Our Summary

This research paper looks at the rate, reasons, and results of emergency hysterectomies (removal of the uterus) performed within six weeks after childbirth. The researchers looked at 128 studies, which included 7,858 women who had undergone this procedure. They found that this type of emergency surgery happened in about 1 in 1,000 deliveries, and was more common in poorer countries, where it occurred in 2.8 out of 1,000 deliveries, compared to 0.7 out of 1,000 in richer countries. The main reasons for the surgery were issues with the placenta (38%), uterus not contracting properly after birth (27%), and rupturing of the uterus (26%). Factors that increased the risk of needing this surgery included having a C-section in the current pregnancy, having had a previous C-section, being older, and having given birth multiple times. Going for prenatal care reduced the risk. Only 3% of these women had a procedure done to prevent the need for a hysterectomy. On average, the women lost about one gallon of blood during the surgery. The death rate was 5.2 out of 100 surgeries, and was higher in poorer countries. The study concludes that emergency hysterectomies after childbirth are linked with significant health problems and death, and occur more often in poorer countries, where the risk of death is also higher. Women who have had a C-section are at higher risk of needing this procedure.

FAQs

  1. What is the rate of emergency hysterectomies performed within six weeks after childbirth according to the research?
  2. What are the main reasons for performing an emergency hysterectomy after childbirth?
  3. What factors increase the risk of needing an emergency hysterectomy after childbirth?

Doctor’s Tip

A doctor might advise a patient undergoing a hysterectomy to follow post-operative care instructions carefully, including taking prescribed medications, avoiding heavy lifting and strenuous activity, and attending follow-up appointments. They may also recommend that the patient discuss any concerns or questions with their healthcare provider, and to seek support from loved ones or a counselor if needed during the recovery process. It is important for the patient to take care of themselves physically and emotionally during this time.

Suitable For

Patients who may be recommended for a hysterectomy include those experiencing:

  1. Uterine fibroids: These noncancerous growths in the uterus can cause heavy menstrual bleeding, pelvic pain, and pressure on the bladder or bowel.

  2. Endometriosis: This condition occurs when the tissue that lines the uterus grows outside of it, causing severe pelvic pain, heavy periods, and infertility.

  3. Uterine prolapse: When the muscles and ligaments that support the uterus weaken, the uterus can descend into the vaginal canal, causing discomfort and urinary incontinence.

  4. Abnormal uterine bleeding: This can be caused by hormonal imbalances, uterine polyps, or endometrial hyperplasia, and may require a hysterectomy if other treatments are ineffective.

  5. Gynecologic cancers: Hysterectomy may be recommended for patients with cervical, uterine, or ovarian cancer to remove the affected organs.

  6. Chronic pelvic pain: If other treatments have been unsuccessful in managing severe pelvic pain, a hysterectomy may be considered as a last resort.

  7. Adenomyosis: This condition occurs when the lining of the uterus grows into the muscle wall, causing heavy periods, pelvic pain, and pressure.

It is important for patients to discuss their symptoms and treatment options with their healthcare provider to determine if a hysterectomy is the best course of action for their individual situation.

Timeline

Before a hysterectomy:

  1. Patient experiences symptoms such as heavy menstrual bleeding, pelvic pain, fibroids, endometriosis, or cancer.
  2. Patient consults with a gynecologist who recommends a hysterectomy as a treatment option.
  3. Patient undergoes pre-operative evaluations, including blood tests and imaging studies.
  4. Patient discusses the risks and benefits of the surgery with their healthcare provider and makes a decision to proceed with the hysterectomy.

After a hysterectomy:

  1. Patient undergoes the surgical procedure to remove the uterus.
  2. Patient stays in the hospital for a few days for recovery.
  3. Patient experiences post-operative pain and discomfort, and is prescribed pain medication.
  4. Patient may have restrictions on physical activity and sexual intercourse for a period of time.
  5. Patient follows up with their healthcare provider for post-operative care and monitoring.
  6. Patient may experience relief from their previous symptoms and improved quality of life after the hysterectomy.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a hysterectomy?
  2. How will a hysterectomy affect my future reproductive health and fertility?
  3. What are the different types of hysterectomy procedures available and which one would be most suitable for me?
  4. What is the recovery process like after a hysterectomy and how long can I expect to be out of work or restricted in my activities?
  5. Are there any alternative treatments or therapies that I could consider before opting for a hysterectomy?
  6. How will a hysterectomy impact my hormonal balance and menopausal symptoms?
  7. What is the long-term impact of a hysterectomy on my overall health and wellbeing?
  8. How frequently do emergency hysterectomies occur after childbirth and what are the main reasons for needing this procedure?
  9. What are the risk factors that increase the likelihood of needing an emergency hysterectomy after childbirth?
  10. How can I reduce my risk of needing an emergency hysterectomy and ensure a safe delivery?

Reference

Authors: van den Akker T, Brobbel C, Dekkers OM, Bloemenkamp KWM. Journal: Obstet Gynecol. 2016 Dec;128(6):1281-1294. doi: 10.1097/AOG.0000000000001736. PMID: 27824773