CESAREAN DELIVERY AND

PERIPARTUM HYSTERECTOMY

Prof. Dr. Daulat H. Sibuea,

SpOG(K)
DEPARTEMENOBSTETRI&GINEKOLOGI
FK-USU/RSHAM-RSPM
2007

CESAREAN DELIVERY AND PERIPARTUM

HYSTERECTOMY

CESAREAN DELIVERY
THE BIRTH OF A FETUS THROUGH INCISIONS IN
THE ABDOMINAL WALL (LAPAROTOMI) AND
UTERINE WALL (HYSTEROTOMY).
THE DERIVATION OF THE TERM IS MORE LIKELY
FROM THE LATIN WORD CAEDO MEANING TO CUT

 PERIPARTUM HYSTERECTOMY CONSIST OF ;

1. CESAREAN HYSTERECTOMY, IS A ABDOMINAL
HYSTERECTOMY, PERFORMED AT THE TIME OF
CESAREAN DELIVERY.
2. POSTPARTUM HYSTERECTOMY IS A ABDOMINAL
HYSTERECTOMY, PERFORMED WITHIN A SHORT
TIME AFTER VAGINAL DELIVERY.
TYPE OF CESAREAN SECTION (CS)
1. ELECTIVE CESAREAN SECTION (CESAREAN DELIVERY
IS PLANNED). THESE WOMEN HAVE TIME FOR
PHYSICAL AND PSYCHOLOGIC PREOPERATIVE
PREPARATION
2. EMERGENCY CESAREAN SECTION (CESAREAN
DELIVERY IS UNPLANNED)

EMERGENCY CS
- ALL PREOPERATIVE PROCEDURES MUST BE
DONE
QUICKLY AND COMPETENTLY
- THE WOMAN APPROACHES SURGERY USUALLY
TIRED AND DISCOUROGED AFTER A
FRUITLESS
LABOR.
SHE IS WORRIED AND FRETFUL ABOUT HER
OWN,
AND THE CHILD CONDITION.
- SHE MAY BE DEHYDRATED, WITH LOW
GLYCOGEN
RESERVES.

 CESAREAN SECTION (CS) RATES

THE RATE FOR CS HAS INCREASED DRAMATICALLY.
CS RATE IN THE USA. FROM THE MID 1960 LESS
5%,
MORE

MORE THAN 15% IN THE EARLY-1980, AND

THAN 25% OF DELIVERIES IN THE 2002.

 TABLE 1 . CONTRIBUTION BY INDICATION

TO OVERALL CESAREAN DELIVERY RATE IN
FOUR COUNTRIES DURING 1990
INDICATIONS

CESAREAN DELIVERY RATE

PER 100 TOTAL DELIVERIES
Norway

Scotland

Sweden

United States

Previous Cesarean
Breech
Dystocia
Fetal distress
Other

1,3
2,1
3,6
2,0
3,7

3,1
2,0
4,0
2,4
2,7

3,1
1,8
1,7
1,6
2,4

8,5
2,6
7,1
2,3
3,2

Overall CS Rate

12,7

14,2

10,6

23,7

MODIFIED FROM NOTZON AND COLLEAGUES (1994)

 TABLE 2 :
INDICATIONS FOR CS AND MATERNAL AND FETAL EFFECTS (MATERNITY AND
GYNAECOLOGIC CARE 2. THE NURSE AND THE FAMILY 1989

INDICATIONS FOR CS
Meternal :
1.Feto Pelvic Disproportion
2.Previous CS
3.Breech Presentation
4.Medical Complication (PIH)
5.Placental Abnormalities (placenta
previa, abruptio placenta)
6. Infection ( Herpes Virus type 2)
7. Trauma To The Pelvis

EFFECT OF CS
Maternal :
1. Mortality ( 1:1000 ) From :
- Anesthesia
- Severe Sepsis
- Thromboembolic Episode
2. Morbidity Higher Than With Vaginal
Delivery Because Of :
- Infection
- Injury To The Urinary Tract

INDICATIONS FOR CS

EFFECT OF CS

Fetal :

Fetal :

1.Fetal Hypoxia

1. Mortality Has Declined Where CS Is Used

2.Prolapse Of The Cord

3.Breech Presentation

In Conjunction With Improved Perinatal

4.Malpresentation ( Shoulder)

Care.

