Clinical Studies on Cesarean Hysterectomy

Jo, Y C; Park, J W; Kwon, S M; Koh, J H; Kim, Y B; Lee, E S; Park, S K

Abstract

OBJECTIVES
To review 19 cases of cesarean hysterectomy performed at Seoul Paik Hospital, College of Medicine, Inje University from January, 1986 to December, 1997.
METHODS
A retrospective study of all cases of cesarean hysterectomy was made, and method of delivery, maternal age, parity, indications for hysterectomy, amounts of transfusion, perinatal mortality, complications were reviewed.
RESULTS
Cesarean hysterectomy was performed in 14 of 2, 964 Cesarean sections (0.47% and in 5 of 7, 173 vaginal deliveries (0.07%. The higher the age and the parity of patients, the higher incidence of Cesarean hysterectomy. The most common indication of Cesarean hysterectomy was uterine atony (47.4%), followed by uterine rupture (21.0%), placenta previa with adhesive placenta (15.7%), adhesive placenta (10.6%), uterine myoma with pregnancy (5.3%). All patients who underwent Cesarean hysterectomy received transfusion from 3 to 58 pints. In aspect of fetal outcome, live births were 15 cases (79.0%), 2 infants were still birth (10.5%), 2 infants were dead during early neonatal period (10.5%), so perinatal mortality rate was 21.0%. The postoperative complications were bladder injury, febrile morbidity, disseminated intravascular coagulation, intestinal obstruction and wound hematoma. There were 2 maternal deaths, of which the causes were disseminated intravascular coaglulation.
CONCLUSIONS
In spite of operative risks, Cesarean hysterectomy is a necessary life saving operation. Prevention of complications that give rise to hysterectomy and optimally timed surgery should decrease maternal morbidity and mortality.