalityat37weeksmaybeupto3timesthenumberat
40weeks,andwaselevatedcomparedto38weeksofgestation.Theseearlytermbirthswerealsoassociatedwithincreaseddeathduring
infancy,comparedtothoseoccurringat39to41weeks("fullterm").[22]Researchersinonestudyandanotherreviewfoundmanybenefitsto
goingfullterm,butnoadverseeffectsinthehealthofthemothersorbabies.[22][23]

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TheAmericanCongressofObstetriciansandGynecologistsandmedicalpolicymakersreviewresearchstudiesandfindincreasedincidenceof
suspectedorprovensepsis,RDS,hypoglycemia,needforrespiratorysupport,needforNICUadmission,andneedforhospitalization>45
days.Inthecaseofcaesareansections,ratesofrespiratorydeathwere14timeshigherinprelaborat37comparedwith40weeksgestation,
and8.2timeshigherforprelaborcaesareanat38weeks.Inthisreview,nostudiesfounddecreasedneonatalmorbidityduetononmedically
indicated(elective)deliverypriorto39weeks.[22]
Forotherwisehealthytwinpregnancieswherebothtwinsareheaddownatrialofvaginaldeliveryisrecommendedatbetween37and38
weeks.[24][25]VaginaldeliveryinthiscasedoesnotworsentheoutcomefortheinfantascomparedwithCaesareansection.[24]Thereis
controversyonthebestmethodofdeliverywerethefirsttwinisheadfirstandthesecondisnot.[24]WhenthefirsttwinisnotheaddownaC
sectionisoftenrecommended.[24]Regardlessofbirthbysectionorvaginally,themedicalliteraturerecommendsdeliveryofdichorionictwins
at38weeks,andmonochorionictwins(identicaltwinssharingaplacenta)by37weeksduetotheincreasedriskofstillbirthinmonochorionic
twinswhoremaininuteroafter37weeks.[26][27]Theconsensusisthatlatepretermdeliveryofmonochorionictwinsisjustifiedbecausethe
riskofstillbirthforpost37weekdeliveryissignificantlyhigherthantherisksposedbydeliveringmonochorionictwinsnearterm(i.e.,3637
weeks).[28]
Theconsensusconcerningmonoamniotictwins(identicaltwinssharinganamnioticsac),thehighestrisktypeoftwins,isthattheyshouldbe
deliveredbycaesareansectionatorshortlyafter32weeks.[29][30][31]
Inaresearchstudywidelypublicized,singletonchildrenbornearlierthan39weeksmayhavedevelopmentalproblems,includingslower
learninginreadingandmath.[32]
Otherrisksinclude:
Wetlung:Retentionoffluidinthelungscanoccurifnotexpelledbythepressureofcontractionsduringlabor.[33]
Potentialforearlydeliveryandcomplications:Pretermdeliveryispossibleifduedatecalculationisinaccurate.Onestudyfoundan
increasedcomplicationriskifarepeatelectiveCaesareansectionisperformedevenafewdaysbeforetherecommended39weeks.[34]
Higherinfantmortalityrisk:InCsectionsperformedwithnoindicatedrisk(singletonatfullterminaheaddownposition),theriskof
deathinthefirst28daysoflifehasbeencitedas1.77per1,000livebirthsamongwomenwhohadCsections,comparedto0.62per
1,000forwomenwhodeliveredvaginally.[35]

Classification
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Caesareansectionshavebeenclassifiedinvariouswaysbydifferentperspectives.[36]Onewaytodiscussallclassificationsystemsistogroup
thembytheirfocuseitherontheurgencyoftheprocedure,characteristicsofthemother,orasagroupbasedonother,lesscommonly
discussedfactors.[36]
Itismostcommontoclassifycsectionsbytheurgencyofperformingthem.[36]Whenthereissomethingunusualaboutthemotherorthe
pregnancy,thenitbecomescommontoclassifythatcsectionbywhateverunusualcharacteristicsareseen.[36]Whendiscussingtheactual
techniqueorsurgicalconditions,thencsectionsareclassifiedbythosetechniques.[36]

Byurgency
Conventionally,caesareansectionsareclassifiedasbeingeitheranelectivesurgeryoranemergencysurgery.[37]Classificationisusedtonote
astrategyforusinganesthesia,asinemergenciesgeneralanesthesiamustbeusedbutwhentimeisavailable,itispreferabletouseregional
anesthesia.[37]
Aplannedcaesarean(orelective/scheduledcaesarean),arrangedaheadoftime,ismostcommonlyarrangedformedicalreasonsandideallyas
closetotheduedateaspossible.Acrash/emergent/emergencyCaesareansectionisperformedinanobstetricemergency,wherecomplications
ofpregnancyonsetsuddenlyduringtheprocessoflabour,andswiftactionisrequiredtopreventthedeathsofmother,child(ren)orboth.
Aplannedorelectivecaesareansectionisanelectivesurgery,meaningthatitisscheduledinadvanceratherthanperformedbecauseofan
unscheduledemergency.Thisconferstheabilitytoperformthedeliveryatatimewhenhospitalresourcesareoptimal,suchasatdaytime
ratherthanwhatmightotherwiseturnouttobeatnight.Thecosttothepatientandthebabyforunnecessarysurgerymaybesubstantial.
Criticsalsoarguethatbecausephysiciansandinstitutionsmaybenefitbyreducingnighttimeandweekendwork,thataninappropriate
incentiveexiststosuggestelectivesurgery.[38]
Electivecaesareansectionsmaybeperformedonthebasisofanobstetricalormedicalindication,orbecauseofanonindicatedmaternal
request.[25]AmongwomenintheUnitedKingdom,SwedenandAustralianabout7%preferredCsectionasamethodofdelivery.[25]Incases
withoutmedicalindicationstheAmericanCongressofObstetriciansandGynecologistsrecommendaplannedvaginaldelivery.[39]The
NationalInstituteforHealthandCareExcellencerecommendsthatifafterawomenhasbeenprovidedinformationontheriskofaplannedC
sectionandshestillinsistsontheprocedureitshouldbeprovided.[25]Ifprovidedthisshouldbedone39weeksofgestationorlater.[39]

Bycharacteristicsofthemother
Caesareandeliveryonmaternalrequest
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Caesareandeliveryonmaternalrequest(CDMR)isamedicallyunnecessarycaesareansection,wheretheconductofachildbirthviaa
caesareansectionisrequestedbythepregnantpatienteventhoughthereisnotamedicalindicationtohavethesurgery.[40]
AfterpreviousCaesarean
Motherswhohavepreviouslyhadacaesareansectionaremorelikelytohaveacsectionforfuturepregnanciesthanmotherswhohavenever
hadacsection.Thereisdiscussionaboutthecircumstancesunderwhichwomenshouldhaveavaginalbirthafterapreviouscaesarean.
Vaginalbirthaftercaesarean(VBAC)isthepracticeofbirthingababyvaginallyafterapreviousbabyhasbeendeliveredthroughcaesarean
section(surgically).[41]AccordingtoTheAmericanCongressofObstetriciansandGynecologists(ACOG),VBACisassociatedwith
decreasedmaternalmorbidityandadecreasedriskofcomplicationsinfuturepregnancies.[42]AccordingtotheAmericanPregnancy
Association,90%ofwomenwhohaveundergonecaesareandeliveriesarecandidatesforVBAC.[19]Approximately6080%ofwomenopting
forVBACwillsuccessfullygivebirthvaginally,whichiscomparabletotheoverallvaginaldeliveryrateintheUnitedStatesin2010.[19][20][43]
Twins
Forotherwisehealthytwinpregnancieswherebothtwinsareheaddownatrialofvaginaldeliveryisrecommendedatbetween37and38
weeks.[24][25]VaginaldeliveryinthiscasedoesnotworsentheoutcomefortheinfantascomparedwithCsection.[24]Thereiscontroversyon
thebestmethodofdeliverywherethefirsttwinisheadfirstandthesecondisnot.[24]Whenthefirsttwinisnotheaddown,aCsectionisoften
recommended.[24]Althoughthesecondtwintypicallyhasahigherfrequencyofproblems,itisnotknownifaplannedCsectionaffects
this.[25]Itisestimatedthat75%oftwinpregnanciesintheUnitedStatesweredeliveredbyCaesareansectionin2008.[44]
Breechbirth
Abreechbirthisthebirthofababyfromabreechpresentation,inwhichthebabyexitsthepelviswiththebuttocksorfeetfirstasopposedto
thenormalheadfirstpresentation.Inbreechpresentation,fetalheartsoundsareheardjustabovetheumbilicus.
Thebottomdownpositionpresentssomehazardstothebabyduringtheprocessofbirth,andthemodeofdelivery(vaginalversusCaesarean)
iscontroversialinthefieldsofobstetricsandmidwifery.
Thoughvaginalbirthispossibleforthebreechbaby,certainfetalandmaternalfactorsinfluencethesafetyofvaginalbreechbirth.The
majorityofbreechbabiesbornintheUnitedStatesaredeliveredbyCaesareansectionasstudieshaveshownincreasedrisksofmorbidityand
mortalityforvaginalbreechdelivery,andmosthospitalpoliciesdonotpermitvaginalbreechbirthforthisreason.Asaresultofreduced
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numbersofvaginalbreechdeliveries,mostobstetriciansdonotreceivetrainingintheskillsetrequiredforsafevaginalbreechdelivery
anymore.