5.Fetal Anomalies (Hydrocephalus) 2. Morbidity

- Birth Trauma Is Reduced
- Reduced Morbidity In Breech Deliveries,
Transverse Lie Of The Fetus, And Placen
-ta Previa.

 TABLE 3
CS RATE PER 100 DELIVERIES IN 9 SELECTED COUNTRIES 1980. (DATA FROM;
CESAREAN SECTION GUIDELINES FOR APROPRIATE UTILIZATION ).

COUNTRY

CS RATE PE 100 DELIVERIES

YEAR 1980

CANADA
NETHERLANDS
BELGIUM
FRANCE
ENGLAND
SAUDI ARABIA
SWEDEN
AUSTRALIA
USA

15,0%
4,7
7,4
10,9
9,0
5,4
12,1
11,2
16,5

CS Rate Per 100 Deliveries At Dr. Pirngadi General Hospital Medan

Year: 1958
: 1,42%
Year 1973 : 7,1%
1960
: 5,32%
1980 : 10,8%
1970
: 6,2 %

TABLE 4
REASON FOR DIFFERENCE IN RATE OF
CS
Non Medical
Medical

Previous CS
Breech Presentation
Cephalopelvic Disproportion
Fetal Distress
Dystocia
Very Low Birth Weight ( < 1500 gr)
Preterm Delivery (<32 Weeks
Gestation)
Birth weights Over 4 Kg (Fetal
Macrosomia)

Maternal Age With Women Of > 35 Years

Old, CS Rate
.Socio Economic Factors (CS Rate With
Women Of Higher Social Class)
Cultural reasours (Culntural factors can
influence CS Rate)
Hospital Reasons (CS Rate At Teaching
Hospital )
Private Practice. Financial Consideration
Certainly Play An Important Role
Geographical Location
CS Rate If The Location Of
Hospital And The Proximity To The
Community)
Litigation (Litigation Is An Important
Factor In CS Rate)
Physician Factor In Any Given Case, Some
May Decided That CS Is Necessary, While
Others May Not

 THE REASONS WHY THE CS RATE INCREASED

1. WOMEN HAVING FEWER CHILDREN
2. THE AVERAGE MATERNAL AGE IS RISING
3. THE USE OF ELECTRONIC FETAL MONITORING IS WIDESPREAD
4. THE VAST MAJORITY OF FETUSES PRESENTING AS BREECH ARE
NOW

DELIVERED BY CESAREAN

5. THE INCIDENCE OF MIDPELVIC FORCEPS AND VACUM

DELIVERIES HAS DECREASED.

6. RATE OF LABOR INDUCTION CONTINUE TO RISE.

INDUCED LABOR ESPECIALLY AMONG NULLIPARAS,
INCREASES THE RISK OF CESAREAN DELIVERY.
7. THE PREVALENCE OF OBESITY HAS RISEN
DRAMATICALLY, AND OBESITY ALSO INCREASES THE
RISK OF CS.
8. CONCERN FOR MALPRACTICE LITIGATION HAS
CONTRIBUTED
SIGNIFICANTLY TO THE PRESENT CS RATE
9. SOME ELECTIVE CS ARE NOW PERFORMED DUE TO
CONCERN OVER PELVIC FLOOR INJURY ASSOCIATED
WITH VAGINAL BIRTH ( MATERNAL REQUEST )

