Clinical Pearls. (Cesarean Section).

This is the fourth Clinical Pearls column devoted to cesarean delivery. The emphasis on this procedure seems reasonable, since it remains the most commonly performed major operation in the United States.

The National Center for Health Statistics recently reported that the cesarean rate jumped 7% to 24.4% in 2001, the highest rate ever. But this maybe only the beginning. I predict that when the 2002 cesarean data are released they will reveal that we have surpassed the 1 million mark for the first time in history. Regardless of whether you think this trend is good or bad, you will probably agree that we are going to be doing large numbers of cesarean operations.

With that in mind, here are more pearls aimed at making those operations go well. Incidentally, all my previous Pearls columns, including the columns on cesarean section mentioned above, can now be accessed on the OB.GYN. NEWS Web site (www.eobgynnews.com) by going to the Archive Collection on the right side of the home page and clicking on "Clinical Pearls."

* Section the primip first.

This pearl obviously applies only when you have two patients in labor who are candidates for nonemergent cesarean.

Actually the whole pearl is this: All other things being equal, section the primip first. In other words, if you have two patients who are both making equivalent progress for their respective parity and are at approximately the same dilatation, and you conclude that both are probably going to need a cesarean, it may be prudent to recommend cesarean for the primipara. Many times the multipara will surprise you and be crowning and ...