Peripartal hysterectomy

Peripartal hysterectomy remains a necessary tool for the consultant obstetrician. Knowledge of this operation and skill at its performance can save lives in the rare event of catastrophic rupture of the uterus or intractable postpartal hemorrhage. The operation can also be utilized to address gynecologic conditions that coexist with obstetrical indications for abdominal delivery. As one expands the indications for peripartal hysterectomy beyond this realm, to the performance of cesarean hysterectomy to address minor gynecologic disorders or for sterilization without coexisting indications for abdominal delivery, one goes further into the realm of controversial indications. A good case can be made for low morbidity, infrequent transfusion, and effectiveness of the operation for the latter indications, especially in the hands of obstetricians who perform this operation regularly and have developed an operating "routine." The operation can be done with minimal morbidity in elective cases; whether it should be done remains a decision best made within the individual physician-patient relationship. Peripartal hysterectomy can be a formidable operation, particularly when performed under the emergency conditions of massive blood loss and distorted anatomic relations. The operation is not easily accomplished by the operator who performs it only on rare occasions. The best time to learn the nuances of the procedure is during the performance of planned, elective cases, wherein the surgeon can pick the assistants and tools and carefully evaluate the patient and prepare the operating team. A routine established in this teaching and learning climate will serve well when the critical emergency case arises. Every obstetric service should have access to a surgical team capable of performing emergency peripartal hysterectomy.(ABSTRACT TRUNCATED AT 250 WORDS)