 METHODS TO DECREASE CS RATE

1. EDUCATING PHYSICIANS, MIDWIVE, AND WOMEN
2. PEER GROUP REVIEWING
3. ENCOURAGING A TRIAL OF LABOR AFTER PRIOR TRANSVERS
CESAREAN DELIVERY
4. RESTRICTING CS FOR DYSTOCIA ONLY TO WOMEN WHO MEET
STRICTLY DEFINED CRITERIA
5. A MANDATORY SECOND OPINION

MATERNAL MORTALITY

HALL & BEWLY (1999) SHOWED IN THE UNITED

KINGDOM
FROM 1994 THROUGH 1996, THAT WHEREAS

EMERGENCY

CS WAS ASSOCIATED WITH AN ALMOST

NINEFOLD RISK OF

MATERNAL DEATH RELATIVE TO

THAT OF VAGINAL DELIVERY,

EVEN ELECTIVE CS WAS ASSOCIATED WITH AN

ALMOST
THREEFOLD RISK OF MATERNAL DEATH RELATIVE TO

THAT

OF VAGINAL DELIVERY.

 TABLE 5 : DIRECT DEATH RATES BY MODE OF DELIVERY IN THE

UNITED KINGDOM 1994-1996
MODE OF DELIVERY

TOTAL
BIRTHS

VAGINAL
1.845.957
ELECTIVE CAESAREAN
153.829
EMERGENCY CAESAREAN 197.781

TOTAL
DEATHS

DEATH RATE
(PER 100.000)

38
9
36

2,1
5,9
18,2

 1. AN INFRAUMBILICAL MIDLINE
VERTICAL INCISION
2. TRANSVERSE INCISIONS,
- A: PFANNENSTIEL INCISION,
- B: MAYLARD INCISION,
- C: COHENS INCISION.
* TYPE OF UTERINE INCISION
1. INCISION IS MAKE IN THE LOWER
UTERINE
SEGMENT TRANSVERSELY ( AS
DESCRIBED BY
MUNRO-

 3. A VERTICAL INTO THE BODY OF THE UTERUS ( ABOVE THE

LOWER UTERINE SEGMENT AND REACHING THE UTERINE FUNDUS) ,
OR
CLASSICAL INCISION)
* THE ADVANTAGE AND DISADVANTAGE OF THE TRANSVERSE SKIN
INCISION

THE COSMETIC ADVANTAGE OF THE TRANVERSE SKIN INCISION.

THE TRANSVERSE SKIN INCISION IS STRONGER AND LESS LIKELY

TO UNDERGO DEHISCENCE.

EXPOSURE IN SOME WOMEN IS NOT AS OPTIMAL AS WITH A

VERTICAL INCISION

WITH REPEAT CS, REENTRY THROUGH A PFANNENSTIEL INCISION

USUALLY IS MORE TIME CONSUMING AND DIFFICULT BECAUSE OF
SCARRING.

FOR MOST CS, THE LOWER UTERINE SEGMENT TRANSVERSE

INCISION IS THE OPERATION OF CHOICE ; ITS ADVANTAGES ARE
THAT IT :

1. IS EASIER TO REPAIR.
2. IS LOCATED AT A SITE LEAST LIKELY TO RUPTURE DURING A
SUBSEQUENT PREGNANCY.
3. DOES NOT PROMOTE ADHERENCE OF BOWEL OR OMENTUM TO
THE INCISIONAL LINE .

A LOWER SEGMEN VERTICAL OR EVEN A CLASSICAL INCISION MAY,

AT TIMES, PROVE TO BE ADVANTAGEOUS, IF :
1. THE FETUS IS NOT PRESENTING BY THE VERTEX
2. THERE ARE MULTIPLE FETUSES
3. THE FETUS IS VERY IMMATURE AND THE WOMEN HAS HAD NO
LABOR
4. PRETERM DELIVERY WITH POORLY FORMED LOWER SEGMENT
5. PREMATURE RUPTURE OF MEMBRANES, POOR LOWER SEGMENT
AND TRANSVERSE THE
6. TRANSVERSE LIE WITH BACK INFERIOR
7. LARGE CERVICAL FIBROID
8. SEVERE ADHESIONS IN LOWER SEGMENT
9. POST MORTEM CESAREAN SECTION
10. PLASENTA PREVIA WITH LARGE VESSELS IN LOWER SEGMENT

