HYSTERECTOMY IN THE PERINATAL AND POSTPARTUM PERIOD IN THE 17-YEAR CLINICAL MATERIAL

Intruduction: Hysterectomy is one of major surgeries. Pregnancy, delivery and postpartum period make the operation even more difficult as it is forced and complicated by various pathological conditions that develop over that time.

Objective: The purpose of study was to analyze the frequency of hysterectomy, indications to undertake it and complications associated with the removal of the uterus in pregnancy and during perinatal and postpartum period. The study analyzed the cases of hysterectomies in perinatal and postpartum period performed over the 17-year clinical material from the Department of Gynaecology and Obstetrics, SZOZ, Lipsko in the years 1985–2001.

Material and methods: The material for analysis were medical records of 15 women who developed complications in pregnancy, perinatal and postpartum period, which were absolute indication to perform hysterectomy. The following parameters were analyzed: patient’s age, number of deliveries, the way pregnancies were terminated, the way present pregnancy was terminated, complications, indications to Caesarean section and perinatal and postpartum hysterectomy, type of hysterectomy performed, other associated procedures and complications.

Results: In total 15 hysterectomies were performed in the period of study which accounts for 0.10% all deliveries. The material revealed the following causes for hysterectomy: placental pathologies (46.7%), inflammatory conditions of internal sex organs (20.0%), uterine atonia after delivery (13.3%), injuries of sex organs (13.3%). Elective hysterectomy in that period was performed in one patient (6.7%). The risk factors predisposing to complications resulting in hysterectomy were history of Caesarean sections in 10 patients (66.7%) and multiple spontaneous deliveries. Complications associated with hysterectomy which enforced additional operations were noted in two cases (13.3%). Total hysterectomy was performed in 8 patients (53.3%) including hysterectomy with adnexia in 3 women (20.0%). Amputation of the uterine body without adnexia was performed in 7 women (46.7%). No complications were noted after hysterectomies performed in the perinatal and postpartum period.

Conclusions: Most common causes of hysterectomies during perinatal and postpartum period were placental pathology associated with massive loss of blood and uterine atonia after delivery. Amputation of the uterine body was enough without other associated procedures in 46.7% cases. Patients with the history of Caesarean sections and multiple deliveries made 66.7% of hysterectomies performed in the perinatal and postpartum period.