Return to theatre--experience at the Mercy Maternity Hospital, Melbourne 1971-1982

This paper summarizes the problems which necessitated return to theatre at the Mercy Maternity Hospital, 1971-1982. There were 154 of 29,488 patients (0.5%) having obstetrical or gynaecological treatment in theatre who made this journey. They all survived, some after heroic resuscitative measures. Haemorrhage necessitated the patient's return to theatre following 0.2% of Caesarean sections and 0.2% of gynaecological operations. Many obstetric patients who return to theatre are potential maternal deaths. The assistance of an experienced colleague is essential in their management. When massive or continuing haemorrhage occurs at Caesarean section, hysterectomy should be considered, especially if the placenta appears to be morbidly adherent, these being the very patients at risk of a return to theatre if hysterectomy is not performed. With the increasing Caesarean section rate, placenta praevia accreta has become more common, to the extent that ultrasonographic localization of the placenta is recommended in all patients who have had a previous Caesarean section. Curettage is not indicated in the treatment of primary postpartum haemorrhage after Caesarean section; moreover, its performance in the management of secondary postpartum haemorrhage when the patient was delivered by Caesarean section should be regarded as a formidable procedure. When a patient who was delivered vaginally returns to theatre because of continuing haemorrhage after curettage performed for secondary postpartum haemorrhage hysterectomy is likely to be required. Safe methods of suturing the lower uterine segment incision at Caesarean section, and the lateral angles of the vaginal vault after abdominal hysterectomy are described.