The conquest of cesarean section-related infections: a progress report.

More than a century ago, Robert P. Harris demonstrated convincingly that death from infection after cesarean section could be reduced significantly by operating early, rather than after several days of labor, by using aseptic surgical technique, and by closing the uterine incision. For the most part, his advice was ignored and the mortality rate remained high, except in hospitals with well-organized and well-controlled obstetric services. Although the incidence of total infections has been decreased by the use of prophylactic antibiotics, too many serious infections and maternal deaths still occur. These can be reduced by proper management of labor, by recognizing the need for cesarean section early, by using alternative methods for delivery when appropriate, by meticulous surgical technique, and by selective use of prophylactic antibiotics. These changes are not likely to occur unless care of obstetric patients is assumed by experienced obstetricians who are prepared to recognize and correct abnormal labor early and to perform instrumental extraction and vaginal breech deliveries rather than cesarean section in carefully selected patients.