EVOLUCIÓN HISTÓRICA DE LA CESÁREA: IMPLICACIONES MÉDICAS Y ÉTICAS

Abstract

Since the first publications on caesarean section, it has become as a useful procedure to save the newborn’s life, being a real alternative to craniotomy and forceps. Its improvement needed the development of practical solutions to three major dilemmas, such as pain, infection and hemorrhage, through the use of anesthesia, antisepsis and better surgical techniques, especially during the second half of the 19th century, when the cesarean section became a real alternative to craniotomy for cases of absolute and relative pelvic disproportion, as well as by the appearance of new indications such as pelvic contractures, tumors, scars and inflammatory deposits. The improvement of surgical techniques is due to three great physicians: Edoardo Porro, Max Sänger and Ferdinand Kehrer, whose contributions are widely recognized as key points for the development of the modern cesarean operation. In Ecuador, Dr. Isidro Ayora Cueva should be mentioned as the surgeon of the first cesarean section with a transverse incision in the lower uterine segment carried out in our country in 1932. The reduction of maternal mortality by the use of cesarean section has been accompanied by an increase in its incidence, in some cases by not very clear medical or obstetrical indications or by non-medical reasons, which highlights the need to have practical guidelines for its implementation, as well as consideration of the ethical aspects involved, in order to fulfill with its rational and justified use.