Ultrasound detection of vault haematoma following vaginal hysterectomy.
OBJECTIVE
To assess whether ultrasound detection of vault haematoma can be used as a predictor of post-operative morbidity following vaginal hysterectomy.


METHODS
Prospective observational study of consecutive cases of vaginal hysterectomy performed between 1991 and 1994.


METHODS
Two hundred and twenty-three women having undergone vaginal hysterectomy.


METHODS
All women had transvaginal ultrasound examination by an independent observer on the third post-operative day. Routine observations and clinical assessments were made by established management protocol, by staff blinded to the ultrasound findings.


METHODS
Febrile morbidity; haemoglobin drop; need for blood transfusion; length of stay in hospital; re-admission rate and length of stay.


RESULTS
Of the 223 scanned women, 55 (25%) had a vault haematoma. This group was compared with the 168 women with no haematoma. Significant increases in febrile morbidity (31% vs 7%), post-operative haemoglobin drop (2.5 g/dL vs 1.6 g/dL), need for blood transfusion (14.5% vs 1.2%), representation to hospital (25.5% vs 5.4%) and length of hospital stay (8.87 days vs 6.25 days) were seen in the haematoma group.


CONCLUSIONS
Ultrasound detection of vault haematoma following vaginal hysterectomy is a common finding associated with increased febrile morbidity, need for blood transfusion, longer hospital stay and higher re-admission rate. In view of increasing demand for early discharge, driven by purchasers and patients, post-operative ultrasound identifies a high risk population and is both convenient and noninvasive. To further reduce morbidity, it also offers the opportunity to perform a controlled trial of prophylactic antibiotics in this identified subset.
Thomson
A J
AJ
Liverpool Women's Hospital NHS Trust, Mersey Regional Health Authority, UK.
Sproston
A R
AR
Farquharson
R G
RG
D005260:Female; D005334:Fever / Q000209:etiology; D005544:Forecasting; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007902:Length of Stay; D010359:Patient Readmission; D011182:Postoperative Care; D011446:Prospective Studies; D012008:Recurrence; D014463:Ultrasonography; D014623:Vaginal Diseases / Q000000981:diagnostic imaging / Q000209:etiology*
D006454:Hemoglobins