Otherways,includingbysurgerytechnique
ThereareseveraltypesofCaesareansection(CS).Animportantdistinctionliesinthetypeofincision(longitudinalorlatitudinal)madeonthe
uterus,apartfromtheincisionontheskin.
TheclassicalCaesareansectioninvolvesamidlinelongitudinalincisionwhichallowsalargerspacetodeliverthebaby.However,itis
rarelyperformedtoday,asitismorepronetocomplications.
Theloweruterinesegmentsectionistheproceduremostcommonlyusedtodayitinvolvesatransversecutjustabovetheedgeofthe
bladderandresultsinlessbloodlossandiseasiertorepair.
AnunplannedCaesareansectionisperformedoncelabourhascommencedduetounexpectedlaborcomplications.
ACaesareanhysterectomyconsistsofaCaesareansectionfollowedbytheremovaloftheuterus.Thismaybedoneincasesof
intractablebleedingorwhentheplacentacannotbeseparatedfromtheuterus.
Traditionally,otherformsofCaesareansectionhavebeenused,suchasextraperitonealCaesareansectionorPorroCaesareansection.
ArepeatCaesareansectionisonethatisdonewhenapatienthadapreviousCaesareansection.Typicallyitisperformedthroughtheold
scar.
TheEXITprocedureisaspecializedsurgicaldeliveryprocedureusedtodeliverbabieswhohaveairwaycompression.
TheMisgavLadachmethodisamodifiedcaesareansectionwhichhasbeenusednearlyallovertheworldsincethe1990s.Itwasdescribedby
MichaelStark,thepresidentoftheNewEuropeanSurgicalAcademy,atthetimehewasthedirectorofMisgavLadach,ageneralhospitalin
Jerusalem.ThemethodwaspresentedduringaFIGOconferenceinMontralin1994[45]andthendistributedbytheUniversityofUppsala,
Sweden,inmorethan100countries.Thismethodisbasedonminimalisticprinciples.Heexaminedallstepsincaesareansectionsinuse,
analyzedthemfortheirnecessityand,iffoundnecessary,fortheiroptimalwayofperformance.Fortheabdominalincisionheusedthe
modifiedJoelCohenincisionandcomparedthelongitudinalabdominalstructurestostringsonmusicalinstruments.Asbloodvesselsand
muscleshavelateralsway,itispossibletostretchratherthancutthem.Theperitoneumisopenedbyrepeatstretching,noabdominalswabsare
used,theuterusisclosedinonelayerwithabigneedletoreducetheamountofforeignbodyasmuchaspossible,theperitoneallayersremain
unsuturedandtheabdomenisclosedwithtwolayersonly.Womenundergoingthisoperationrecoverquicklyandcanlookafterthenewborns

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soonaftersurgery.Therearemanypublicationsshowingtheadvantagesovertraditionalcaesareansectionmethods.However,thereisan
increasedriskofabruptioplacentaanduterineruptureinsubsequentpregnanciesforwomenwhounderwentthismethodinprior
deliveries.[46][47]

Technique
Antibioticprophylaxisisusedbeforeanincision.[48]Theuterusisincised,andthisincisionisextended
withbluntpressurealongacephaladcaudadaxis.[48]Theinfantisdelivered,andtheplacentaisthen
removed.[48]Thesurgeonthenmakesadecisionaboututerineexteriorization.[48]Singlelayeruterine
closureisusedwhenthemotherdoesnotwantafuturepregnancy.[48]Whensubcutaneoustissueis
2cmthickormore,surgicalsutureisused.[48]Discouragedpracticesincludemanualcervicaldilation,
anysubcutaneousdrain,orsupplementaloxygentherapywithintenttopreventinfection.[48]
Caesareansectioncanbeperformedwithsingleordoublelayersuturingoftheuterineincision.[49]A
Cochranereviewcametotheresultthatsinglelayerclosurecomparedwithdoublelayerclosurewas
associatedwithastatisticallyreductioninmeanbloodloss.[50]Suturingclosedtheperitoneumalso
doesnotappeartoberequired.[51]

Pullingoutthebaby

Inmanyhospitals,especiallyinArgentina,theUnitedStates,UnitedKingdom,Canada,Norway,
Sweden,Finland,Australia,andNewZealand,themother'spartnerisencouragedtoattendthesurgery
tosupportthemotherandsharetheexperience.Theanaesthetistwillusuallylowerthedrape
temporarilyasthechildisdeliveredsotheparentscanseetheirnewborn.

Anaesthesia
Bothgeneralandregionalanaesthesia(spinal,epiduralorcombinedspinalandepiduralanaesthesia)
IllustrationdepictingCaesarean
areacceptableforuseduringCaesareansection.Regionalanaesthesiaispreferredasitallowsthe
section.
mothertobeawakeandinteractimmediatelywithherbaby.[52]Otheradvantagesofregionalanesthesia
includetheabsenceoftypicalrisksofgeneralanesthesia:pulmonaryaspiration(whichhasarelatively
highincidenceinpatientsundergoinganesthesiainlatepregnancy)ofgastriccontentsandOesophagealintubation.[53]

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Regionalanaesthesiaisusedin95%ofdeliveries,withspinalandcombinedspinalandepiduralanaesthesiabeingthemostcommonlyused
regionaltechniquesinscheduledCaesareansection.[54]RegionalanaesthesiaduringCaesareansectionisdifferentfromtheanalgesia(pain
relief)usedinlaborandvaginaldelivery.Thepainthatisexperiencedbecauseofsurgeryisgreaterthanthatoflaborandthereforerequiresa
moreintensenerveblock.ThedermatomallevelofanesthesiarequiredforCaesareandeliveryisalsohigherthanthatrequiredforlabor
analgesia.[53]
Generalanesthesiamaybenecessarybecauseofspecificriskstomotherorchild.Patientswithheavy,uncontrolledbleedingmaynottolerate
thehemodynamiceffectsofregionalanesthesia.Generalanesthesiaisalsopreferredinveryurgentcases,suchasseverefetaldistress,when
thereisnotimetoperformaregionalanesthesia.

Preventionofcomplications
Postpartuminfectionisoneofthemaincausesofbadoutcomes[55][56]anddeatharoundchildbirth,accountingforaround10%ofmaternal
deathsglobally.[57]Caesareansectiongreatlyincreasestheriskofinfectionandassociatedmorbidity(estimatedtobebetween5and20times
ashigh).[55]Infectioncanoccurinaround8%ofwomenwhohavecaesareans,[56]largelyendometritis,urinarytractinfectionsandwound
infections.
Antibioticprophylaxisiseffectiveforendometritis,preventingasmanyas3outof4cases.[55][56]Takingantibioticsbeforeskinincisionrather
thanaftercordclampingreducestheriskforthemother,withoutincreasingadverseeffectsforthebaby.[56][58]Whetheraparticulartypeof
skincleanerimprovesoutcomesinunclear.[59]
Somedoctorsbelievethatduringacaesareansection,mechanicalcervicaldilationwithafingerorforcepswillpreventtheobstructionof
bloodandlochiadrainage,andtherebybenefitthemotherbyreducingriskofdeath.[60]Theavailableclinicalevidenceisnotsufficienttodraw
aconclusionontheeffectofthispractice.[60]

Recoveryperiod
Typically,therecoverytimedependsonthepatientandherpaintoleranceandinflammationlevels.Doctorsdorecommendabstentionfrom
strenuouswork(e.g.,liftingobjectsover10lbs(4.5kg).,running,walkingupstairs,orathletics)foruptosixteenweeks,andawaitingperiod
of~18monthsbeforeattemptingtoconceiveanotherchild.

