Cesarean Section Hysterectomy
The distinguishing features of an abdominal hysterectomy performed on a pregnant patient, whether associated with cesarean section or performed after a vaginal delivery, are (1) the greater vascularity compared with the nonpregnant patient, (2) the close association of a dilated cervix and vagina with the greatly distended ureters, and (3) a tendency for the postpartum patient to form blood clots. Most hysterectomies in this setting are performed as an emergency operation, typically to treat bleeding difficulties (Figs. 19–1A–C).
The ureters must be identified on the right and left sides of the pelvis. They are best located as they cross the common iliac vessels and descend into the pelvis. The best operation to perform under these circumstances is a subtotal hysterectomy (Fig. 19–2). The cervix can be removed months or years later, via the vaginal or the abdominal route, if necessary. The subtotal hysterectomy is least likely to result in ureteral injury and is completed most rapidly.
