Cesarean Hysterectomy Revisited

Abstract

This study sought to evaluate the morbidity and cost associated with planned and emergent peripartum hysterectomy in a residency setting. The authors also evaluated planned hysterectomy compared with delivery and subsequent hysterectomy. The charts of 64 patients who underwent emergent or planned peripartum hysterectomies were reviewed. Comparisons were made in the following areas: gravidity and parity, number of prior cesarean sections, fetal weight, blood loss, number of transfused blood units, length of stay, charges, and indications for hysterectomy. A cost analysis was performed comparing planned peripartum hysterectomy with delivery and subsequent hysterectomy. When planned cesarean hysterectomies were compared with delivery and subsequent hysterectomy, it was found that the planned hysterectomy for cervical dysplasia and leiomyoma had no significant complications. There were also significant cost savings when vaginal or cesarean delivery was compared with interim hysterectomy. Planned hysterectomies also resulted in shorter hospital stays, lower blood loss, and lower hospital costs compared with emergent hysterectomies. Residents who participated in planned cesarean hysterectomy felt more prepared when an emergent hysterectomy arose at a later date than those who had not participated in any. Peripartum hysterectomy is an option when the patient has a concurrent gynecologic indication for surgery, and it has significantly less morbidity than emergent peripartum hysterectomy.