Elective Caesarean Hysterectomy. Indications and Outcome: A 17‐Year Experience of 140 Cases

Ian Bukovsky, David F. Schneider, Rami Langer, Shlomo Arieli, Eliahu Caspi

Research output: Contribution to journalArticlepeer-review

Abstract

EDITORIAL COMMENT: Elective Caesarean hysterectomy for sterilization alone or for sterilization when there is other gynaecological pathology present (fibromyomas, menorrhagia) is not widely practised in Australia in so far as this editor is aware. This is quite different from results of practice reported from the United States of America or, as this paper reports, in Israel. This paper reports remarkably good results that justify the authors' practice of performing more than 5 Caesarean hysterectomies electively for every 1 performed as an emergency procedure (140 versus 26). It is not always easy to decide when a Caesarean Hysterectomy is elective; if the patient has many children and especially if she has had several Caesarean sections, then ‘difficulty with haemostasis’ or ‘a defective lower segment scar’ can become an ‘indication’ for emergency Caesarean hysterectomy. In this series the total incidence of Caesarean hysterectomy was 1 in 396 confinements (166 in 65,723); the incidence was 1 in 470 for elective and I in 2,528 confinements for emergency Caesarean hysterectomy. For perspective and contrast, readers are referred to Emergency Hysterectomy in Obstetrics ‐ a Review of 117 Cases A l‐Sibai MH, Rahman J, Butalack F. Aust NZ J Obstet Gynaecol 1987; 27:180–184. Table 1 below shows the total experience of Caesarean hysterectomy at the Mercy Maternity Hospital, Melbourne, where religious considerations preclude the practice of sterilization procedures. It is seen that the operation was performed 1 in 1,098 confinements and that in 70% of cases (46 of 66) the patient had had a previous Caesarean section. This table shows little change in the indications for Caesarean hysterectomy in the 16 years reviewed, apart from the remarkable increase in the incidence of placenta praevia accreta, an increase that cannot adequately be explained by the increasing Caesarean section rate. Summary: In an earlier report of 86 elective Caesarean hysterectomies (1970–1979) we showed that the operation was associated with few complications but a high blood transfusion rate. In this paper we report an extended series comprised of 140 cases (1970–1986), and compare results of the 1970's series with that of the 1980's. The operative and postoperative complications were minimal during the entire period. The blood transfusion rate which was 64% in 86 cases of the 1970–1979 period decreased to 17% in 54 cases of the 1980–1986. Our results show that Caesarean hysterectomy is a safe procedure with some long‐term advantages; therefore this option should be discussed with women who ask for tubal sterilization at the time of Caesarean section.

Original languageEnglish
Pages (from-to)287-290
Number of pages4
JournalAustralian and New Zealand Journal of Obstetrics and Gynaecology
Volume29
Issue number3
DOIs
StatePublished - Aug 1989

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