Caesarean and post-partum hysterectomy 1968-1983.

There have been 47 caesarean or post-partum hysterectomies over a period of 15 years at Birmingham Maternity Hospital, a frequency of 7 per 10 000 deliveries. In 12 patients the procedure was performed electively for a gynaecological or haematological disorder. In the remainder, emergency hysterectomy was necessary as a life saving measure, in most instances to overcome uncontrollable haemorrhage. The commonest cause of uncontrollable bleeding was a morbidly adherent placenta which occurred in 1 per 4348 pregnancies, and was associated with previous uterine surgery particularly if combined with placenta praevia. Such patients require the presence of an experienced obstetrician to make an early decision to operate and perform a technically demanding operation.