ELECTIVE CESAREAN DELIVERY PREPARATION

* A SEDATIVE, SUCH AS SECOBARBITAL 100 MG, MAY BE GIVEN AT
BEDTIME THE NIGHT BEFORE THE OPERATION.
* ORAL INTAKE IS STOPPED AT LEAST 8 HOURS BEFORE
SURGERY

CASEREAN DELIVERY PREOPERATIVE

NURSING ACTIONS :
THE ABDOMEN IS SHAVED AND DOWN TO THE PUBIC AREA
INSERT A RETENTION CATHETER ( FOLEY )
ADMINISTER PREOPERATIVE MEDICTION
ANALGESIA TO PROMATE RELAXATION BEFORE SURGERY
ATROPIN TO MINIMIZE AMOUNT OF SECRETIONS IN
BRONCHIAL
TREE
ANTACID TO PREVENT IRRITAVIVE PNEUMONIA IF

IF SPINAL OR EPIDURAL ANESTHESIA IS USED, AN ANTACID MAY

BE
THE MEDICATION ADMINISTERED.
BEGIN IV INFUSION, 1000 ML RINGERS LACTATE SOLUTION, OR

5%

DEXTOSE IN WATER OR SALINE, TO MAINTAIN HYDRATION

SEND BLOOD FOR TYPING AND CROSS-MATCHING. TWO UNITS

OF
MATCHED BLOOD ARE KEPT IN RESERVE FOR 48 HOURS

AFTER
SURGERY.

SEND URINE FOR ROUTINE ANALYSIS

SEND BLOOD FOR CBC AND CHEMISTRY

TAKE AND RECORD VITAL SIGNS, BLOOD PRESSURE, FHR

READY THE WOMENS CHART FOR USE IN SURGERY AND TO

SEE
WETHER PERMISSION FORMS FOR CARE OF THE MOTHER AND
INFANT
ARE SIGNED. IF THE WOMAN HAS RECEIVED AN ANALGESIC
OR
ANAESTHETIC, THE RESPONSIBLE ADULT ACCOMPANYING THE
WOMAN SIGNS THE NECESSARY FORMS.

PROVIDE AS MUCH INFORMATION AS POSSIBLE TO THE

WOMAN

THE PRERATION OF THE WOMEN FOR CS IS THE SAME FOR EITHER

ELECTIVE OR EMERGENCY SURGERY
THE OBSTETRICIAN DISCUSSES THE NEED FOR THE CESAREAN
DELIVERY AND THE PROGNOSIS FOR MOTHER AND INFANT WITH
THE WOMAN AND HER FAMILY
THE ANESTHESIOLOGIST ASSESSES THE WOMANS CARDIOPULMONARY SYSTEM AND PRESENTS THE OPTION FOR
ANESTHESIA
INFORM CONSENT IS OBTAINED FOR THE PROCEDURES.

ONCE THE WOMEN HAS BEEN TAKEN TO SURGERY HER CARE

BECOMES THE RESPONSIBILITY
OF THE : - OBSTETRIC TEAM
- SURGEON
- ANESTHESIOLOGIST
- PEDIATRICIAN
- NURSING STAFF

 CARE OF THE INFANT IS DELEGATED TO A PEDIATRICIAN AND A

NURSE BECAUSE THESE INFANTS ARE CONSIDERED TO BE AT
RISK UNTIL THERE IS EVIDENCE OF PHYSIOLOGIC STABILITY
AFTER DELIVERY.
THOSE RESPONSIBLE FOR CARE ARE EXPERT IN RESUSCITATIVE
TECHNIQUES, AS WELL AS IN OBSERVATIONAL SKILLS FOR
DETECTING NORMAL INFANT RESPONSES

AFTER BIRTH, IF THE INFANTS CONDITION PERMITS, SHE OR HE IS

GIVEN TO THE FATHER TO HOLD AND TO SHOW TO THE MOTHER

 INDICATION FOR CESAREAN SECTION

DIFFICULT LABOUR OR DYSTOCIA

FETAL DISTRESS

PREVIOUS CESAREAN SECTION

BREECH PRESENTATION

PREMATURE FETUS.

