What is a peripartum hysterectomy?
This term refers to the removal of a woman's womb either immediately after giving birth or up to six weeks after delivery.
It includes hysterectomies carried out during Caesarean section operations as well as the planned removal of the uterus up to six weeks after a woman has given birth. The major reason for peripartum hysterectomy is massive post-delivery bleeding.
Massive peripartum haemorrhage is the loss of greater than 1,000ml of blood from the genital tract from the time of birth to within the first six weeks of delivery. It is usually due to loss of muscle tone in the uterus. If initial treatment with blood products and other pharmaceutical agents does not control the bleeding, it may be necessary to proceed to hysterectomy in order the save a woman's life.
The reported incidence of hysterectomy following vaginal delivery is 0.02 per cent.
What is a Caesarean hysterectomy?
Caesarean hysterectomy is the term for the removal of a woman's womb immediately after the birth of her child by Caesarean section.
The most common reason for performing a Caesarean hysterectomy is uncontrollable haemorrhage from the uterus. Although post-delivery haemorrhage is relatively common (occurring after about 1 per cent of deliveries), life-threatening haemorrhage is rare.
The most important risk factor for emergency Caesarean hysterectomy is a previous Caesarean section, especially when the placenta (afterbirth) lies over the old surgical scar. A lack of tone in the uterine muscle and a rupture of the womb itself are other recognised indications for proceeding to Caesarean hysterectomy.
Caesarean hysterectomy is an operation of last resort. It has a reported incidence of approximately 0.7 per cent and should only be undertaken when all other measures to control bleeding have failed.