Hysterectomy at the time of cesarean section: analysis of 108 cases.

One hundred eight cases of cesarean hysterectomy are analyzed. Important differences in operative complications and postoperative morbidity between elective and emergency cases are emphasized. Elective cases had a higher incidence of urinary tract injury but a much lower incidence of excessive blood loss, blood transfusion, and febrile morbidity. Transfusion was required in 19% of all operations, including 66.6% of emergency cases and 11.8% of elective operations. Febrile morbidity occurred in 30.5% and morbidity of all types in 35.2% of patients. A close correlation is demonstrated between operating time and febrile morbidity. No maternal mortality occurred in this series. Operative injury to the urinary tract, adnexal bleeding, broad ligament hematomas, vaginal cuff bleeding, and adequate identification of the cervix are problems that must be dealt with when performing a cesarean hysterectomy. Details of operative technique are described that address these problems and minimize blood loss and postoperative morbidity.