ANTEPARTUM HAEMORRHAGE
- SOLUSIO PLACENTA
- PLACENTA PREVIA
- VASA PREVIA

TWINS PREGNANCY

CORD PROLAPSE

 MATERNAL DISEASES
DIABETES MELLITUS
INDIOPATHIC THROMBOCYTOPENIA PURPURA
OBSTETRIC CHOLESTASIS
PREECLAMPSIA
OVARIAN AND CERVICAL MALIGNANCY
HERPES SIMPLEX
FETAL CONDITIONS
FETAL MACROSOMIA
TRANSVERSE LIE
FETAL ANOMALIES HYDROPCEPHALUS
MATERNAL REQUEST

TECHIQUES FOR PERFORMING CESAREAN SECTION

1. PRECAUTION ARE IMPORTANT TO AVOID RISK ASSOCIATED WITH
EXPOSURE TO, OR INOCULATION OF BODY FLUIDS (e.g, HIV,
HEPATITIS B)
2. POSITION OF THE PATIENT WITH LEFT LATERNAL TILT OF 10 TO 15
3. CATHETERIZATION
THE USE OF AN INDWELLING CATHETER AFTER CESAREAN SECTION
UNDER EPIDURAL IS THOUGHT TO LESSEN THE RISK OF URINARY
RETENTION AND THE NEED FOR REPEAT CATHETERIZATION
4. THE OPTION FOR ANESTHESIA IS : GENERAL ANESTHESIA , OR
REGIONAL ANESTHESIA ( SPINAL, OR EPIDURAL ANESTHESIA ).

5. PREPARTION OF THE SKIN

POVIDONE IODINE AND TINCTURE OF CHLORHEXIDINE
GLUCONATE
( 0,5% IN 70% ISOPROPYL ALCOHOL ) ARE USUALLY
RECOMMENDED.
6. THE LENGTH OF THE SKIN INCISION SHOULD BE ADEQUAT ( 15
CM ) # # TYPE OF SKIN INCISION :
I. VERTICAL ( MIDLINE ) INCISION
A VERTICAL INCISION HAS ADVANTAGES :
A LESS VASCULAR RAPID ENTRY AND GOOD EXPOSURE
OF
BOTH THE ABDOMEN AND PELVIS
THIS INCISION MAY BE INDICATED IN CASES OF URGENCY

II. PFANNENSTIEL INCISION.

A PANNENSTIEL INCISCION HAS ADVANTAGES :
THIS INCISION IS EXTENSIVELY USED BECAUSE OF ITS
EXCELLENT COSMETIC RESULTS;
EARLY AMBULATION, AND LOW INCIDENCE OF WOUND
DISRUPTION, DEHISCENCE AND HERNIA.
PFANNENSTIEL INCISION HAS DISADVENTAGES,
MAY RESULT INJURY TO THE ILIOINGUINAL AND
ILIOHYPOGASTRIC NERVE;
USE OF THIS INCISION LIMITS VIEWS OF THE UPPER
ABDOMEN.
III. OTHER
JOEL COHEN`S INCISION
MAYLARD INCISION

7. UTERINE INCISION
* TYPE OF UTERINE INCISION.
I. LOWER UTERINE SEGMENT TRANSVERSE INCISION (MUNRO-KERR)
LOWER UTERINE SEGMEN VERTICAL INCISION ( KRONIG, DE LEE
AND CORNELL )
BECAUSE OF THE RISK OF BLADDER EXTENSION, IT REMAINS
ADVISABLE TO DO A LOWER SEGMENT TRANSVERSE INCISION
WHENEVER THE LOWER SEGMENT IS WILL FORMED.
II. CLASSICAL INCISION ( A VERTICAL INCISION IN TO THE BODY OF
THE UTERUS ).
III. LOWER UTERINE SEGMENT VERTICAL INCISION .

