Caesarean section is a surgical procedure in which the fetus and its appendages are delivered through an incision in the abdomen and uterine wall of the pregnant woman. The German Desopo definition is more precise: “Any cesarean section in which the uterus is opened and a fetus weighing 500 g or more is removed is called a cesarean section, whereas a fetus weighing less than 500 g is called a hysterotomy”. However, before the invention of blood transfusions, anesthesia and antibiotics, the procedure itself was very dangerous and was often used to save dying women and fetuses. Cesarean delivery accounted for only about 3% of the different types of deliveries in the country in the 1950s. However, in recent years, the rate of cesarean deliveries in the country has surprisingly exceeded that of natural deliveries, and the World Health Organization’s opinion is that the rate of cesarean deliveries should not exceed 15%. Cesarean delivery without indication is named as social factor, precious child or cut expectant child on the first page of the discharge medical record, lamenting that I had to spend my spare time reviewing the history about cesarean delivery! The history of caesarean section is distant and splendid, and can be said to run through the entire history of obstetrics. It can be roughly divided into the period of myths and legends, the period of cesarean delivery in the body of the uterus, and the period of cesarean delivery in the lower part of the uterus. The myths and legends are as follows: The ancient civilizations have all left behind magical legends about cutting open the belly and removing the fetus. According to Greek mythology, Asclepius, the god of medicine (Asclepius) is by his father Apollo, the sun god (Apollo) from his mother, Princess Thessaly Coronis (Coronis) of the womb, after giving birth to Asclepius, his mother left the world. According to the scripture story, Buddha Jodharma? Prince Siddhartha was born from the right rib of Mrs. Moya, and his mother died of illness just seven days after Siddhartha’s birth. After all, myth is a myth, caesarean section in the end when the origin, it is difficult to test. Our “Historical Records? The tenth volume of “The Family of Chu” records an event around 2400 B.C.: “Wu Hui gave birth to Lu Jian. Lu finally gave birth to six sons, chap and give birth. Its long one said Kun Wu; two said Sen Hu; three said Peng Zu; four said Hui Ren; five said Cao surname; six said Ji Lian, L surname, Chu its descendants.” The Book of Jin? Four yi biography? Yanqi State” contains ” An lady cunning Hu’s daughter, expecting a body for 12 months, cut open the birth of a son, said will, established as the son of the world.” Caesarean section is also recorded in the Susruta-samhita, a great Indian medical work written around the 4th century B.C. In the West, the German word for cesarean section is Kaiserschnitt (literally: Emperor’s section); the English name “Caesarean Section” is derived from ” Caesarea” is derived from “Caesarea”. The English name “Caesarean Section” is derived from “Caesarea”. To be interpreted literally, both mean “emperor’s section”, and Japanese and Korean also translate this way. American English uses e instead of ae in the first syllable of Caesarean, which is converted to Cesarean, while British still retains this syllable. The relationship between the operation and the Roman emperor or Caesar (Gaius Julius Caesar, 102.7.13 BC-44.3.15 BC) has been variously described: the Caesarean section was originally performed on the body of a pregnant woman. Numa, the ancient European Roman, 715-672 B.C.E. Numa Pompilius, who founded the Senate and the priesthood, promulgated a law known as the Lex Caesarea (Caesarean Law). According to this law, the uterus of all pregnant women who were full term and about to give birth and who were critically ill was to be cut open to remove their fetus. It was also stipulated that if a pregnant woman and her fetus died, the mother and the fetus should be buried separately. According to Pliny the Elder’s (23-79) Natural History, Julius Caesar or one of his ancestors gave birth by this operation. However, Julius Caesar’s mother (Aurelia Cotta) died when Caesar was forty-five years old, so Caesar himself would not have given birth by Caesarean section. There is also a reference to the Latin word for “cutting” (caedere and seco), which turns out to be related to Julius Caesar, but it is just an association. Caesarean section was described in the writings of Galen (129-199), a Roman court physician, who also admitted that it was not his invention. There are some scattered records of early caesarean sections of dying women, which were also called last resort for religious reasons to save the fetus. The Catholic saint (Raymond Nonnatus (1204-1240), whose Latin name natus derives from his birth “not born”; the birth of Robert II of Scotland by cesarean section in 1316, just after the death of his mother (Marjorie Bruce); these events gave Shakespeare (1564-16) the opportunity to give birth to his son. These events inspired Shakespeare (1564-1616) to write Macbeth, one of the four great tragedies. In the play, the witches prophesied that Macbeth would become emperor, and also that none of woman born shall harm Macbeth. But Macduff broke the spell and killed Macbeth because he was cut out of his mother’s womb before he was full term. The play “Macbeth” was also adapted for public performance by the Shanghai Kun Theatre as “The Blood Hand”. Caesarean sections on living mothers were rare but not unheard of before the Middle Ages (c. 476 to 1453 A.D.). In 1500 AD, a Swiss butcher (Sowgelder) who specialized in pig castration is said to have given birth to his wife by Caesarean section when 13 midwives were helpless, and then to have given birth five times normally. However, this legend is not substantiated, and it is likely that the Laparotomy for abdominal Pregnancy Speert, otherwise she would not have escaped uterine rupture. Coincidentally, the same year, the same thing happened to a woman named Jacob Nufer. The same year, the same thing happened to a German castrator named Jacob Nufer, and his wife survived until after the normal delivery of the second child. It is probably not unreasonable that the veterinarian was familiar with anatomy. However, it is not entirely excluded that mistakes such as “Lu fish di tiger, three boars wading in the river” occurred in the transcription of Latin literature. The anatomical development was promoted by the Renaissance of the 14th and 16th centuries, when anatomy was developed by the likes of Michelangelo (1475-1564) and Leonardo da Vinci (1475-1564). Leonardo da Vinci was a master of anatomy, and his atlas of anatomy is so precise that it can be seen in his “Fetus in the Womb”; Vesalius (1514-1564), a physician from the Netherlands, wrote a systematic book called “The Structure of the Human Body” (1543). In 1540, C. Maini performed a successful caesarean section on a healthy pregnant woman, and in 1580, F. Rousset collected 15 successful cases of caesarean section. The first Italian book on obstetrics (Mercurio, 1596) advocated the management of a narrow pelvis by caesarean section. The real and reliable source is the book of 21 April 1610, by two surgeons, Jeremiah Trautman, and the Italian surgeons of the same name. Trautman and Gusth were in Wittenberg, Germany, where Martin Luther’s Reformation originated. They performed a cesarean section on a live woman in Wittenberg, Germany (the birthplace of the Reformation of Martin Luther), where the uterine incision was left open and the bleeding was stopped only by the natural contraction of the uterine muscles. The woman died 25 days after the operation, due to bleeding and infection, but the baby lived for nine years. Later, in 1689, Jean Ruleau of Sainaes, France, died of hemorrhage and infection. In 1689, Jean Ruleau of Sainaes, France, performed a successful cesarean section on a pregnant woman with rickets, and both mother and baby lived. The first successful case in the United States was performed by Jesse Bennett (1769-1842), a Virginia physician, on his wife in 1794, using tincture of opium for pain relief and linen sutures, and both mother and child were safe. 1852 saw the switch to silver sutures for closing the uterine incision by Pauline in the United States. Other early American caesarean practitioners included Brodie, S. Herndon, W.G. Smith, and C. Mills, who performed a second operation on the same woman in 1856 and 1857, respectively. This high mortality rate was such that caesarean sections were strongly opposed by advocates of fetal dismemberment. Even in 1870, the German pathologist R. Virchow reported 40 deaths by cesarean section. It is no wonder that in the 17th century, the famous French obstetrician Mauriceau even believed that “to perform a cesarean section was to kill the mother”, and that there was a coalition against cesarean delivery. The advent of modern anesthesiology in the 19th century paved the way for obstetric operations, and in 1853 the British obstetrician Simpson gave birth to Prince Leopoldo to Queen Victoria painlessly using chloroform. On May 21, 1876, the Italian obstetrician Eduardo Porro (1842-1902) of Pavia He performed a cesarean section on a short, 25-year-old woman with a rickets pelvis, also under chloroform anesthesia, whose uterine incision was made from left to right, diagonally across the base of the uterus, with great difficulty in delivering the fetus. The uterus was then simply removed from 2 cm above the endometrium, along