Hysterectomy after childbirth carries higher risks

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In Sunday’s L.A. Times, we reported on rising rates of maternal mortality in the United States. Two studies in the June issue of the journal Obstetrics & Gynecology address this disturbing development. On Monday in Booster Shots, we reported on the first study, which shows why it may be safer for some women to have vaginal birth after a cesarean instead of repeat cesareans.

The second relevant study in the journal describes the stunning complications of having an emergency hysterectomy following childbirth. According to the authors of the paper, cesarean delivery is the most important risk factor for childbirth-related hysterectomy. Although this complication is uncommon, women who have C-sections are six times more likely to need a hysterectomy compared to women who have vaginal birth.

At other times of life, hysterectomies are typically very safe. When the surgery is performed after childbirth, however, it is often an emergency procedure due to a hemorrhage following a cesarean section. One would expect that complications would be greater in hysterectomies performed in this type of situation -- and are they ever. The study, by researchers at Columbia University College of Physicians & Surgeons examined data from almost 5,000 women who had a hysterectomy following childbirth and compared that group to 578,179 women who had a non-obstetric hysterectomy.

Although deaths are rare, they were 25 times higher when performed following childbirth compared to non-obstetric hysterectomies. Bladder and ureteral injuries were more common in hysterectomy following childbirth (9% and 0.7% compared to 1% and 0.1% in the non-obstetric hysterectomy). The need for a second operation was higher (4% compared to 0.5%) as was postoperative hemorrhage (5% compared to 2%), wound complications (10% compared to 3%) and blood clots (1% compared to 0.7%). This is despite the fact that women having post-childbirth hysterectomies are likely to be much younger and in generally better health than women having non-obstetric hysterectomy.

Changes have been proposed to lower maternal mortality rates, including lowering the rate of Cesarean sections and having rapid response teams in case of a hemorrhage. The authors of the study note that the complications and risks associated with a subsequent hysterectomy should be part of the focus on expanding patient safety in obstetrics.

-- Shari Roan

Praphic: Maternal mortality has risen in the United States and in California in the past decade. Credit: Los Angeles Times.