Usage
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IntheUnitedKingdom,in2008,theCaesareansectionratewas24%.[61]InIrelandtheratewas26.1%in2009.[62]TheCanadianratewas
26%in20052006.[63]AustraliahasahighCaesareansectionrate,at31%in2007.[64]IntheUnitedStatestherateofCsectionisaround33%
andvariesfrom23%to40%dependingonthestateinquestion.[4]
InItalytheincidenceofCaesareansectionsisparticularlyhigh,althoughitvariesfromregiontoregion.[65]InCampania,60%of2008births
reportedlyoccurredviaCaesareansections.[66]IntheRomeregion,themeanincidenceisaround44%,butcanreachashighas85%insome
privateclinics.[67][68]
Withnearly1.3millionstays,CaesareansectionwasoneofthemostcommonproceduresperformedinU.S.hospitalsin2011.Itwasthe
secondmostcommonprocedureperformedforpeopleages18to44yearsold.[69]CaesareanratesintheU.S.haverisenconsiderablysince
1996.[70]Theprocedureincreased60%from1996to2009.In2010,theCaesareandeliveryratewas32.8%ofallbirths(aslightdecreasefrom
2009'shighof32.9%ofallbirths).[71]Astudyfoundthatin2011,womencoveredbyprivateinsurancewere11%morelikelytohavea
caesareansectiondeliverythanthosecoveredbyMedicaid.[72]
ChinahasbeencitedashavingthehighestratesofCsectionsintheworldat46%asof2008.[73]
StudieshaveshownthatcontinuityofcarewithaknowncarermaysignificantlydecreasetherateofCaesareandelivery[74]butthereisalso
researchthatappearstoshowthatthereisnosignificantdifferenceinCaesareanrateswhencomparingmidwifecontinuitycareto
conventionalfragmentedcare.[75]
MoreemergencyCaesareansabout66%areperformedduringthedayratherthanduringthenight.[76]
Theratehasrisento46%inChinaandtolevelsof25%andaboveinmanyAsian,EuropeanandLatinAmericancountries.[77]Theratehas
increasedintheUnitedStates,to33%ofallbirthsin2012,upfrom21%in1996.[4]AcrossEurope,therearedifferencesbetweencountries:in
ItalytheCaesareansectionrateis40%,whileintheNordiccountriesitis14%.[78]

Increasinguse
IntheUnitedStatesCsectionrateshaveincreasedfromjustover20%in1996to33%in2011.[4]Thisincreasehasnotresultedinimproved
outcomesresultinginthepositionthatCsectionsmaybedonetoofrequently.[4]

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TheWorldHealthOrganizationofficiallywithdrewitspreviousrecommendationofa15%CsectionratesinJune2010.Theirofficial
statementread,"Thereisnoempiricalevidenceforanoptimumpercentage.Whatmattersmostisthatallwomenwhoneedcaesareansections
receivethem."[79]
TheUSNationalInstitutesofHealthsaysrisesinratesofCaesareansectionsarenot,inisolation,acauseforconcern,butmayreflect
changingreproductivepatterns:"TheWorldHealthOrganizationhasdeterminedanidealrateofallcaesareandeliveries(suchas15percent)
forapopulation.Onesurgeon'sopinionisthatthereisnoconsistencyinthisidealrate,andartificialdeclarationsofanidealrateshouldbe
discouraged.Goalsforachievinganoptimalcaesareandeliveryrateshouldbebasedonmaximizingthebestpossiblematernalandneonatal
outcomes,takingintoaccountavailablemedicalandhealthresourcesandmaternalpreferences.Thisopinionisbasedontheideathatifleft
unchallenged,optimalcaesareandeliveryrateswillvaryovertimeandacrossdifferentpopulationsaccordingtoindividualandsocietal
circumstances."[40]
Somehavespeculatedthatcaesareansectionrateshaveincreasedduetoarelationshipbetweenbirthweightandmaternalpelvissize,positing
onthebasisofDarwinianinspiredlogicthatsincetheadventofsuccessfulCaesareanbirthoverthelast150years,moremotherswithsmall
pelvisesandbabieswithlargebirthweightshavesurvivedandcontributedtothesetraits.However,thisideafailstotakeintoaccountthat
historicallydisproportioninchildbirthwascausedbymaternalmalnutritioninchildhood,inparticularmalformedpelvicbonesdueto
childhoodrickets.Improvedmaternalnutritionshouldhaveledtoincreasedeaseinvaginalbirth,notanincreaseincaesareansections.[80]

History
ThemotherofBindusara(bornc.320BCE,ruled298c.272BCE),thesecondMauryan
Samrat(emperor)ofIndia,accidentallyconsumedpoisonanddiedwhenshewascloseto
deliveringhim.Chanakya,theChandragupta'steacherandadviser,madeuphismindthat
thebabyshouldsurvive.Hecutopenthebellyofthequeenandtookoutthebaby,thus
savingthebaby'slife.[81][82]
AccordingtotheancientChineseRecordsoftheGrandHistorian,Luzhong,asixth
generationdescendantoftheYellowEmperor,hadsixsons,allbornby"cuttingopenthe
body".ThesixthsonJilianfoundedtheHouseofMithatruledtheStateofChu(c.1030
223BCE).[83]
IntheIrishmythologicaltexttheUlsterCycle,thecharacterFurbaideFerbendissaidto
havebeenbornbyposthumouscaesareansection,afterhismotherwasmurderedbyhis
evilauntMedb.
http://en.wikipedia.org/wiki/Caesarean_section

SuccessfulCaesareansectionperformedby
indigenoushealersinKahura,Uganda.Asobserved
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TheBabylonianTalmud,anancientJewishreligioustext,mentionsaproceduresimilartothecaesareansection.Theprocedureistermed
yotzeidofen.[82]
PlinytheEldertheorizedthatJuliusCaesar'snamecamefromanancestorwhowasbornbycaesareansection,butthetruthofthisisdebated
(seethearticleontheEtymologyofthenameofJuliusCaesar).TheAncientRomancaesareansectionwasfirstperformedtoremoveababy
fromthewombofamotherwhodiedduringchildbirth.Caesar'smother,Aurelia,livedthroughchildbirthandsuccessfullygavebirthtoher
son,rulingoutthepossibilitytheRomanrulerandgeneralwasbornbycaesareansection.Hisfirstwifehoweverdiedinchildbirth,giving
birthtoastilbornsonwhomighthavelivedhadacaesareantakenplace.
TheCatalansaintRaymondNonnatus(12041240),receivedhissurnamefromtheLatinnonnatus("notborn")becausehewasbornby
caesareansection.Hismotherdiedwhilegivingbirthtohim.[84]
AnearlyaccountofcaesareansectioninIranismentionedinthebookofShahnameh,writtenaround1000AD,andrelatestothebirthof
Rostam,thenationallegendaryheroofIran.[85][86]AccordingtotheShahnameh,theSimurghinstructedZaluponhowtoperformaCaesarean
section,thussavingRudabaandthechildRostam.[87]
Caesareansectionusuallyresultedinthedeathofthemotherthefirstrecordedincidenceofawomansurvivingacaesareansectionwasinthe
1580s,inSiegershausen,Switzerland:JakobNufer,apiggelder,issupposedtohaveperformedtheoperationonhiswifeafteraprolonged
labour.[88]However,thereissomebasisforsupposingthatwomenregularlysurvivedtheoperationinRomantimes.[89]Formostofthetime
sincethe16thcentury,theprocedurehadahighmortalityrate.However,itwaslongconsideredanextrememeasure,performedonlywhenthe
motherwasalreadydeadorconsideredtobebeyondhelp.InGreatBritainandIreland,themortalityratein1865was85%.Keystepsin
reducingmortalitywere:
IntroductionofthetransverseincisiontechniquetominimizebleedingbyFerdinandAdolfKehrerin1881isthoughttobefirstmodern
CSperformed.
TheintroductionofuterinesuturingbyMaxSngerin1882
ModificationbyHermannJohannesPfannenstielin1900,seePfannenstielincision
ExtraperitonealCSandthenmovingtolowtransverseincision(Krnig,1912)
Adherencetoprinciplesofasepsis
Anesthesiaadvances
Bloodtransfusion
Antibiotics
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EuropeantravelersintheGreatLakesregionofAfricaduringthe19thcenturyobservedCaesareansectionsbeingperformedonaregular
basis.[90]Theexpectantmotherwasnormallyanesthetizedwithalcohol,andherbalmixtureswereusedtoencouragehealing.Fromthewell
developednatureoftheproceduresemployed,Europeanobserversconcludedtheyhadbeenemployedforsometime.[90]Dr.JamesBarry
carriedoutthefirstsuccessfulCaesareanbyaEuropeandoctorinAfricainCapeTown,whilepostedtherebetween1817and1828.[91]
ThefirstsuccessfulCaesareansectiontobeperformedinAmericatookplaceinwhatwasformerlyMasonCounty,Virginia(nowMason
County,WestVirginia),in1794.TheprocedurewasperformedbyDr.JesseBennettonhiswifeElizabeth.[92]
OnMarch5,2000,inMexico,InsRamrezperformedaCaesareansectiononherselfandsurvived,asdidherson,OrlandoRuizRamrez.[93]
SheisbelievedtobetheonlywomantohaveperformedasuccessfulCaesareansectiononherself.

