title: Comparison of morbidity in cesarean section hysterectomy versus cesarean section tubal ligation.
abstract: This study was undertaken to compare the morbidity of cesarean section hysterectomy (C-HYST) and cesarean section bilateral tubal ligation (C-BTL) in a nonemergency or elective environment. Charts were reviewed for patients who underwent elective C-HYST or elective C-BTL before the onset of labor, without the use of antibiotics. Demographics, maternal morbidity, operative difficulties and postoperative complications were compared. Statistically significant differences in patient demographics include a higher maternal age in the C-HYST group than for those in the C-BTL group (31.0 +/- 5.8 versus 27.7 +/- 5.4 years; p = 0.002). C-BTL patients had higher gestational ages (39.4 +/- 1.6 versus 38.7 +/- 1.3 years; p = 0.0017). The C-HYST group had a higher estimated blood loss (1,201 +/- 472 versus 718 +/- 364 milliliters; p = 0.001), change in hematocrit level (6.0 +/- 4.4 percent versus 4.5 +/- 3.4 percent; p = 0.013) and operating time (115 +/- 37 versus 74 +/- 26 minutes; p = 0.0001). Blood transfusion was similar in both groups. Febrile morbidity was higher in the C-BTL group (68.0 percent versus 50.0 percent; p = 0.01). Endometritis was the significant determinant of febrile morbidity for the C-BTL group (41.7%) and cuff cellulitis in the C-HYST group (25.6 percent). Intraoperative and postoperative complications between the two groups were rare and not statistically different. Clinical morbidity for C-HYST is not significantly different than C-BTL. Elective C-HYST may be used in place of C-BTL when indications for hysterectomy are present.
authors.affiliation: Department of Obstetrics and Gynecology, Louisiana State University Medical Center, New Orleans 70112.
authors.forename: M A
authors.initials: MA
authors.lastname: Bey
authors.forename: J G
authors.initials: JG
authors.lastname: Pastorek
authors.forename: P Y
authors.initials: PY
authors.lastname: Lu
authors.forename: H
authors.initials: H
authors.lastname: Gabert
authors.forename: R L
authors.initials: RL
authors.lastname: Letellier
authors.forename: J M
authors.initials: JM
authors.lastname: Miller
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006400:Hematocrit; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008423:Maternal Age; D009017:Morbidity; D011247:Pregnancy; D012189:Retrospective Studies; D013246:Sterilization, Tubal / Q000009:adverse effects*; D013997:Time Factors