with the left fallopian tube and ovary. Later, a small cyst was found on the right ovary, which was also removed. A drainage tube was extended from the cervix and the cervical stump was sewn to the lower corner of the extraperitoneal wound on the abdominal wall. The abdominal wall incision was closed with four silver sutures through the incision. Although the patient could not get up until a month later, death due to bleeding and infection was avoided. This became a major advance in the management of obstructed labor, and Harris (1881) counted 50 cases of this operation, with a maternal mortality rate of 58% and an infant survival rate of 86%, a significant increase over the previous one. However, women who had such a cesarean section would lose the possibility of pregnancy forever. Most recent indications for Porro’s surgery are obvious prenatal uterine infections and removal of the uterus to remove the source of the inflammation. With the development of surgical asepsis and suturing techniques, Max Sönger (1853-1903) of Leipzig, Germany, pioneered the “conservative or classical cesarean section” based on his American counterpart in 1882. “This was an important twist in the history of cesarean section, in which a longitudinal incision was made at the base of the uterus to remove the fetus and suture the uterus, preserving the uterus. John Cooke performed the first classical cesarean section in Australia in 1888 at the Alfred Hospital in Melbourne because the patient had a cyst in her vagina that prevented a normal delivery; the woman survived, but the baby died of enterocolitis soon after. The first cesarean section was performed by J.M. Swan in 1892 in Guangdong Province, China. The operation was performed in Guangzhou, China. The woman was 29 years old, in her third child, and the cesarean section was performed due to obstruction of the birth canal by a chondroma in the pelvis, with three silk ligatures in the bleeding area and three stitches in the incision of the uterus, all of which were exposed outside the abdomen for cutting. The fetus, weighing four and a half pounds, survived, but the mother died of a pelvic abscess. at the end of the 19th century, surgical anesthesia and analgesia techniques were introduced, and cesarean delivery became safer. However, the uterine body cesarean section is more prone to rupture of the uterine incision scar due to thick walls, rich vascularity and bleeding, poor healing of the uterine incision, high incidence of postoperative intestinal distention and intestinal paralysis, and repeat pregnancies. The lower uterine segment or low cervical cesarean section was designed and advocated by Qsiander in 1805, but was not given much attention. In 1907, Frank first applied the extraperitoneal operation with a transverse incision of the wall peritoneum, followed by incision of the bladder peritoneal reflex, closure of the peritoneal cavity by suturing the upper edge of the wall peritoneum to the upper edge of the dirty peritoneal incision, and then incision of the lower uterine segment to reduce the chance of peritonitis in infectious cases. In 1908, Hugo Sellheim (1871-1936) made a detailed analysis of the relationship between the lower uterine segment and its surrounding tissues and pointed out the advantages of using this non-contracted part for easy suturing, less bleeding and faster healing. This provided the basis for the improvement of extraperitoneal cesarean section. In the same year, W. Latzko (1861-1944) devised a method of exposing the lower segment of the uterus by dissection from the lateral fossa of the bladder, which was later improved and described by Norton and others as the lateral entry extraperitoneal cesarean section. In 1940 Waters (1898-?) also found a way to access the lower uterine segment by stripping from the top of the bladder, known as the parietal extraperitoneal cesarean section. Although extraperitoneal cesarean delivery played an important role in preventing infection, it still had many disadvantages, such as complicated operation and easy damage to the bladder. Krönig analyzed the features of extraperitoneal cesarean delivery as the use of the non-contracting lower uterine segment and the covering of the incision with the peritoneum. In 1912, he applied this principle and proposed the incision of the uterine vesica-peritoneal reflex to expose the lower uterine segment for cesarean extraction and suturing of the uterine vesica-peritoneal reflex to cover the uterine incision, but he made a longitudinal incision in the lower uterine segment at that time. It was not until 1926 that Dr. Kerr invented the transverse incision of the lower uterus, which is widely used in modern obstetrics. In China, Wang Shuzhen first performed an extraperitoneal cesarean section in 1954 in Shanghai, and in 1995, Peng Peng reported a summary of “extraperitoneal finger separation cesarean section”, which uses the finger to bluntly separate the bladder outside the peritoneum, combining the advantages of the top entry, side entry, top-lateral combination and hierarchical separation methods, from the high transverse abdominal fascia to the bladder fascia, and then pushing the bladder After pushing the top edge of the bladder downward, the bladder is separated from the peritoneum via the left posterior peritoneal fold with a preference for the “small triangle” of the left edge of the bladder, allowing rapid and adequate exposure of the uterus. The finger-splitting method does not require bladder filling and causes little bladder irritation, which increases the safety of the procedure. This method is indicated for all intraperitoneal cesarean deliveries except in cases of cesarean exploration, and is used with caution for placental abruption and is contraindicated for ruptured uterus with preeclampsia. In 1994, at the World Congress of Obstetrics and Gynecology held in Montreal, Canada, Professor Michael Stark of Israel presented his new method of cesarean section, which was named “Misgav-Ladach method” after his hospital, and was also described in the literature as “In 1996, “Misgav-Ladach cesarean section” was introduced to our country and was referred to as M-L cesarean section or Mi-La cesarean section. It simplifies the surgical procedure by adopting a modified lower transverse abdominal wall incision (Joel-Cohen incision), which is 2-3 cm higher than the traditional Pfannenstiel incision to avoid the conus muscle below the rectus abdominis muscle, facilitating the tearing of subcutaneous tissues, muscles and peritoneum, allowing the blood vessels and nerves to be preserved with their own elasticity, with less tissue damage and 2-3 wide sutures for the whole layer of skin and subcutaneous fat. It is less damaged, and the skin and subcutaneous fat are sutured with 2-3 stitches at a wide distance, with less bleeding, which is conducive to wound healing and scar formation, without suturing the peritoneum to reduce adhesions, and compared with the previous operation, the fetus is delivered faster, often within a minute, and the whole operation is as short as 10 minutes, with less postoperative pain and earlier exhaustion, and the stitches are removed 5 days after the operation, reducing medical costs. It has been widely performed in more than 20 countries around the world and in China. If the uterine wall and body cavity are cut before pregnancy for various reasons (including previous cesarean delivery), it is called scarred uterus. The management of patients with a previous caesarean scar poses a dilemma in the world of obstetrics (The management of patients with a previous caesarean scar poses a dilemma). There is also a history of recognition of repeat cesarean section. Given the high risk of rupture of the scarred uterus after a cesarean section, and the lack of blood banks and fetal monitoring at the time, it was not possible to perform a repeat cesarean section. On May 12, 1916, Edwin Bradford Craigin told his famous dictum: “Once a cesarean, always a cesarean” at the Eastern Medical Association in New York. In recent years, with the development of incisions in the lower uterine segment, antibiotics, anesthesia and blood transfusion techniques, vaginal birth after caesarean section (VBAC) has been successfully practiced. The possibility of vaginal delivery is higher if the opening is already 4 cm at the time of first cesarean section. This also suggests that E’s maxim is no longer relevant. From September 21-27, 1982, the Society of Obstetrics and Gynecology of the Chinese Medical Association held a national symposium on perinatal medicine in Shanghai. According to the international practice, the participants considered that cesarean section refers to the delivery of a fetus ≥ 28 weeks of gestational age or weight ≥ 1000g (equivalent to preterm birth, full-term birth, and overdue birth) by incising the uterine wall through the abdomen. This criterion was adopted to facilitate clinical work and to facilitate the statistics of operative rates and maternal and infant mortality. There was also an anecdote at the beginning of the century. On March 5, 2000, a peasant woman named Inés Ramírez Pérez (1960- ) in Oaxaca, Mexico (the birthplace of Mexican corn), who had no medical training, performed a fairly successful cesarean section on herself. The nearest midwife was 50 miles away. After 12 hours of pain, and to avoid another stillbirth, she drank some strong alcohol and decided to perform her own cesarean and cut 17 cm along the right side of her belly button from the rib cage to the pubic bone (bearing in mind that the bikini-line incision for a cesarean is only 10 cm). When the baby came out, she cried at once. She tied her bleeding stomach with her clothes and called her 6 year old son out for help. She eventually traveled 8 hours by car to the nearest hospital, and 16 hours later, she underwent a surgical incision repair. 