Obstetric hysterectomy--an 11-year experience

A total of 31 women had obstetric hysterectomy at St Mary's Hospital, Manchester, between 1972 and 1982. Elective caesarean hysterectomy was performed on nine occasions mainly because of preexisting gynaecological problems such as fibroids or menorrhagia. Emergency hysterectomy most frequently followed uterine rupture, postpartum bleeding and major degrees of placenta praevia. The majority of patients required blood transfusion but postoperative problems were few. Late complications included infected discharge and cyclical bleeding after subtotal hysterectomy. There was one neonatal death but no maternal deaths. Although the operation is usually straightforward, and no major technical problems, such as urinary tract injury occurred, the decision to perform it as an emergency must be made before the patient's condition is extreme; the availability of senior staff is important.