Societyandculture
Etymology
TheRomanLexRegia(royallaw),latertheLexCaesarea(imperiallaw),ofNumaPompilius(715673BCE),[94]requiredthechildofa
motherdeadinchildbirthtobecutfromherwomb.[95]Thisseemstohavebegunasareligiousrequirementthatmothersnotbeburied
pregnant,[96]andtohaveevolvedintoawayofsavingthefetus,withRomanpracticerequiringalivingmothertobeinhertenthmonthof
pregnancybeforeresortingtotheprocedure,reflectingtheknowledgethatshecouldnotsurvivethedelivery.[97]SpeculationthattheRoman
dictatorJuliusCaesarwasbornbythemethodnowknownasCsectionisapparentlyfalse.[98]AlthoughCaesareansectionswereperformedin
Romantimes,noclassicalsourcerecordsamothersurvivingsuchadelivery[95][99]theearliestrecordedsurvivaldatestothe12thcentury
scholarandphysicianMaimonides(seeCommentarytoMishnahBekhorot8:2).Thetermhasalsobeenexplainedasderivingfromtheverb
caedere,"tocut",withchildrendeliveredthiswayreferredtoascaesones.PlinytheElderreferstoacertainJuliusCaesar(anancestorofthe
famousRomanstatesman)asabuterocaeso,"cutfromthewomb"givingthisasanexplanationforthecognomen"Caesar"whichwasthen
carriedbyhisdescendents.[95]Nonetheless,eveniftheetymologicalhypothesislinkingthecaesareansectiontoJuliusCaesarisafalse
etymology,ithasbeenwidelybelieved.Forexample,theOxfordEnglishDictionarydefinesCaesareanbirthas"thedeliveryofachildby
cuttingthroughthewallsoftheabdomenwhendeliverycannottakeplaceinthenaturalway,aswasdoneinthecaseofJuliusCaesar".[100]
MerriamWebster'sCollegiateDictionary(11thedition)leavesroomforetymologicaluncertaintywiththephrase,"fromthelegendary
associationofsuchadeliverywiththeRomancognomenCaesar"[101]
SomelinkwithJuliusCaesarorwithRomanemperorsexistsinotherlanguagesaswell.Forexample,themodernGerman,Norwegian,
Danish,Dutch,Swedish,TurkishandHungariantermsarerespectivelyKaiserschnitt,keisersnitt,kejsersnit,keizersnede,kejsarsnitt,sezaryen,
andcsszrmetszs(literally:"Emperor'scut").[102]TheGermantermhasalsobeenimportedintoJapanese(teisekkai)andKorean
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(jewangjeolgae),bothliterallymeaning"emperorincision".SimilarinwesternSlavic(Polish)ciciecesarskie,(Czech)csaskez
and(Slovak)cisrskyrez(literally"imperialcut"),whereasthesouthSlavictermisSerbianandSloveniancrskirz,which
literallymeans"tzar"cut.TheRussiantermkesarevosecheniye(ksarevosenije)literallymeansCaesar'ssection.The
Arabicterm(wilaadaqaySaryya)alsomeans"Caesareanbirth."TheHebrewterm(nitakhKeisri)translatesliterally
asCaesareansurgery.InRomaniaandPortugal,[103]itisusuallycalledcesariana,meaningfrom(orrelatedto)Caesar.
AccordingtoShahnamehancientPersianbook,theheroRostamwasthefirstpersonwhowasbornwiththismethodandterm
(rostamineh)iscorrespondedtoCaesarean.Also,HindumythicalmonkeygodHanumanwasbornthroughasimilarprocedureonhermother
Anjani.
Finally,theRomanpraenomen(givenname)CaesowassaidtobegiventochildrenwhowerebornviaCsection.Whilethiswasprobablyjust
folketymologymadepopularbyPlinytheElder,itwaswellknownbythetimethetermcameintocommonuse.[104]

Orthography
Theterm"Caesareansection"isspelledinmanydifferentways.
Onevariationisthee/ae/variationwhichreflectsAmericanandBritishEnglishspellingdifferences.Becausesomesourcessaytheprocedure
isnamedafterJuliusCaesar,theprocedure'snameissometimescapitalized.Thecapitalversuslowercasevariationreflectsastyleof
lowercasingsomeeponymousterms(e.g.,caesarean,eustachian,fallopian,mendelian,parkinsonian,parkinsonism).[105]Capitaland
lowercasestylingscoexistinprevalentusage.
Becauseof(1)theevsaedigraphvariation,(2)therelatedaevstypographicligaturevariation,(3)thecapitalvslowercasevariation
(whichisbasedontheideaofeponymousorigin,whetherthatishistoricallyaccurateornotseeeponym>orthographicconventions),and(4)
theeanvsiansuffixvariation,thesefactorscrossmultipliedinatablecausethiswordtobeoneoftheveryfewwordsinpresentday
Englishorthographytohavemanydifferentnormativespellingsororthographicstylings,whichamountto12fromthepointofviewof
characterencoding(thatis,thereare12differentcharacterstringsthatareallacceptedasnormativeorthographicrepresentationsofthisone
word):

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Multiplicationtable

C+e

c+e

C+ae

c+ae

C+

c+

ean Cesarean cesarean Caesarean caesarean Csarean csarean

ian Cesarian

cesarian

Caesarian

caesarian

Csarian

csarian

Specialpopulations
InJudaismthereisadisputeamongtheposkim(Rabbinicauthorities)astowhetherafirstbornsonfromaCaesareansectionhasthelawsofa
bechor.[106]Traditionally,amalechilddeliveredbyCaesareanisnoteligibleforthePidyonHaBendedicationritual.[107][108]
Inrarecases,caesareansectionscanbeusedtoremoveadeadfetus.AlatetermabortionusingCaesareansectionproceduresistermeda
hysterotomyabortionandisveryrarelyperformed.
Selfinflictedcaesareansectionistheconceptofamotheraloneperformingherowncaesareansection.Therehaveapparentlybeenafew
successfulcases,notablyInsRamrezPrezofMexicowhoinMarch2000,performedasuccessfulCaesareansectiononherself.[109][110]

References
1. "Fearafactorinsurgicalbirths"(http://www.smh.com.au/news/national/fearafactorinsurgicalbirths/2007/10/06/1191091421081.html).TheSydney
MorningHerald.7October2007.
2. "Kiwicaesareanratecontinuestorise"(http://www.stuff.co.nz/stuff/4198257a11.html).Stuff.co.nz.12September2007.Retrieved22September2011.
3. FingerC(2003)."CaesareansectionratesskyrocketinBrazil.ManywomenareoptingforCaesareansinthebeliefthatitisapracticalsolution".Lancet
362(9384):628.doi:10.1016/S01406736(03)142043(https://dx.doi.org/10.1016%2FS01406736%2803%29142043).PMID12947949
(https://www.ncbi.nlm.nih.gov/pubmed/12947949).
4. "SafePreventionofthePrimaryCesareanDelivery"
(http://www.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery).American
http://en.wikipedia.org/wiki/Caesarean_section

