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Caesarean Hysterectomy
Abstract
BACKGROUND: Caesarean hysterectomy is an obstetric emergency procedure performed to save maternal life in uncontrollable haemorrhage and few elective indications. It could be a planned procedure but more often it is an emergency operation.
OBJECTIVE: To ensure adequate exposure and mastery of this emergency procedure by residents in training in Obstetrics and Gynaecology in Nigeria.
METHODS: Review of the pertinent literature, selected references, and internet services through Medline search on caesarean hysterectomy.
RESULTS: The incidence for emergency caesarean hysterectomy is 0.01-0.05%. The maternal death rate associated with caesarean hysterectomy from all causes is 0.7% compared to 0.05% for all caesarean sections.
Porro's operation was a subtotal amputation but opinion now favours a total hysterectomy where practicable. Inexperienced surgeons may encounter identification of the lower margin of the cervix as limiting factor, for fully effaced and dilated cervix. Subtotal hysterectomy may therefore be the more prudent, safest and fastest option, but the potential problems of a residual cervical stump must always be borne in mind.
CONCLUSION: Caesarean hysterectomy though a rare procedure is a life saving obstetric emergency. There is need for adequate exposure and mastery by the residents and a must for all obstetricians in their practice.
OBJECTIVE: To ensure adequate exposure and mastery of this emergency procedure by residents in training in Obstetrics and Gynaecology in Nigeria.
METHODS: Review of the pertinent literature, selected references, and internet services through Medline search on caesarean hysterectomy.
RESULTS: The incidence for emergency caesarean hysterectomy is 0.01-0.05%. The maternal death rate associated with caesarean hysterectomy from all causes is 0.7% compared to 0.05% for all caesarean sections.
Porro's operation was a subtotal amputation but opinion now favours a total hysterectomy where practicable. Inexperienced surgeons may encounter identification of the lower margin of the cervix as limiting factor, for fully effaced and dilated cervix. Subtotal hysterectomy may therefore be the more prudent, safest and fastest option, but the potential problems of a residual cervical stump must always be borne in mind.
CONCLUSION: Caesarean hysterectomy though a rare procedure is a life saving obstetric emergency. There is need for adequate exposure and mastery by the residents and a must for all obstetricians in their practice.
