Obstetric hysterectomy – an alarming report

AIMS Journal, Spring 2000, Vol 12 No 1

Emergency hysterectomy has to be done occasionally to save the mother’s life at delivery when there is uncontrollable haemorrhage.

A recent report from St. George’s Hospital in London shows that emergency hysterectomies at delivery have increased seven-fold in recent years. Between 1992 and 1998 the unit did 10 such operations. Only two were done in the first four years, making it a rare occurrence of one in 7,000 deliveries. However in 1996-8 they did 8 – which meant one in 1,000 deliveries.

All of the women had given birth before. In two of the cases the women had been induced following the death of the fetus. Only two of the cases followed spontaneous labour and normal vaginal delivery (they do not say if the births had been speeded up); both these women had had previous terminations, and one of them had had five. These two women both needed manual removal of the placenta although it was not morbidly adherent. Seven women had a caesarean at a previous birth. The authors point out that there had been an increase in the section rate from 21% in 1992 to 23.4% from 1996 onwards – a rise of 8%. However the section rate in multips had gone up by 23%, with a similar increase in women having a repeat section.

Four of the women had caesareans for placenta praevia, and the placenta was “morbidly adherent” to the earlier scar.

In one particularly tragic case the woman had a spontaneous rupture at 30 weeks. She had had a rupture in her first pregnancy following an amniotomy using a Drew-Smythe catheter. In her second pregnancy she lost the baby after a rupture at 28 weeks. The third child – from the hysterectomy birth – is brain damaged.

All the women survived – though one died 18 months later of pre-existing heart problems. One had to have 38 units of blood and many had serious complications. One had premature ovarian failure at 39, requiring HRT.

Whereas the commonest reason for obstetric hysterectomy used to be uterine rupture (sometimes caused by rotational high forceps), or post partum haemorrhage caused by failure of the uterus to contract, the usual cause now is abnormal embedding of the placenta into the wall of the uterus (so uncontrollable haemorrhage can be caused when it is removed) following a previous caesarean section.

Women with a previous section are up to 27 times more likely to need obstetric hysterectomy than those who have had only vaginal deliveries.

AIMS Comment

This report confirms what we already knew – caesarean sections increase risk at future deliveries. However, this report covers only physical damage, not emotional damage. We have fortunately seen only a few cases at AIMS, but we know the women are devastated.

  • Gould D. et al. Emergency obstetric hysterectomy – an increasing incidence. Journ. Obstet. Gynaeacol. 1999 19 580-583.

What can you do?

Look after your Spleen energy a lot better. (See Heather’s easy birthing package – especially the cold . .it may well be iatrogenesis).

Attack the acupuncture point Sp 1 with a fingernail whilst in the birthing suite – and possibly the bleeding will stop.

If it does not – try Sp 4.

(put diagrams in each case).