18/27

17/3/2015

CaesareansectionWikipedia,thefreeencyclopedia

CongressofObstetriciansandGynecologistsandtheSocietyforMaternalFetalMedicine.March2014.Retrieved20February2014.
5. AmericanCongressofObstetriciansandGynecologists,"FiveThingsPhysiciansandPatientsShouldQuestion"(http://www.choosingwisely.org/doctor
patientlists/americancollegeofobstetriciansandgynecologists/),ChoosingWisely:aninitiativeoftheABIMFoundation(AmericanCongressof
ObstetriciansandGynecologists),retrievedAugust1,2013,whichcites
Main,ElliottOshiro,BryanChagolla,BrendaBingham,DebraDangKilduff,LeonaKowalewski,Leslie,EliminationofNonmedically
Indicated(Elective)DeliveriesBefore39WeeksGestationalAge(http://www.cdph.ca.gov/programs/mcah/Documents/MCAHEliminationOfNon
MedicallyIndicatedDeliveries.pdf),MarchofDimesCaliforniaMaternalQualityCareCollaborativeMaternal,ChildandAdolescentHealth
DivisionCenterforFamilyHealthCaliforniaDepartmentofPublicHealth,retrieved1August2013
6. TurnerR(1990)."CaesareanSectionRates,ReasonsforOperationsVaryBetweenCountries".FamPlannPerspect.(GuttmacherInstitute)22(6):
2812.doi:10.2307/2135690(https://dx.doi.org/10.2307%2F2135690).JSTOR2135690(https://www.jstor.org/stable/2135690).
7. Hofmeyr,GJHannah,ME(2003)."Plannedcaesareansectionfortermbreechdelivery.".TheCochranedatabaseofsystematicreviews(3):CD000166.
doi:10.1002/14651858.CD000166(https://dx.doi.org/10.1002%2F14651858.CD000166).PMID12917886
(https://www.ncbi.nlm.nih.gov/pubmed/12917886).
8. SavageW(2007)."TherisingCaesareansectionrate:alossofobstetricskill?".JObstetGynaecol27(4):33946.doi:10.1080/01443610701337916
(https://dx.doi.org/10.1080%2F01443610701337916).PMID17654182(https://www.ncbi.nlm.nih.gov/pubmed/17654182).
9. WeiChingT,KanagalingamD,HakKoonT(2003)."RisingCaesareanSectionRatesWhereDoWeGoFromHere?".SGHProceedings12(4):208
12.
10. Domenjoz,IKayser,BBoulvain,M(October2014)."Effectofphysicalactivityduringpregnancyonmodeofdelivery.".Americanjournalof
obstetricsandgynecology211(4):401.e111.doi:10.1016/j.ajog.2014.03.030(https://dx.doi.org/10.1016%2Fj.ajog.2014.03.030).PMID24631706
(https://www.ncbi.nlm.nih.gov/pubmed/24631706).
11. "CaesareanSection"(http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=71&sectionId=7681).NHSDirect.Retrieved20060726.
12. LiuS,ListonRM,JosephKS,HeamanM,SauveR,KramerMS(2007)."Maternalmortalityandseveremorbidityassociatedwithlowriskplanned
cesareandeliveryversusplannedvaginaldeliveryatterm"(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1800583).CMAJ176(4):45560.
doi:10.1503/cmaj.060870(https://dx.doi.org/10.1503%2Fcmaj.060870).PMC1800583(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1800583).
PMID17296957(https://www.ncbi.nlm.nih.gov/pubmed/17296957).
13. Pai,Madhukar(2000)."MedicalInterventions:CaesareanSectionsasaCaseStudy".EconomicandPoliticalWeekly35(31):275561.
14. "WhyareCaesareansDone?"(http://www.gynaecworld.com/Pregnancy/pg9.html#3).Gynaecworld.Retrieved20060726.
15. SilverRM,LandonMB,RouseDJ,LevenoKJ,SpongCY,ThomEA,MoawadAH,CaritisSN,HarperM,WapnerRJ,SorokinY,MiodovnikM,
CarpenterM,PeacemanAM,O'SullivanMJ,SibaiB,LangerO,ThorpJM,RaminSM,MercerBM(2006)."Maternalmorbidityassociatedwith
multiplerepeatcesareandeliveries".ObstetGynecol107(6):122632.doi:10.1097/01.AOG.0000219750.79480.84
(https://dx.doi.org/10.1097%2F01.AOG.0000219750.79480.84).PMID16738145(https://www.ncbi.nlm.nih.gov/pubmed/16738145).(seealsoreview
byWebMD.com(http://www.webmd.com/content/article/123/115093?action=related_link))

http://en.wikipedia.org/wiki/Caesarean_section

19/27

17/3/2015

CaesareansectionWikipedia,thefreeencyclopedia

byWebMD.com(http://www.webmd.com/content/article/123/115093?action=related_link))
16. OldeE,vanderHartO,KleberR,vanSonM(January2006)."Posttraumaticstressfollowingchildbirth:areview".ClinPsycholRev26(1):116.
doi:10.1016/j.cpr.2005.07.002(https://dx.doi.org/10.1016%2Fj.cpr.2005.07.002).PMID16176853(https://www.ncbi.nlm.nih.gov/pubmed/16176853).
17. GurolUrganci,I.BouAntoun,S.Lim,C.P.Cromwell,D.A.Mahmood,T.A.Templeton,A.vanderMeulen,J.H.(2013)."ImpactofCaesarean
sectiononsubsequentfertility:asystematicreviewandmetaanalysis".HumanReproduction28(7):19431952.doi:10.1093/humrep/det130
(https://dx.doi.org/10.1093%2Fhumrep%2Fdet130).ISSN02681161(https://www.worldcat.org/issn/02681161).
18. "BirthAfterPreviousCaesareanBirth,GreentopGuidelineNo.45"(https://www.rcog.org.uk/globalassets/documents/guidelines/gtg4511022011.pdf).
RoyalCollegeofObstetriciansandGynaecologists.February2007.
19. "VaginalBirthafterCesarean(VBAC)"(http://www.americanpregnancy.org/labornbirth/vbac.html).AmericanPregnancyAssociation.Retrieved
20120616.
20. VaginalbirthafterCsection(VBAC)guide(http://www.mayoclinic.com/health/vbac/VB99999),MayoClinic
21. AmericanCongressofObstetriciansand,Gynecologists(Aug2010)."ACOGPracticebulletinno.115:Vaginalbirthafterpreviouscesareandelivery.".
Obstetricsandgynecology116(2Pt1):45063.doi:10.1097/AOG.0b013e3181eeb251(https://dx.doi.org/10.1097%2FAOG.0b013e3181eeb251).
PMID20664418(https://www.ncbi.nlm.nih.gov/pubmed/20664418).
22. "EliminationofNonmedicallyIndicated(Elective)DeliveriesBefore39WeeksGestationalAge"
(http://www.patientsafetycouncil.org/uploads/MOD_39_Weeks_Toolkit.pdf).Retrieved20120713.
23. "TermPregnancy:APeriodofHeterogeneousRiskforInfantMo...:Obstetrics&Gynecology"
(http://journals.lww.com/greenjournal/Abstract/2011/06000/Term_Pregnancy__A_Period_of_Heterogeneous_Risk_for.5.aspx).Retrieved20120712.
24. Biswas,ASu,LLMattar,C(Apr2013)."Caesareansectionforpretermbirthand,breechpresentationandtwinpregnancies.".Bestpractice&
research.Clinicalobstetrics&gynaecology27(2):20919.doi:10.1016/j.bpobgyn.2012.09.002
(https://dx.doi.org/10.1016%2Fj.bpobgyn.2012.09.002).PMID23062593(https://www.ncbi.nlm.nih.gov/pubmed/23062593).
25. NationalCollaboratingCentreforWomensandChildrensHealth(November2011)."Caesareansection"
(http://www.nice.org.uk/nicemedia/live/13620/57162/57162.pdf)(pdf).NICE.RoyalCollegeofObstetriciansandGynaecologist.pp.70103.Retrieved
12June2014.
26. "Deliveryoftwins"(http://www.ncbi.nlm.nih.gov/pubmed/22713501).Retrieved20140611.
27. "Increasedperinatalmortalityandmorbidityinmonochorionicversusdichorionictwinpregnancies:clinicalimplicationsofalargeDutchcohortstudy"
(http://www.ncbi.nlm.nih.gov/pubmed/17999692).BJOG:AnInternationalJournalofObstetricsandGynaecology.Retrieved20140611.
28. "Increasedstillbirthinuncomplicatedmonochorionictwinpregnancies:asystematicreviewandmetaanalysis"
(http://www.ncbi.nlm.nih.gov/pubmed/23812469).Obstetrics&Gynecology.Retrieved20140611.
29. "Highperinatalsurvivalinmonoamniotictwinsmanagedbyprophylacticsulindac,intensiveultrasoundsurveillance,andCesareandeliveryat32weeks'
gestation"(http://www.ncbi.nlm.nih.gov/pubmed/17001748).Retrieved20140611.
30. "Perinataloutcomeandclinicalfeaturesofmonochorionicmonoamniotictwingestation"(http://www.ncbi.nlm.nih.gov/pubmed/23510453).Retrieved
http://en.wikipedia.org/wiki/Caesarean_section

