title: Vaginal hysterectomy in women with a history of 2 or more cesarean deliveries.
abstract: OBJECTIVE
  To perform vaginal hysterectomy (VH) safely in women with a history of 2 or more cesarean deliveries (CDs).
  
  
  METHODS
  A 4-step method was followed to safeguard the bladder, access the vesicouterine peritoneum (VUP), and perform VH in 312 patients with a history of 2 or more CDs. If access to the VUP did not occur at the end of step 2, step 3 and, if necessary, step 4 were implemented.
  
  
  RESULTS
  Hysterectomy was performed vaginally in 311 patients, and the abdominal route was resorted to in 1 patient because of hemorrhage. Only 1 patient incurred bladder trauma, which was promptly repaired.
  
  
  CONCLUSIONS
  In the absence of contraindications, the 4-step VH method described and the surgical techniques involved are safe to implement in women with a history of 2 or more CDs who need a hysterectomy.
authors.affiliation: Breach Candy Hospital, Mumbai, India. silsal@bom2.vsnl.net.in
authors.forename: Shirish S
authors.initials: SS
authors.lastname: Sheth
mesh_terms: D017604:Cesarean Section, Repeat; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D001743:Urinary Bladder / Q000293:injuries*