 A LOWER UTERINE SEGMENT VERTICAL INCISION OR EVEN

A CLASSICAL INCISION MAY, AT TIMES, PROVE TO BE
ADVANTAGEOUS, IF :
THE FETUS IS NOT PRESENTING BY THE VERTEX
THERE ARE MULTIPLE FETUSES
THE FETUS IS VERY IMMATURE ( < 26 WEEKS ) AND THE
WOMAN
HAS HAD NO LABOR.
PRETERM DELIVERY WITH POORLY FORMED LOWER
SEGMENT
PROLONGED RUPTURE OF THE MEMBRANE.
POOR LOWER SEGMENT AND TRANSVERSE LIE
THE LOWER SEGMENT IS INACCESSIBLE DUE TO :
= A DENSE ADHESION OR LARGE FIBROIDS, OR PLACENTA

 THE CLASSICAL UPPER UTERINE SEGMENT VERTICAL

INCISION IS THOUGHT TO BE ASSOCIATED WITH :
EXCESSIVE BLOOD LOSS
INFECTION
POOR HEALING
AN INCREASED RISK OF UTERINE RUPTURE IN SUBSEQUENT
PREGNANCIES.

8. DELIVERY OF THE FETUS

INDUCTION DELIVERY INTERVAL OF MORE THAN 8 MINUTS

UNDER
GENERAL ANESTESIA AND INCISION DELIVERY INTERVALS MORE
THAN
3 MINUTS UNDER BOTH GENERAL OR SPINAL ANAESTHETIC
WERE
ASSOCIATED WITH INCREASED NUMBER OF LOW APGAR SCORES
AND
NEONATAL ACIDOSIS.

9. DELIVERY OF THE PLACENTA

10. CLOSURE .
SUTURING OF THE UTERUS USING POLYGLACTIN
( VICRYL ), OR POLYGLYCOLIC ACID ( DEX ON ).
PERITONEAL CLOSURE USING VICRYL, OR DEXON
CLOSURE OF FASCIA USING VICRYL OR DEXON
CLOSURE SUBCUTANEOUS SPACE USING VICRYL , OR
DEXON.
CLOSURE OF SKIN BY INTRA CUTANEOUS SUTURES, OR
BY
SUBCUTICULAR SUTURES USING VICRYL, OR DEXON..

10. SKIN INCISION DRESSING WITH AN ABUNDANCE OF ADHESIC

TAPE, THE SURGERY IS COMPLETED
11.THE MOTHER IS TRANSFERRED TO RECOVERY ROOM FOR
INTENSIVE CARE UNTIL HER CONDITION STABILIZER, THE
PATENTS IS ASSESSED AT LEAST HOURLY FOR 4 HOURS AND
THERE AFTER AT INTERVALS OF 4 HOURS.

POST CESAREAN SECTION PHYSICIANS ORDERS ( THESE ORDERS DO

NOT APPLY TO DIABETIC, HYPERTENSION OR PREECLAMPSIA /
ECLAMPSIA ).
1. PATIENTS WITH SPINAL OR EPIDURAL MUST BE ABLE TO MOVE
LEGS BEFORE LEAVING RECOVERY ROOM
2. BLOOD PRESSURE, PULSES, TEMPERATURE, FUNDAL CHECK;
AND BLOOD LOSS ASSESSMENT; NOTIFY PHYSICIAN IF PULSE >
110; SYSTOLIC BP > 150 OR < 90 mmHg; DIASTOLIC BP > 100
mmHg; TEMPERATUR > 38C.
3. PROPHYLACTIC ANTIBIOTIC HAVE BEEN SHOWN TO REDUCE THE
INCIDENCE OF INFECTION.
4. CLEAR LIQUID DIET; AND SOLID FOOD MAY BE OFFERED WITHIN 8
HOURS OF SURGERY

