Caesarean and postpartum hysterectomy

To review the cases of caesarean and post-partum hysterectomy performed over a 10-year period (1986-1996) in a teaching hospital, looking specifically at the associated morbidity.

Retrospective review of case files.

During the study period, there were 14 cases of caesarean and post-partum hysterectomy. Caesarean hysterectomy was performed in 0.17% of caesarean sections and a hysterectomy was done in 0.02% of cases following a vaginal delivery. Uterine atony was associated with 43% of cases. Histological evidence of placenta accreta or increta was noted in 7 (50%) cases, while 8 (57%) cases had placenta praevia. A subtotal hysterectomy was performed in 7 cases, where the mean operating time was significantly shorter than that in cases of total hysterectomy. There were no maternal deaths. Fever (28%), urinary tract infection (21%) and chest infection/atelectasis (21%) were the common post-operative morbidity. Relaparotomy for continuing vaginal bleeding was required in 2 cases.

Emergency peri-partum hysterectomy for obstetric haemorrhage is a rare operation (1 in 2,550 deliveries). In spite of the intra-operative risks and post-operative morbidity, it remains a potentially life-saving procedure.