Evaluation of cesarean section hysterectomy as a sterilization procedure

Correlates of hysterectomy in Australia

With around one in five women undergoing hysterectomy by the age of 50, the prevalence of hysterectomy in Australia is greater than in Europe but less than in the United States. In this paper, data from a nationally representative sample survey of 2547 Australian women aged 20-59 years are employed to identify correlates of hysterectomy and tubal sterilization over the last 30 years. Physiological, socio-economic and supply-side factors all influence the propensity to undergo hysterectomy, and a comparison with the correlates of tubal sterilization reveals parallels and contrasts between the determinants of the two operations. Age and parity are important predictors of hysterectomy. In addition, use of oral contraceptives for at least five years reduces the risk of hysterectomy, as do tubal sterilization, tertiary education and birthplace in Southern Europe. Conversely, risk increases after experiencing side effects with the IUD or repeated foetal losses, or after bearing a third child before the age of 25.

Obstetric hysterectomy--an 11-year experience

A total of 31 women had obstetric hysterectomy at St Mary's Hospital, Manchester, between 1972 and 1982. Elective caesarean hysterectomy was performed on nine occasions mainly because of preexisting gynaecological problems such as fibroids or menorrhagia. Emergency hysterectomy most frequently followed uterine rupture, postpartum bleeding and major degrees of placenta praevia. The majority of patients required blood transfusion but postoperative problems were few. Late complications included infected discharge and cyclical bleeding after subtotal hysterectomy. There was one neonatal death but no maternal deaths. Although the operation is usually straightforward, and no major technical problems, such as urinary tract injury occurred, the decision to perform it as an emergency must be made before the patient's condition is extreme; the availability of senior staff is important.

Elective cesarean hysterectomy--revisited

A review of 80 cases of planned or anticipated cesarean hysterectomies done at major centers in the greater Los Angeles area is presented. There were no deaths and five cases of morbidity. Nineteen percent, or one of five cases, required blood transfusions. According to the recommendation of the American Association of Blood Banks, a program of homologous blood replacement should be instituted. Cesarean hysterectomy is a formidable procedure but should not be discarded. In proper hands there are numerous advantages to the operation. Residency training programs should include the teaching of planned or anticipated cesarean hysterectomy in order that skills for the occasional emergency cesarean hysterectomy may be developed.

Sterilization at the time of cesarean section: tubal ligation or hysterectomy?

The operative, postoperative and subsequent course of 86 patients who underwent cesarean hysterectomy (C.H.) during the years 1970-1979 are compared to an equal number of cesarean sections with tubal ligation (C.S.L.). Both groups are similar regarding age, gravidity, parity, number of living children and indications for abdominal delivery. Operative and postpartum complications of both groups were all minor, although significantly (p less than 0.05) more frequent in the C.S.L. group. More patients of the C.H. group required blood transfusions than the C.S.L. group (p less than 0.01). The mean period of hospitalization was similar in both groups. Two pregnancies occurred after tubal sterilization, a failure rate of 1:43. During the follow-up period, 49 surgical gynecological procedures were performed in the C.S.L. group compared to 1 in the C.H. group. Ten patients of the C.S.L. group subsequently underwent abdominal hysterectomy. Hysterectomy is the procedure of choice for permanent sterilization and prevention of many subsequent gynecological problems. Consideration must be given to coexisting gynecological conditions while considering sterilization at elective C.S. and C.H. should be offered to those patients.

Sterilization: a comparative review

Publications relating to surgical procedures for sterilization have been reviewed, and the incidences of complications and subsequent pregnancies compared. Laparoscopic sterilization has the lowest incidence of complication, the morbidity rate being lower than that of laparotomy sterilization or hysterectomy, and the mortality rate lower than that of a single pregnancy or taking oral contraceptives for 1 year.

Elective cesarean hysterectomy: a 5 year comparison with cesarean section

Elective cesarean sections performed on the obstetric service at the University of Arkansas Medical Center were reviewed for the period January 1, 1970, through December 31, 1974. The purpose of the review was to compare operative and postoperative complications of cesarean section, cesarean section and tubal ligation, and cesarean section and elective hysterectomy. A total of 1,255 cesarean sections were performed of which 207 (17 per cent) were associated with tubal ligation and 242 (18 per cent) with hysterectomy. Elective cesarean hysterectomies were performed for elective sterilization (68 per cent), for medically indicated sterilizations (11 per cent), or for definitive treatment of uterine pathology(21 per cent). All cesarean sections were obstetrically indicated with the exception of 34 primary cesarean hysterectomies performed as definitive treatment of carcinoma in situ of the cervix. The operative procedures were compared in regard to the following characteristics or complications: operating time; incidence of blood transfusions, urinary tract injuries, postoperative bleeding, febrile morbidity, and other postoperative complications; and postoperative hospital days.

A review of recent developments in human fertility control

Recent and significant developments in the field of fertility control are reviewed. Consideration is given to new aspects of existing methods, recent modifications to steroidal formulations and Intrauterine devices, increased utilization of older methods (abortion and sterilization) and evaluation of new fields (postcoital contraception, prostaglandins and immunological techniques). There is an increasing demand for better application of newly developed methods and a rational decision in the selection of appropriate methods.

Prophylactic internal iliac artery ligation at cesarean hysterectomy

One hundred and eight preplanned cesarean hysterectomies have been evaluated in an effort to determine that advisability of prophylactic bilateral hypogastric artery ligation when there is anticipated heavy bleeding associated with surgery. The data indicates that prophylactic bilateral internal iliac artery ligation is of questionable value in reducing operative bleeding, which can be controlled by more conventional means. However, when used therapeutically, it may be a lifesaving operation. Familiarity with the procedure is necessary for all those performing operative obstetrics and gynecology.