[Peripartal hysterectomy--definition, follow-up and risk]

39 peripartal hysterectomies from 1983 to 1993 were divided into three groups. Indication, post-operative development and complications were analysed. The first group contains the planned Caesarean section hysterectomies. The patients (n = 18) in this group hat the smallest blood loss and fewest complications. The second group includes the hysterectomies after Caesarean section without emergency (n = 8). The main reason was the rupture of the uterus without clinical signs during delivery. The complication rate of this group was also low. In the third group all operations were performed for vital risk of the patient (n = 13). Complications as placenta accreta (n = 8) or atonal bleeding of the uterus (n = 5) ended up in hysterectomy (eight after vaginal deliveries, five after Caesarean section). In this group we could observe a high blood loss as well as a high rate of complications. The prognosis of the patient depends on blood loss per time period, the dynamic of the bleeding. The mortality was higher in the group where patients needed a relaparotomy because of bleeding partially as a cause of clotting disorders. The most important task is to prevent shock situations by early sufficient blood transfusion. Because of the higher mortality of relaparatomy selective angiographic arterial embolisation should be considered.