The Porro procedure: steps toward decreasing post-cesarean mortality

In the second part of the 19th century, maternal mortality following classical cesarean section was nearly 100%. In 1876, the Italian obstetrician, Eduardo Porro, developed a cesarean section technique consisting of uterine corpus amputation and suturing of the cervical stump into the abdominal wall incision in an attempt to prevent life-threatening hemorrhage and infection. The successful outcome in Porro’s test case was due to his adherence to surgical principles that are well recognized today, but were not firmly established in 1876. He achieved hemostasis by use of the occluding snare of Cintrat. He irrigated the peritoneal cavity with carbolized sponges, drained the operative bed, and exteriorized the cervical stump in an effort to prevent access of bacteria from the lower genital tract into the peritoneal cavity. Despite the lack of blood products, intravenous fluids, and antibiotics, the Porro operative technique subsequently decreased maternal mortality to 58%. His innovative, carefully planned approach for cesarean hysterectomy was a major innovation in obstetric surgery.