Cesarean Hysterectomy

About Cesarean Hysterectomy

Cesarean hysterectomy is the removal of the uterus at the time of cesarean delivery, either immediately after the birth of the baby or shortly afterward. It is most often performed for placenta accreta spectrum, in which the placenta grows abnormally deeply into or through the uterine wall and cannot separate after birth, a condition that has become more common as cesarean rates have risen because previous uterine scars are a major risk factor. Other indications include uterine rupture and severe postpartum hemorrhage that cannot be controlled by medications, uterine compression sutures, balloon tamponade or other conservative measures. When placenta accreta is diagnosed before birth by ultrasound or MRI, a planned operation by a multidisciplinary team at a specialist center, with blood products and support from anesthesia, urology and interventional radiology available, is associated with better outcomes than an unplanned emergency operation. In accreta cases the placenta is often left in place and removed together with the uterus to avoid massive bleeding. The operation is technically demanding because of enlarged pregnancy blood vessels and altered anatomy. Blood loss can be very large, and cell salvage, massive transfusion protocols and sometimes balloon occlusion of the pelvic arteries are used. Complications include hemorrhage, injury to the bladder or ureters, which is more likely than in a routine hysterectomy, infection, blood clotting abnormalities such as disseminated intravascular coagulation, and admission to intensive care. The procedure ends the possibility of future pregnancy. Cesarean hysterectomy was first performed successfully by the Italian obstetrician Edoardo Porro in 1876, at a time when it greatly reduced maternal deaths from infection and bleeding after cesarean section.