20/27

17/3/2015

CaesareansectionWikipedia,thefreeencyclopedia

20140611.
31. "Monoamniotictwinsincontemporarypractice:asinglecenterstudyofperinataloutcome"(http://www.ncbi.nlm.nih.gov/pubmed/19718582).Retrieved
20140611.
32. "AcademicAchievementVariesWithGestationalAgeAmongChildrenBornatTerm"
(http://pediatrics.aappublications.org/content/early/2012/06/27/peds.20112157d.abstract?sid=b95d99e5556e45d38326e77459528363).Retrieved
20120712.
33. GCassady,(1971),"Effectofcesareansectiononneonatalbodywaterspaces",NewEnglandJournalofMedicine
34. Study:EarlyRepeatCSectionsPutsBabiesAtRisk(http://www.npr.org/templates/story/story.php?storyId=99132594).Npr.org(8January2009).
Retrievedon20110726.
35. "Highinfantmortalityrateseenwithelectivecsection"(http://www.medicineonline.com/news/12/6008/Highinfantmortalityseenwithelectivec
section.html).ReutersHealthSeptember2006.Medicineonline.com.14September2006.Retrieved20110726.
36. Althabe,FernandoTorloni,MariaReginaBetran,AnaPilarSouza,JoaoPauloWidmer,MarianaAllen,TomasGulmezoglu,MetinMerialdi,Mario
(2011)."ClassificationsforCesareanSection:ASystematicReview".PLoSONE6(1):e14566.doi:10.1371/journal.pone.0014566
(https://dx.doi.org/10.1371%2Fjournal.pone.0014566).ISSN19326203(https://www.worldcat.org/issn/19326203).
37. Lucas,DNYentis,SMKinsella,SMHoldcroft,AMay,AEWee,MRobinson,PN(Jul2000)."Urgencyofcaesareansection:anew
classification.".JournaloftheRoyalSocietyofMedicine93(7):34650.PMID10928020(https://www.ncbi.nlm.nih.gov/pubmed/10928020).
38. Vernon,David(2005).HavingaGreatBirthinAustralia.AustralianCollegeofMidwives.p.25.ISBN097516743X.
39. AmericanCollegeofObstetriciansand,Gynecologists(Apr2013)."ACOGcommitteeopinionno.559:Cesareandeliveryonmaternalrequest.".
Obstetricsandgynecology121(4):9047.doi:10.1097/01.AOG.0000428647.67925.d3(https://dx.doi.org/10.1097%2F01.AOG.0000428647.67925.d3).
PMID23635708(https://www.ncbi.nlm.nih.gov/pubmed/23635708).
40. NIH(2006)."StateoftheScienceConferenceStatement.CesareanDeliveryonMaternalRequest".ObstetGynecol107(6):138697.
doi:10.1097/0000625020060600000027(https://dx.doi.org/10.1097%2F0000625020060600000027).PMID16738168
(https://www.ncbi.nlm.nih.gov/pubmed/16738168).
41. VaginalBirthAfterCesarean(VBAC)Overview(http://www.webmd.com/baby/tc/vaginalbirthaftercesareanvbacoverview),WebMD
42. AmericanCollegeofObstetriciansand,Gynecologists(Aug2010)."ACOGPracticebulletinno.115:Vaginalbirthafterpreviouscesareandelivery.".
Obstetricsandgynecology116(2Pt1):45063.doi:10.1097/AOG.0b013e3181eeb251(https://dx.doi.org/10.1097%2FAOG.0b013e3181eeb251).
PMID20664418(https://www.ncbi.nlm.nih.gov/pubmed/20664418).
43. "NCHSDataBrief:RecentTrendsinCesareanDeliveryintheUnitedStatesProducts"(http://www.cdc.gov/nchs/data/databriefs/db35.htm#ref1).
CentersforDiseaseControlandPrevention.March2010.Retrieved20120616.
44. LeeHC,GouldJB,BoscardinWJ,ElSayedYY,BlumenfeldYJ(2011)."TrendsincesareandeliveryfortwinbirthsintheUnitedStates:19952008"
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202294).ObstetGynecol118(5):1095101.doi:10.1097/AOG.0b013e3182318651
(https://dx.doi.org/10.1097%2FAOG.0b013e3182318651).PMC3202294(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202294).PMID22015878
21/27

http://en.wikipedia.org/wiki/Caesarean_section

17/3/2015

CaesareansectionWikipedia,thefreeencyclopedia

(https://dx.doi.org/10.1097%2FAOG.0b013e3182318651).PMC3202294(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202294).PMID22015878
(https://www.ncbi.nlm.nih.gov/pubmed/22015878).
45. StarkM.Techniqueofcesareansection:MisgavLadachmethod.In:PopkinDR,PeddleLJ(eds):WomensHealthToday.Perspectivesoncurrent
researchandclinicalpractice.ProceedingsoftheXIVWorldCongressofGynaecologyandObstetrics,Montreal.ParthenonPublishinggroup,New
York,815
46. NabhanAF(2008)."Longtermoutcomesoftwodifferentsurgicaltechniquesforcesarean".IntJGynaecolObstet100(1):6975.
doi:10.1016/j.ijgo.2007.07.011(https://dx.doi.org/10.1016%2Fj.ijgo.2007.07.011).PMID17904561(https://www.ncbi.nlm.nih.gov/pubmed/17904561).
47. HudiI,BujoldE,FatuiZ,SkokiF,LatifagiA,KapidiM,FatuiJ(2012)."TheMisgavLadachmethodofcesareansection:astepforwardin
operativetechniqueinobstetrics".Arch.Gynecol.Obstet.286(5):11416.doi:10.1007/s0040401224486(https://dx.doi.org/10.1007%2Fs00404012
24486).PMID22752598(https://www.ncbi.nlm.nih.gov/pubmed/22752598).
48. Dahlke,JoshuaD.MendezFigueroa,HectorRouse,DwightJ.Berghella,VincenzoBaxter,JasonK.Chauhan,SuneetP.(2013)."Evidencebased
surgeryforcesareandelivery:anupdatedsystematicreview".AmericanJournalofObstetricsandGynecology209(4):294306.
doi:10.1016/j.ajog.2013.02.043(https://dx.doi.org/10.1016%2Fj.ajog.2013.02.043).ISSN00029378(https://www.worldcat.org/issn/00029378).
49. StarkM,ChavkinY,KupfersztainC,GuedjP,FinkelAR(March1995)."Evaluationofcombinationsofproceduresincesareansection".IntJGynaecol
Obstet48(3):2736.doi:10.1016/00207292(94)02306J(https://dx.doi.org/10.1016%2F00207292%2894%2902306J).PMID7781869
(https://www.ncbi.nlm.nih.gov/pubmed/7781869).
50. Dodd,J.M.Anderson,E.R.Gates,S.(2008).Dodd,JodieM,ed."CochraneDatabaseofSystematicReviews".
doi:10.1002/14651858.CD004732.pub2(https://dx.doi.org/10.1002%2F14651858.CD004732.pub2).|chapter=ignored(help)
51. Bamigboye,AAHofmeyr,GJ(Aug11,2014)."Closureversusnonclosureoftheperitoneumatcaesareansection:shortandlongtermoutcomes.".
TheCochranedatabaseofsystematicreviews8:CD000163.doi:10.1002/14651858.CD000163.pub2
(https://dx.doi.org/10.1002%2F14651858.CD000163.pub2).PMID25110856(https://www.ncbi.nlm.nih.gov/pubmed/25110856).
52. HawkinsJL,KooninLM,PalmerSK,GibbsCP(1997)."AnesthesiarelateddeathsduringobstetricdeliveryintheUnitedStates,19791990".
Anesthesiology86(2):27784.doi:10.1097/0000054219970200000002(https://dx.doi.org/10.1097%2F0000054219970200000002).PMID9054245
(https://www.ncbi.nlm.nih.gov/pubmed/9054245).
53. AfolabiBB,LesiFE,MerahNA(2006).Afolabi,BosedeB,ed."RegionalversusgeneralanaesthesiaforCaesareansection".CochraneDatabaseSyst
Rev(4):CD004350.doi:10.1002/14651858.CD004350.pub2(https://dx.doi.org/10.1002%2F14651858.CD004350.pub2).PMID17054201
(https://www.ncbi.nlm.nih.gov/pubmed/17054201).
54. BucklinBA,HawkinsJL,AndersonJR,UllrichFA(2005)."Obstetricanesthesiaworkforcesurvey:twentyyearupdate".Anesthesiology103(3):645
53.doi:10.1097/0000054220050900000030(https://dx.doi.org/10.1097%2F0000054220050900000030).PMID16129992
(https://www.ncbi.nlm.nih.gov/pubmed/16129992).
55. Smaill,FMGyte,GM(Jan20,2010)."Antibioticprophylaxisversusnoprophylaxisforpreventinginfectionaftercesareansection."
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4007637).TheCochranedatabaseofsystematicreviews(1):CD007482.
http://en.wikipedia.org/wiki/Caesarean_section

