title: Vaginal hysterectomy in women with history of previous cesarean delivery.
abstract: OBJECTIVE
  This study aimed to compare surgical outcomes with vaginal hysterectomy between women who have had >/=1 cesarean delivery and those who have not had a cesarean delivery. A secondary objective was to analyze the effect of previous vaginal birth on the complication rate of vaginal hysterectomy.
  
  
  METHODS
  A retrospective analysis was performed on 221 women undergoing vaginal hysterectomy. Women were separated into those who had a history of previous cesarean deliveries (N = 35) and those who did not (N = 186). The groups were analyzed for the indications for surgery, perioperative hemoglobin loss, operative time, length of hospitalization, and complications. Trends in the complication rate for women in the previous cesarean group were also studied from the perspectives of numbers of previous cesarean deliveries and of vaginal delivery history. The 95% confidence intervals for the difference between proportions as well as P values for probability tests were calculated. P <.05 was considered significant.
  
  
  RESULTS
  Previous cesarean delivery experience did not affect hemoglobin change, hospital stay, or operative time among women undergoing vaginal hysterectomy. A total of 11.3% of women in the previous cesarean group had complications, versus 4.3% for the noncesarean group (P =.10, 95% confidence interval -3.8% to 18.0%). Complications did not increase with increasing number of previous cesarean deliveries (U = 1020.5, P =.28). Also, a trend toward fewer complications among patients with a history of cesarean delivery who had also had a vaginal delivery was demonstrated (U = 836, P =.05). Overall, women who were undergoing vaginal hysterectomy who had a history of >/=1 previous vaginal delivery had a complication rate of 3.2%, versus 17.6% for women who had not had a previous vaginal birth (P =.004, 95% confidence interval -27.5% to -1.3%).
  
  
  CONCLUSIONS
  In this study women who had a history of previous cesarean delivery were not at higher risk for greater hemoglobin loss, longer hospital stay, more prolonged operative time, or significantly more perioperative complications when undergoing vaginal hysterectomy than were those women who had no history of previous cesarean delivery. Likewise, increasing the number of previous cesarean deliveries did not have an adverse impact on the complication rate. Previous vaginal delivery lowered the risk of complications from vaginal hysterectomy.
authors.affiliation: Department of Obstetrics and Gynecology, Marshfield Clinic, and the Division of Gynecology, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Unger
authors.forename: G R
authors.initials: GR
authors.lastname: Meeks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007045:Hysterectomy, Vaginal; D007902:Length of Stay; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins