Bayer H
Zentralbl Gynakol. 1983;105(7):401-10.
Starting point of this survey is the 1954 paper about obstetrical operations from H. Kraatz. It is demonstrated, that there were and there are defined principles, which continue to exist unchanged. They are the fundamentals of indication and technique of operations in obstetrics. Nevertheless there are distinct changes, too, caused by two factors, progress in medicine (development of antibiotics, anaesthesiology and neonatology) as well as change of aspect in obstetrics (e.g. toxemias of pregnancy, preterm labour). The methods are discussed in detail. Operations by vaginal route come in the foreground in the last years more again. They should be preferred in maternal interest. The enlarged indication for caesarean section was not able to succeed on a large scale. An uniform procedure is proposed both in cephalic and breech presentation, and the new formulated preconditions to these operations are discussed. All three techniques two abdominal ones and one vaginal one) are demanded in caesarean sections, because they come into question in special situations. There is a change in operative indications in cases of bleeding, because of an early diagnosis by ultrasound. The qualification and experience of the obstetrician is more decisive than the selected method of operation or the instrument's type. Therefore there should not be any cut in instruction and training. The versatility of operative technique is a prerequisite to a qualified indication.
本次调查的起点是H. 克拉茨1954年发表的关于产科手术的论文。结果表明，过去和现在都存在一些既定原则，这些原则一直未变。它们是产科手术指征和技术的基础。然而，也有明显的变化，这是由两个因素导致的，医学的进步（抗生素、麻醉学和新生儿学的发展）以及产科观念的转变（例如妊娠中毒症、早产）。文中对这些方法进行了详细讨论。近年来，经阴道手术再次成为重点。出于对产妇的考虑，应优先选择此类手术。剖宫产指征扩大的做法未能大规模成功。文中针对头先露和臀先露情况都提出了统一的手术步骤，并讨论了这些手术的新制定前提条件。剖宫产需要三种技术（两种腹部技术和一种阴道技术），因为它们在特殊情况下都有用武之地。由于超声能够早期诊断，出血病例的手术指征发生了变化。产科医生的资质和经验比所选的手术方法或器械类型更具决定性。因此，培训指导不应有任何削减。手术技术的多样性是做出合理指征的前提条件。