22/27

17/3/2015

CaesareansectionWikipedia,thefreeencyclopedia

doi:10.1002/14651858.CD007482.pub2(https://dx.doi.org/10.1002%2F14651858.CD007482.pub2).PMC4007637
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4007637).PMID20091635(https://www.ncbi.nlm.nih.gov/pubmed/20091635).
56. NationalCollaboratingCentreforWomen'sandChildren'sHealth(UK)."CaesareanSection"
(https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0050829/).NICEClinicalGuidelines,No.132.RCOGPress.Retrieved25May2014.
57. Kassebaum,NJBertozziVilla,ACoggeshall,MSShackelford,KASteiner,Cetal(May2,2014)."Global,regional,andnationallevelsandcauses
ofmaternalmortalityduring19902013:asystematicanalysisfortheGlobalBurdenofDiseaseStudy2013.".Lancet384(9947):9801004.
doi:10.1016/S01406736(14)606966(https://dx.doi.org/10.1016%2FS01406736%2814%29606966).PMID24797575
(https://www.ncbi.nlm.nih.gov/pubmed/24797575).
58. Mackeen,A.DhanyaPackard,RogerEOta,ErikaBerghella,VincenzoBaxter,JasonKMackeen,A.Dhanya(2014)."Timingofintravenous
prophylacticantibioticsforpreventingpostpartuminfectiousmorbidityinwomenundergoingcesareandelivery".doi:10.1002/14651858.CD009516.pub2
(https://dx.doi.org/10.1002%2F14651858.CD009516.pub2).
59. Hadiati,DRHakimi,MNurdiati,DSOta,E(Sep17,2014)."Skinpreparationforpreventinginfectionfollowingcaesareansection.".TheCochrane
databaseofsystematicreviews9:CD007462.doi:10.1002/14651858.CD007462.pub3(https://dx.doi.org/10.1002%2F14651858.CD007462.pub3).
PMID25229700(https://www.ncbi.nlm.nih.gov/pubmed/25229700).
60. Liabsuetrakul,TippawanPeeyananjarassri,KrantaratLiabsuetrakul,Tippawan(2011)."Mechanicaldilatationofthecervixatnonlabourcaesarean
sectionforreducingpostoperativemorbidity".doi:10.1002/14651858.CD008019.pub2(https://dx.doi.org/10.1002%2F14651858.CD008019.pub2).
61. "Focuson:caesareansectionNHSInstituteforInnovationandImprovement"
(http://www.institute.nhs.uk/quality_and_value/high_volume_care/focus_on:_caesarean_section.html).Institute.nhs.uk.8October2009.
62. "CaesareanSectionRatesRoyalCollegeofPhysiciansofIreland:"(http://www.rcpi.ie/News/Pages/CaesareanSectionRatesMatrixMarch2011.aspx).
Rcpi.ie.
63. "CsectionrateinCanadacontinuesupwardtrend"(http://www.canada.com/windsorstar/story.html?id=cd328013086c4ad7a03d6211b1cf1f2d).
Canada.com.26July2007.
64. "Topushornottopush?It'sawoman'srighttodecide"(http://www.smh.com.au/opinion/societyandculture/topushornottopushitsawomans
righttodecide2011010119ch2.html).TheSydneyMorningHerald.2January2011.
65. "Laclinicadeirecord:9neonatisu10naticonilpartocesareo"
(http://www.corriere.it/cronache/09_gennaio_14/clinica_cesareo_margherita_de_bac_83de8688e20411ddb22700144f02aabc.shtml).Corrieredella
Sera.14January2009.Retrieved20090205.
66. "SaglioccodenunciaboomdiparticesareiinCampania"(http://www.pupia.tv/campania/politica/3798/saglioccodenunciaboomparticesarei
campania.html).Pupia.tv.31January2009.Retrieved20090205.
67. http://www.asplazio.it/asp_online/tut_soggetti_deb/files/files_cesareo/09/TC_tot08_09.pdf
68. "Cesarei,allaMaterDeiilrecord"(http://www.tgcom.mediaset.it/cronaca/articoli/articolo438555.shtml=).Tgcom.mediaset.it.14January2009.
Retrieved20090205.

http://en.wikipedia.org/wiki/Caesarean_section

23/27

17/3/2015

CaesareansectionWikipedia,thefreeencyclopedia

Retrieved20090205.
69. PfuntnerA.,WierL.M.,StocksC.MostFrequentProceduresPerformedinU.S.Hospitals,2011.HCUPStatisticalBrief#165.October2013.Agency
forHealthcareResearchandQuality,Rockville,MD.[1](http://www.hcupus.ahrq.gov/reports/statbriefs/sb165.jsp).
70. "Births:PreliminaryDatafor2007"(http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf).NationalCenterforHealthStatistics.Retrieved
20061123.
71. http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf
72. MooreJE,WittWP,ElixhauserA.(April2014)."ComplicatingConditionsAssociateWithChildbirth,byDeliveryMethodandPayer,2011."
(https://www.hcupus.ahrq.gov/reports/statbriefs/sb173ChildbirthDeliveryComplications.jsp).HCUPStatisticalBrief#173.Rockville,MD:Agency
forHealthcareResearchandQuality.
73. "China'sCSectionRateHighestWorldwide,WHOStudySays,"(http://www.medicalnewstoday.com/articles/176128.php)MedicalNewsToday,15
January2010>
74. HomerCS,DavisGK,BrodiePM,SheehanA,BarclayLM,WillsJ,ChapmanMG(2001)."Collaborationinmaternitycare:arandomisedcontrolled
trialcomparingcommunitybasedcontinuityofcarewithstandardhospitalcare".BJOG108(1):1622.doi:10.1016/S03065456(00)00022X
(https://dx.doi.org/10.1016%2FS03065456%2800%2900022X).PMID11212998(https://www.ncbi.nlm.nih.gov/pubmed/11212998).
75. HodnettEDHodnett,Ellen(2000).Hodnett,Ellen,ed."Continuityofcaregiversforcareduringpregnancyandchildbirth".CochraneDatabaseSyst
Rev(2):CD000062.doi:10.1002/14651858.CD000062(https://dx.doi.org/10.1002%2F14651858.CD000062).PMID10796108
(https://www.ncbi.nlm.nih.gov/pubmed/10796108).
HodnettEDHenderson,Sonja(2008).Henderson,Sonja,ed."WITHDRAWN:Continuityofcaregiversforcareduringpregnancyandchildbirth".
CochraneDatabaseSystRev(4):CD000062.doi:10.1002/14651858.CD000062.pub2(https://dx.doi.org/10.1002%2F14651858.CD000062.pub2).
PMID18843605(https://www.ncbi.nlm.nih.gov/pubmed/18843605).
76. GoldstickO,WeissmanA,DruganA(2003)."Thecircadianrhythmof"urgent"operativedeliveries".IsrMedAssocJ5(8):5646.PMID12929294
(https://www.ncbi.nlm.nih.gov/pubmed/12929294).
77. "Csectionratesaroundglobeatepidemiclevels"(http://www.msnbc.msn.com/id/34826186/).AP/msnbc.com.12January2010.Retrieved
21February2010.
78. "WomencanchooseCaesareanbirth"(http://www.bbc.co.uk/news/health15840743).BBCNews.23November2011.
79. "ShouldtherebealimitonCaesareans?"(http://www.bbc.co.uk/news/10448034).BBCNews.30June2010.
80. Walsh,JosephA.(2008)."EvolutionandtheCesareanSectionRate".TheAmericanBiologyTeacher70(7):401404.doi:10.1662/0002
7685(2008)70[401:ETCSR]2.0.CO2(https://dx.doi.org/10.1662%2F00027685%282008%2970%5B401%3AETCSR%5D2.0.CO%3B2).ISSN0002
7685(https://www.worldcat.org/issn/00027685).
81. WilhelmGeiger(1908).TheDpavasaandMahvasaandtheirhistoricaldevelopmentinCeylon.EthelM.Coomaraswamy.H.C.Cottle,
GovernmentPrinter,Ceylon.p.40.OCLC559688590(https://www.worldcat.org/oclc/559688590).
82. LurieS(2005)."Thechangingmotivesofcesareansection:fromtheancientworldtothetwentyfirstcentury".ArchivesofGynecologyandObstetrics
http://en.wikipedia.org/wiki/Caesarean_section

