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Hysterotomy - Procedure and Associated Complications

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In the hysterotomy procedure, an incision is made on the uterus to remove its content. This is done during pregnancy in different clinical situations.

Medically reviewed by

Dr. Vrinda Khemani

Published At May 12, 2023
Reviewed AtFebruary 8, 2024

Introduction:

Physical changes during the pregnancy are normal. But in certain cases, the physical changes during this period can be fatal. In such cases, emergency procedures are required. A hysterotomy is a procedure that can be used in emergencies to save the life of the mother and fetus.

What Is Hysterotomy?

This is a surgical process in which an incision is made on the uterus to remove the content of the uterus. This procedure is done at a later stage of pregnancy (second trimester, between the third and sixth months). The indication of such a procedure is:

  1. Hysterotomy Abortion - This procedure is done if the traditional process of abortion has failed. Also, in medical conditions where medical abortion is needed in such cases, it is done. Such cases are:

  • Low-Lying Placenta - In this case, the placenta is attached low in the uterus. This is also called placenta previa. This is characterized by fresh red-colored bleeding from the vagina, usually after 20 weeks of pregnancy.

  • Hematoma - Subchorionic hematomas are very common in the second trimester and are associated with the detachment of the chorion membrane (the outermost layer of the amniotic sac) from the uterus.

  • Placental Abruption - The placenta is detached from the uterus in this condition. This causes less supply of oxygen and nutrients to the baby. This is caused by trauma or loss of amniotic fluid.

  • Fetomaternal Transfusion - This is characterized by entering fetal blood into the maternal circulation.

  • Presence of Infection - The presence of severe infection or chronic conditions like severe diabetes or uncontrolled hypertension is responsible for abortion.

2. Fetal Surgery - Surgery on the fetus is necessary to save the newborn's life. These conditions are:

  • Neural Tube Defects - Defects in the neural tube may cause conditions like myelomeningocele. This is a severe type of spina bifida. In this condition, the bones of the spine do not close. As a result, the nerves and the membranes form a sac.

  • Congenital Cystic Adenomatoid Malformation - This is an abnormality of lung development. This is caused by the excessive proliferation of tubular bronchial structures (which carry air from the windpipe to the lungs). This causes the development of cyst-like structures in the lungs.

  • Congenital Diaphragmatic Hernia - This is characterized by a hole in the membrane separating the abdomen from the diaphragm. As a result, the contents of the abdominal cavity go into the thoracic cavity.

  • Congenital Heart Disease - The presence of a congenital heart defect is indicated for fetal surgery.

  • Sacrococcygeal Teratoma - This type of tumor grows at the end of the tailbone. Though such tumors are benign, they may grow significantly in size and cause neurological and life-threatening problems.

  • Pulmonary Sequestration - Abnormal lung tissues in the respiratory system characterize this. This is also called bronchopulmonary sequestration, as the tissue may be present outside the lobule of the lungs.

  • Twin-To-Twin Transfusion Syndrome - This is a rare condition of abnormal blood supply. In this condition, two twins receive an unequal amount of blood supply. As a result, the growth rate for the twins is different.

3. Resuscitative Hysterotomy - This is done in relatively emergency cases to save the life of the mother and the fetus. Sudden compression in the inferior vena cava (vein which carries blood from the lower portion of the body) and abdominal aorta (main artery which supplies blood to the abdomen) causes cardiac arrest of the mother. This can only be done when the age of the fetus is more than 24 weeks.

4. Cesarean Section - The traditional abdominal approach and the uterine approach can perform cesarean section. The uterine approach is known as a low transverse incision or hysterotomy. Complications of the abdominal approach, like delayed wound healing and bleeding, and this technique can evert thromboembolism.

What Happens During a Hysterectomy Procedure?

The doctor will decide on the best hysterectomy procedure that needs to be performed. The patient will change into a gown and get attached to the monitors, which track the heart rate. The medications and fluids will be delivered through an IV (intravenous) line.

What Is the Procedure?

For this procedure, several types of incision can be used. These are the Joel-Cohen incision, Pfannenstiel incision, and midline vertical incision. A number 10 surgical blade is used to create this incision. A Pfannenstiel skin incision is placed 2 to 3 centimeters above the symphysis pubis (joint between left and right pubic bone), and a Joel-Cohen incision is a straight type of incision that is extended 3 centimeters below the line connecting the anterior superior iliac spines (bony projection in the iliac bone). After uterine entry, the incision is extended laterally with the help of blunt instruments. During this procedure, the index and middle fingers of the operator should be used to separate the uterine wall away from the fetus. The fetal head is elevated after this hand is inserted into the uterine cavity. For a very low transverse uterine incision, the incision is placed 1 to 2 centimeters below the traditional incision, known as the bikini line approach. For abortion procedures, preoperative feticide injection of Digoxin or potassium chloride can be given to ensure fetal death.

What Are the Side Effects of the Hysterectomy Procedure?

The common side effects are

  • Vaginal drainage.

  • Irritation at the site of surgery.

  • Hot flashes.

  • Vaginal dryness.

  • Reduced libido.

  • Insomnia.

What Are the Complications?

The potential complications associated with this procedure are:

  1. Bladder Injury - As this is a low-level incision, the urinary bladder may be injured. This is avoided by displacing the bladder inferiorly. Also, decompression of the distended bladder can be done with needle aspiration.

  2. Injury to the Fetus - Injury to the fetus can be avoided using blunt instruments. Also, careful manipulation of the placenta with the hand can be useful.

  3. Arterial Injury - Injury to the main arteries can make the situation more difficult. Abdominal incisions are avoided to avoid injury to the main blood vessels midline. Also, lateral incisions are avoided to protect blood vessels running laterally.

How Long Will It Take for the Recovery After Hysterectomy?

Usually, people recover from a hysterectomy in about six weeks. The recovery is based on the type of surgery done and how well it was performed. Vaginal and laparoscopic hysterectomy takes less recovery time when compared to abdominal hysterectomy.

Conclusion:

Hysterotomy is a surgical procedure involving an incision in the uterus. It is primarily performed when vaginal birth or traditional cesarean section is not feasible or poses risks to the mother or baby. Hysterotomy allows for the safe delivery of the baby while closely monitoring and addressing any complications. Although it carries potential risks and complications, the procedure is conducted under general anesthesia, and the recovery process is the same as that of a cesarean section. It is better to consult a healthcare professional for personalized information and guidance regarding hysterotomy.

Dr. Vrinda Khemani
Dr. Vrinda Khemani

Obstetrics and Gynecology

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