7 days later, doctors repaired the intestines she had accidentally injured during her own surgery. Fortunately, Inés was discharged from the hospital 10 days later. Her frightening case was written up in the International Journal of Obstetrics and Gynecology in 2004 and is believed to be the only woman known to have performed a cesarean section on herself. Fortunately, Inés says she does not advise other women to follow her example. I would like to say a few more words about cesarean delivery and caesarean section: Professor Jiang Sen of Shandong, who has learned from the East and the West, and has a deep knowledge of the Chinese language, often uses words with great care, and first of all suggests that the word caesarean section is inappropriate and should be changed to cesarean delivery (Long Jinghe). In fact, there should be a difference between the two. Cesarean section is to cut open the uterus to deliver the fetus, and it is not necessary to cut open the peritoneal cavity. Most of the surgical methods need to cut open the abdomen first and then cut open the uterus, such as uterine body cesarean section and lower uterine section, but extraperitoneal cesarean section is not to cut open the peritoneal cavity, so strictly speaking it does not belong to cesarean section. In addition, there are rare abdominal pregnancies that require cesarean delivery without dissection of the uterus. Therefore, cesarean delivery and caesarean section are not exactly the same thing. Hence the derivation of terms such as cesarean extraction, cesarean extraction, and cesarean delivery. Of course it also depends on the understanding of the word abdomen, is it the abdominal wall, the abdominal cavity or the peritoneal cavity? There is no need to overly chew on words, as not every term in the medical field is perfect. In obstetrics, the term “cesarean section” seems to be more reasonable and elegant than cesarean delivery. Cesarean section has gone through several stages of development, including cadaveric cesarean section, cesarean section without sutures, Porro’s cesarean hysterectomy, classical cesarean section, transabdominal extraperitoneal cesarean section, extraperitoneal cesarean section, lower uterine cesarean section, and new cesarean section. In modern obstetric clinics, various procedures are becoming more and more perfect, and cesarean section has become one of the important means to solve difficult labor. The cesarean rate has increased rapidly over the past 20 years, from 2% in Europe 20 years ago to 20% today. 29.4% in Australia in 2004, compared to 19.3% in 1995. In the United States, it was 31.8 percent in 2007. Due to public misconceptions, Brazil has the highest publicly reported cesarean rate, with public hospitals at 35% and private clinics at nearly 80%. This situation is also particularly striking in our country, where it is as high as 70% or even higher in some areas. Although the prognosis of mothers and infants has been improved to some extent, cesarean delivery is after all a non-physiological mode of delivery, and some retrospective analyses of large samples of data now show that when the cesarean rate rises to a certain level and then blindly increases the cesarean rate, the maternal and perinatal morbidity and mortality rates will not continue to decrease, but rather the adverse effects of some surgical complications on the health of mothers and infants will be clearly evident. In Shanghai, a summary of maternal mortality by cesarean section in the city over the past 20 years shows that the relative risk (RR) of maternal death increases as the cesarean section rate decreases below 20%; above 30%, the RR increases as the cesarean section rate increases, and the RR is smallest between 20% and 30%. Most scholars believe that a cesarean delivery rate of 20% – 30% is appropriate. The risk of maternal or neonatal complications during or after a cesarean section without an indication is high. Therefore, as obstetricians, we should teach the public to correctly understand the advantages and disadvantages of cesarean delivery, popularize the knowledge of pregnancy and childbirth, and create favorable conditions for natural delivery; strive to improve the technical level, strictly master the indications for cesarean delivery, and reduce the rate of cesarean delivery; reasonably apply antibiotics to maximize the health of mother and child, so as not to bring unnecessary pain to the mother and child.