24/27

17/3/2015

CaesareansectionWikipedia,thefreeencyclopedia

(Springer)271(4):281285.doi:10.1007/s0040400507244(https://dx.doi.org/10.1007%2Fs0040400507244).PMID15856269
(https://www.ncbi.nlm.nih.gov/pubmed/15856269).
83. SimaQian."(HouseofChu)"(http://www.guoxue.com/shibu/24shi/shiji/sj_040.htm).RecordsoftheGrandHistorian(inChinese).Retrieved
3December2011.
84. "St.RaymondNonnatus"(http://www.catholic.org/saints/saint.php?saint_id=314).CatholicOnline.Retrieved20060726.
85. Shahbazi,A.Shapur."RUDABA"(http://www.iranica.com/newsite/index.isc?Article=http://www.iranica.com/newsite/articles/sup/Rudaba.html).
EncyclopediaIranica.Retrieved20090719.
86. TORPINR,VAFAIEI(1961)."ThebirthofRustam.AnearlyaccountofcesareansectioninIran".Am.J.Obstet.Gynecol.81:1859.
PMID13777540(https://www.ncbi.nlm.nih.gov/pubmed/13777540).
87. WIKIPEDIARostam
88. Conner,CliffordD.,APeople'sHistoryOfScience::Miners,Midwives,And"lowMechanicks",pg3
89. BossJ(1961)."THEANTIQUITYOFCAESAREANSECTIONWITHMATERNALSURVIVAL:THEJEWISHTRADITION"
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1034600).Medicalhistory5(2):11731.doi:10.1017/S0025727300026089
(https://dx.doi.org/10.1017%2FS0025727300026089).PMC1034600(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1034600).PMID16562221
(https://www.ncbi.nlm.nih.gov/pubmed/16562221).
90. "CesareanSectionABriefHistory:Part2"(http://www.nlm.nih.gov/exhibition/cesarean/part2.html).U.S.NationalInstitutesofHealth.25June2009.
Retrieved20101127.
91. Pain,Stephanie(6March2008)."The'male'militarysurgeonwhowasn't"(http://www.newscientist.com/article/mg19726462.000historiesthemale
militarysurgeonwhowasnt.html).NewScientist.com.Retrieved16March2008.
92. "Woman'sIlls"(http://www.time.com/time/magazine/article/0,9171,815000,00.html).TimeMagazine.18June1951.Retrieved20090401.
93. MolinaSosaAGalvanEspinosaHGabrielGuzmanJValleRF(2004)."Selfinflictedcesareansectionwithmaternalandfetalsurvival.".IntJ
GynaecolObstet84(3):287290.doi:10.1016/j.ijgo.2003.08.018(https://dx.doi.org/10.1016%2Fj.ijgo.2003.08.018).PMID15001385
(https://www.ncbi.nlm.nih.gov/pubmed/15001385).
94. Segen,J.C.(1992).TheDictionaryofModernMedicine:ASourcebookofCurrentlyUsedMedicalExpressions,JargonandTechnicalTerms
(http://books.google.com/?
id=FbSlyyshjOoC&pg=PA102&dq=Caesarean+section+royal+law+Regia#v=onepage&q=Caesarean%20section%20royal%20law%20Regia&f=false).
Taylor&Francis.p.102.ISBN1850703213.Retrieved20121207.
95. "Caesareansection?:etymologyandearlyhistory"(http://www.sajog.org.za/index.php/SAJOG/article/viewFile/158/117),SouthAfricanJournalof
ObstetricsandGynaecology,August2009byPieterW.J.vanDongen
96. "AstherewasaculturaltabooagainstburyinganundeliveredwomaninRomanandGermansocieties,accordingtoLexCaesarea..."UHgberg,E
Iregren,CHSiven,"Maternaldeathsinmedievalsweden:anosteologicalandlifetableanalysis",JournalofBiosocialScience,1987,19:495503
CambridgeUniversityPress

http://en.wikipedia.org/wiki/Caesarean_section

25/27

17/3/2015

CaesareansectionWikipedia,thefreeencyclopedia

CambridgeUniversityPress
97. UniversityofVirginiaHealthSystem,ClaudeMooreSciencesHealthLibrary,AncientGynecology:CaesareanSection
(http://www.hsl.virginia.edu/historical/artifacts/antiqua/gynecology.cfm)
98. "BadMedicine:MisconceptionsandMisusesRevealed,"byChristopherWanjek,p.5(JohnWiley&Sons,2003)
99. "...couldnotsurvivethetraumaofaCaesarean"OxfordClassicalDictionary,ThirdEdition,"Childbirth"
100. "Caesarean|Caesarian,adj.andn.".OEDOnline.June2013.OxfordUniversityPress.13June2013<http://www.oed.com/view/Entry/26016>.
101. MerriamWebster(2003),MerriamWebster'sCollegiateDictionary(11theded.),Springfield,Massachusetts,USA:MerriamWebster,ISBN9780
877798095
102. Forasummary(inGerman),ofanarticle(alsoinGerman)thatdealsusefullywithmanyoftherelevanthistoricalandlinguisticquestionsraisedhere,
gohere[2](http://www.etymologie.info/~e/d_/demedizi.html#Kaiserschnitt).
103. http://www.priberam.pt/DLPO/cesariana
104. BlumenfeldKosinski,Renate(1991).Notofwomanborn:representationsofcaesareanbirthinmedievalandRenaissanceculture(1sted.ed.).Ithaca,
N.Y.:CornellUniversityPress.ISBN0801499747."Appendix:CreativeEtymology:CaesareanSectionfromPlinytoRousset"(pp.143153)
presentsanexcellenthistoryofthelegendofcaesareanbirthsinWesternculture.
105. Elsevier(2007).Dorland'sIllustratedMedicalDictionary(31sted.).Philadelphia:Elsevier.ISBN9781416023647.
106. SeeChokYaakov470:2KafhaChayim470:3http://www.torah.org/advanced/weeklyhalacha/5758/pesach.html
107. "PidyonHaBenDefinitionofPidyonHaBen(RedemptionoftheFirstborn)"(http://judaism.about.com/od/lifeevents/g/pidyonhaben.htm).
Judaism.about.com.19October2012.
108. "Kohanimforeverfromthesources,whoisacohen,theblessingoftheCohanim,.Mitvahofthecohen,Halacha,Templeservicegroups,pidyon
redemptionofthefirstborn"(http://www.cohenlevi.org/the_cohens_heritage/pidyon_ha_ben.htm).Cohenlevi.org.
109. "Truegrit:themumwhodeliveredherownbaby"(http://www.smh.com.au/articles/2004/06/01/1086037758224.html).TheSydneyMorningHerald.1
June2004.Retrieved4November2010.
110. MolinaSosa,AGalvanEspinosa,HGabrielGuzman,JValle,RF(2004)."Selfinflictedcesareansectionwithmaternalandfetalsurvival".
InternationalJournalofGynecology&Obstetrics84(3):287290.doi:10.1016/j.ijgo.2003.08.018(https://dx.doi.org/10.1016%2Fj.ijgo.2003.08.018).
PMID15001385(https://www.ncbi.nlm.nih.gov/pubmed/15001385).

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