The impact of a previous cesarean section on the risk of perioperative and postoperative complications during vaginal hysterectomy

• Published in: International journal of gynecology and obstetrics 2024-02, Vol.164 (2), p.557-562
• Main Authors: Weiss, Moran, Baumfeld, Yael, Rotem, Reut, Gedalia, Yuval, Erenberg, Miriam, Weintraub, Adi Y.
• Format: Article
• Language: English
• Subjects: Cesarean Section - adverse effects; clavien‐Dindo classification; esarean sections; Female; Humans; Hysterectomy - adverse effects; Hysterectomy - methods; Hysterectomy, Vaginal - adverse effects; Hysterectomy, Vaginal - methods; major surgical complications, minor surgical complications; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Pregnancy; previous cesarean section; previous two cesarean sections; Retrospective Studies; vaginal hysterectomy
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.15105

Objective To investigate whether a previous cesarean section increases the risk of perioperative and postoperative complications during vaginal hysterectomy. Methods A retrospective cohort study of women who had undergone a vaginal hysterectomy for benign indications between 2014 and 2019 was conducted, comparing patients with or without a previous cesarean section. Perioperative and postoperative complications during vaginal hysterectomy were assessed according to the Clavien‐Dindo classification system within 30 days of surgery. Duration of surgery, estimated blood loss, and postoperative hospitalization days were also recorded. A two‐sided P value of less than 0.05 was considered significant. Results A total of 185 women were included, 25 (13.5%) patients had undergone a previous cesarean section (study group) and 160 (86.5%) had no history of cesarean section (comparison group). We found no significant differences in demographic and clinical characteristics as well as postoperative complications and interventions, duration of surgery, estimated blood loss, and postoperative hospitalization days (P > 0.05). However, patients who underwent two or more cesarean sections had a significantly (P = 0.01) higher rate and grade of complications during vaginal hysterectomy, compared with women with only one previous cesarean section. All women who underwent two or more cesarean sections had mild complications during vaginal hysterectomy (40% grade I and 60% grade II, P = 0.01). Conclusion Vaginal hysterectomy is a safe procedure with few severe complications, regardless of a previous cesarean section. More than one previous cesarean section may increase the risk of minor complications during a vaginal hysterectomy. Patients who underwent a previous cesarean section could be reassured that they do not face an increased risk of complications during a vaginal hysterectomy. Synopsis Comparative study showing similar complication rates for VH in women with and without previous CS, and higher complication rates for women with ≥2 CS.