Postmortem and perimortem cesarean section: historical, religious and ethical considerations

Area of Science:

• Medical History
• Surgical Procedures
• Obstetrics

Background:

• The term cesarean section (CS) was first used in 1598, with its name becoming universal in the 20th century.
• Historically, CS was primarily performed as a postmortem cesarean section (PMCS) to deliver a live infant from a deceased mother.
• Evidence suggests abdominal delivery practices existed across various cultures and religions, including ancient Jewish texts, Catholicism, and medieval Muslim countries.

Purpose of the Study:

• To explore the historical origins and evolution of the term and practice of cesarean section.
• To discuss the historical and contemporary applications of postmortem CS (PMCS) and perimortem CS (PRMCS).
• To examine the ethical and legal considerations surrounding PMCS and PRMCS.

Main Methods:

• Historical literature review examining ancient texts, religious books, and medieval records.
• Analysis of surgical practices and their cultural/religious contexts.
• Discussion of contemporary medical guidelines and ethical frameworks for emergency obstetric procedures.

Main Results:

• Cesarean section has a long history, with PMCS being a significant early application.
• Islamic rulings historically supported PMCS, and contemporary guidelines recommend PRMCS for maternal cardiac arrest.
• Emergent PRMCS within four minutes of CPR initiation is believed to enhance maternal survival and neonatal neurological integrity.
• Physicians are generally not held legally liable for outcomes of PMCS and PRMCS.

Conclusions:

• Cesarean section, particularly PMCS and PRMCS, has evolved significantly from ancient practices to modern emergency interventions.
• PRMCS is a critical intervention in cases of maternal cardiac arrest, offering improved survival chances for both mother and neonate.
• Ethical considerations, including the performance of PMCS on brain-dead individuals, require careful deliberation.