Cesarean hysterectomy is the removal of the uterus during cesarean delivery or childbirth. Previously, it was mainly performed to prevent infections and haemorrhage (or bleeding) during cesarean delivery. Later, the advent of antibiotics and improvised therapeutics declined the incidence of cesarean hysterectomy. Nowadays, a cesarean hysterectomy is done to deal with recalcitrant haemorrhage. 

Cesarean Hysterectomy

Cesarean hysterectomy is challenging as there are immense physiological and anatomical changes at the time of pregnancy. There are always chances of massive blood flow towards the uterus at the term. The hysterectomy procedure during delivery is opted frequently in emergencies and unplanned situations. The step to perform the cesarean hysterectomy is necessary to deal with the situation wherein there is a risk to the mother’s life. 

A cesarean hysterectomy is done to avoid the following

  • 1. Infections after surgery
  • 2. Intense blood loss (Haemorrhage)
  • 3. Prevent peritonitis
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Cesarean Hysterectomy Indications

Leading indications for cesarean hysterectomy are :

Placenta accreta (an abnormal condition in pregnancy wherein the placenta grows abnormally deep inside the uterine walls and remains attached)

Uterine atony ( the condition when the uterine is unable to contract appropriately during childbirth)

Maternal cesarean Hysterectomy Complications 

  • 1. Transfusion of blood or blood products like RBCs, plasma, or platelets
  • 2. Subsequent laparotomy
  • 3. Ureteral injury
  • 4. UTIs (Urinary Tract Infections)
  • 5. Bowel injury
  • 6. Septic Pelvic Thrombophlebitis
  • 7. Cuff abscess
  • 8. Fever
  • 9. Death
  •  

Cesarean Hysterectomy Risks

  • 1. Bleeding
  • 2. Bladder injury 
  • 3. Injury to ureters
  • 4. Death
  •  

Risk after a Few Weeks of Cesarean Hysterectomy

DVT (Deep Vein Thrombosis is blood clot accumulation in legs)

Bowel obstruction (abdominal blockage causing pain and nausea)

Infection (at the site of incision and bladder)

Scar tissue (abnormally thick scar)

C-section Hysterectomy Safety and care Post Surgery

Cesarean hysterectomy is safer as blood loss is not excessive to arise complications. Following instructions are given to ensure post-operative care:

  • 1. Stick to the appointment scheduled for post-operative follow-up
  • 2. Take high fibre diet to avoid constipation that puts pressure on the abdomen
  • 3. Have plenty of fluids like drinks and juices
  • 4. Proper medications should be taken according to the prescription
  • 5. Take a shower without rubbing the sensitive regions like incisions
  • 6. Strenuous activities are not allowed
  • 7. Take proper rest and have naps in the day time as well.
  • 8. Prevent intercourse for 6-7 weeks
  • 9. Tampons should not be used
  • 10. Heavy lifting must be avoided completely
  • 11. No heavy exercises for at least 5 weeks and walking can be resumed after 1-2 weeks.
  • 12. No long travelling
  •  

When to consult a doctor?

Following health complications are the danger signals and need doctor consultation:

  • 1. High fever
  • 2. Heavy bleeding
  • 3. Severe pain in back
  • 4. Painful urination
  • 5. Pus in wounds
  • 6. Foul discharge
  •  

ERAS (Enhanced Recovery After Surgery)

It is a pathway for the optimization of a patient’s recovery after a cesarean hysterectomy. The ERAS pathway is designed to promote care and help in reducing blood loss, eventually to allow patients to return to their baseline functioning. It decreased the opioid exposure of the patients, helped them in early mobilization, and prevented adverse outcomes.

Frequently Asked Questions

Can a doctor perform a hysterectomy during C-section?

Yes, a hysterectomy can be done during C- a section or cesarean and that kind of hysterectomy is called cesarean hysterectomy. The procedure of cesarean hysterectomy is associated with uterus removal at the time of cesarean delivery of the baby.

How common is a hysterectomy after C-section?

Hysterectomy after C-section is not very common in India. There are cases of hysterectomy after cesarean delivery to prevent excessive blood loss and avoid infections post-surgery.

Why would a woman need a hysterectomy after childbirth?

Women require a hysterectomy after childbirth when there is intense bleeding from the uterus (womb). This may happen because of the following health complications:

  • 1. Improper contractions of the uterus (called uterine atony)
  • 2. Rupture of the womb
  • 3. Fibroids
  • 4. Blood clotting issues 
  • 5. Injury or damage to the blood vessel.
  •  

Is hysterectomy recovery worse than C-section?

Is a hysterectomy procedure somewhat like C-section?

There are similarities in the surgical procedure for abdominal hysterectomy and C-sections. An incision is made in the abdominal region in C-section, similar to the incision made in the surgical procedure for a hysterectomy.

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