5. N0TIFY PHYSICIAN , IF URINE OUT PUT < 100 ML IN ANY 4 HOURS

INTERVAL
THE BLADDER CATHETER MOST OFTEN CAN BE REMOVED BY 12
HOURS POST OPERATIVELY.
6. EACH INTRAVENA TO RUN AT 125-150 ML/ HOUR ; DO NOT
EXCEED 250 ML IN ANY HOURS. 1000 ML D5-RL WITH 10 IU
OXYTOCIN ADDED.
7. NOTIFY PHYSICIAN , IF PAIN RELIEF INADEQUATE
8. NOTIFY PHYSICIAN , IF PROMETHAZINE 25 MGR, INTRA
MUSCULAR, INADEQUATE
9. ANTACID 30 ML PER ORAL
10. BISOCODYL SUPPOSITORIA
11. CHECK Hb, NOTIFY PHYSICIAN, IF HB CONCENTRATION < 8 GR
%, BLOOD TRANSFUSIONS SHOULD BE PRESCRIBED

12. ROOMING IN, IF DESIRED

13. AMBULATION
IN MOST INSTANCES, BY THE DAY AFTER SURGERY, SHE MAY WALK
WITHOUT ASSISTANCE
14. THE INCISION INSPECTED EACH DAY, AND SKIN SUTURES OFTEN
CAN BE REMOVED ON THE FOURTH DAY OF THE SURGERY.
15. BY THE THIRD POSTPARTUM DAY BATHING BY SHOWER IS NOT
HARMFUL TO THE INCISION
16. BREAST FEEDING CAN BE INITIATED THE DAY OF SURGERY
17. UNLESS THERE ARE COMPLICATIONS DURING THE PUERPERIUM,
THE MOTHER GENERALLY IS DISCHARGED ON THE THIRD OR
FOURTH POSTPARTUM DAY.

COMPLICATIONS DURING CS
1. DIFICULT DELIVERIES AF THE FETUS .
2. HAEMORRHGE
MATERNAL BLOOD LOSS IS REPORTED TO BE MORE WITH
PRETERM CS, PROLONGED LABOR, SECOND STAGE CS,
PLACENTA PREVIA, CHORIOAMNIONITIS, CLASSICAL INCISION,
GENERAL ANAESTHESIA, ATONIA UTERI, COUVELAIRE UTERI,
AND OBESITY.
3. SURGICAL INJURIES TO THE URINARY AND GASTRO-INTESTINAL
TRACT DURING CS ARE INFREQUENT.

PERIPARTUM AND POST PARTUM HYSTERECTOMY

INCIDENCE PERIPARTUM HYSTRECTOMY :
HYSTERECTOMY WAS PERFORMED 1 IN EVERY 200 CESAREAN
DELIVERIES ( DATA FROM, MATERNAL FETAL MEDICINE UNITS
NETWORK CENTERS, 2001).

INCIDENCE POST PARTUM HYSTERECTOMY;

HYSTERECTOMY WAS PERFORMED 1 IN EVERY 500 VAGINAL
DELIVERIES ( DATA FROM, PARKLAND HOSPITAL, USA, 2002 ).S

 INDICATION PERI AND POSTPARTUM HYSTERECTOMY :

- ATONIA UTERI
- COUVELAIRE UTERI WITH ATONIA UTERI
- PLACENTA ACCRETA/ INCRETA / PERCRETA
- LASERATION OF MAYOR UTERINE VESSELS
- LARGE MYOMAS
- CERVICAL CARCINOMA INSITU.

SUPRACERVICAL HYSTERECTOMY, OR TOTAL

HYSTERECTOMY IS
PERFORMED USING STANDARD OPERATIVE
TECHNIQUES.

THANKYOU