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    Peripartum Hysterectomy

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    Jacob Trisusilo Salean
    This document discusses peripartum hysterectomy, which is a hysterectomy performed during or shortly after childbirth. It notes that the rate of peripartum hysterectomy at one hospital was 1.7 per 1000 births over a 25-year period. The increasing rates of cesarean delivery and its complications in subsequent pregnancies have led to an increase in the need for peripartum hysterectomy. The major complications of peripartum hysterectomy are increased blood loss and a greater risk of urinary tract damage. The document then describes the technique for performing a supracervical or total hysterectomy during this procedure, including steps such as deflecting the bladder, ligating and dividing various ligaments, and suturing

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    Peripartum Hysterectomy

    Uploaded by

    Jacob Trisusilo Salean
    419 views10 pages
    This document discusses peripartum hysterectomy, which is a hysterectomy performed during or shortly after childbirth. It notes that the rate of peripartum hysterectomy at one hospital was 1.7 per 1000 births over a 25-year period. The increasing rates of cesarean delivery and its complications in subsequent pregnancies have led to an increase in the need for peripartum hysterectomy. The major complications of peripartum hysterectomy are increased blood loss and a greater risk of urinary tract damage. The document then describes the technique for performing a supracervical or total hysterectomy during this procedure, including steps such as deflecting the bladder, ligating and dividing various ligaments, and suturing

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    Peripartum Hysterectomy

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    This document discusses peripartum hysterectomy, which is a hysterectomy performed during or shortly after childbirth. It notes that the rate of peripartum hysterectomy at one hospital was 1.7 per 1000 births over a 25-year period. The increasing rates of cesarean delivery and its complications in subsequent pregnancies have led to an increase in the need for peripartum hysterectomy. The major complications of peripartum hysterectomy are increased blood loss and a greater risk of urinary tract damage. The document then describes the technique for performing a supracervical or total hysterectomy during this procedure, including steps such as deflecting the bladder, ligating and dividing various ligaments, and suturing

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    419 views10 pages

    Peripartum Hysterectomy

    Uploaded by

    Jacob Trisusilo Salean
    This document discusses peripartum hysterectomy, which is a hysterectomy performed during or shortly after childbirth. It notes that the rate of peripartum hysterectomy at one hospital was 1.7 per 1000 births over a 25-year period. The increasing rates of cesarean delivery and its complications in subsequent pregnancies have led to an increase in the need for peripartum hysterectomy. The major complications of peripartum hysterectomy are increased blood loss and a greater risk of urinary tract damage. The document then describes the technique for performing a supracervical or total hysterectomy during this procedure, including steps such as deflecting the bladder, ligating and dividing various ligaments, and suturing

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 10

    PERIPARTUM

    HYSTERECTOMY

    Jacob Trisusilo Salean


    Resident Obstetric Ginecology
    Dr. Soetomo Hospital- Airlangga University

    Indication

    Hysterectomy is more commonly performed


    during or after cesarean delivery but may be
    needed following vaginal birth.
    During a 25-year period, the rate of peripartum
    hysterectomy at Parkland Hospital was 1.7 per
    1000 births (Hernandez, 2012).
    Most of this increase is attributed to the
    increasing rates of cesarean delivery and its
    associated complications in subsequent
    pregnancy (Bateman, 2012; Bodelon, 2009;
    Flood, 2009; Orbach, 2011).

    Major complications of peripartum


    hysterectomy :
    Increased blood loss
    Greater risk of urinary tract damage.

    Peripartum Hysterectomy
    Technique
    Supracervical or total hysterectomy is
    performed using standard operative
    techniques.
    For this, adequate exposure is essential.
    The bladder flap is deflected downward to
    the level of the cervix if possible to permit
    total hysterectomy.

    The round ligaments are


    clamped, doubly ligated,
    and transected bilaterally.

    The posterior leaf of the broad


    ligament is divided inferiorly
    toward the uterosacral
    ligament.

    The posterior leaf of the


    broad ligament adjacent to
    the uterus is perforated just
    beneath the fallopian tube,
    uteroovarian ligaments, and
    ovarian vessels.

    The bladder is dissected


    sharply from the lower
    uterine segment.

    The uteroovarian
    ligament and fallopian
    tube are doubly clamped
    and cut bilaterally.
    The lateral pedicle is
    doubly ligated.

    The uterine artery and veins on


    either side are doubly clamped
    immediately
    adjacent to the uterus and divided.
    A third medial clamp will prevent
    back bleeding. B&C. The

    Total Hysterectomy
    Even if total hysterectomy is planned, we
    find it in many cases technically easier to
    finish the operation after amputating the
    uterine fundus and placing Ochsner or
    Kocher clamps on the cervical stump for
    traction and hemostasis.
    To remove the cervix, the bladder is
    mobilized further if needed.

    The cardinal ligaments are clamped,


    incised, and ligated.

    The lateral angles of the vaginal cuff


    are secured to the cardinal and
    uterosacral
    ligaments.

    A curved clamp is placed across the


    lateral vaginal fornix below the level of
    the
    cervix, and the tissue incised medially
    to the point of the clamp.

    A running-lock suture approximates the


    vaginal wall edges.

    Thank You

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