Abdominal hysterectomy is a surgical procedure in which the

uterus is removed through an incision in the lower abdomen

(figure 1). One or both ovaries and fallopian tubes may also be
removed during the procedure (figure 2

REASONS FOR ABDOMINAL HYSTERECTOMY

A hysterectomy may be recommended for a number of

conditions. For some of these conditions, there may be an
alternative to hysterectomy, described below. (See 'Alternatives
to hysterectomy' below.)

Abnormal uterine bleeding — Excessive uterine bleeding,

called menorrhagia, can lead to anemia (low blood iron count),
fatigue, and contribute to missed days at work or school.
Menorrhagia is generally defined as bleeding that lasts longer
than seven days or saturates more than one pad per hour for
several hours.

Heavy or irregular bleeding are generally treated first with

medication or other surgical alternatives to hysterectomy.
(See"Patient information: Menorrhagia (excessive menstrual
bleeding)".) However, abnormal uterine bleeding that does not
improve with conservative treatments may require hysterectomy.

Fibroids — Fibroids (also known as leiomyoma) are

noncancerous growths of uterine muscle that occur in up to one-
third of all women. Fibroids may become larger during pregnancy,
and typically shrink after menopause. They may cause excessive
bleeding and pelvic pain or pressure. (See "Patient information:
Uterine fibroids".)

Pelvic organ prolapse — Pelvic organ prolapse occurs due to

stretching and weakening of the pelvic muscles and ligaments.
This allows the uterus to fall (or prolapse) into the vagina.
Prolapse is more common in women who have been pregnant,
had vaginal childbirth, and in those with certain genetic factors,
lifestyle factors (repeated heavy lifting over the lifetime), or
chronic constipation.

Cervical abnormalities — Hysterectomy is rarely needed for

carcinoma in situ (CIN 3) that does not resolve after other
procedures (such as cone biopsy, laser or cryosurgery).
(See "Patient information: Management of atypical squamous
cells (ASC-US and ASC-H) and low grade cervical squamous
intraepithelial lesions (LSIL)" and "Patient information:
Management of high grade cervical squamous intraepithelial
lesions (HSIL) and glandular abnormalities (AGC)".)

Endometrial hyperplasia — Endometrial hyperplasia is the term

used to describe excessive growth of the endometrium (the tissue
that lines the uterus). It can sometimes lead to endometrial
cancer. Although endometrial hyperplasia can often be treated
with medication, a hysterectomy is sometimes needed or
preferred to medical therapy.

Cancer — Cancer of the uterus (endometrium), cervix, or ovaries

may require hysterectomy. (See "Patient information: Cervical
cancer treatment; early stage cancer" and "Patient information:
Endometrial cancer treatment" and "Patient information: Ovarian
cancer treatment".)

Severe bleeding after childbirth — Hysterectomy may rarely

be required in women who have uncontrollable bleeding after
childbirth.

Chronic pelvic pain — Chronic pelvic pain can be due to the

effects of endometriosis or scarring (adhesions) in the pelvis and
between pelvic organs. However, pelvic pain can also be caused
by other sources, including the gastrointestinal and urinary
systems. (See "Patient information: Chronic pelvic pain in
women".) It is important for a woman with pelvic pain to ask
about the probability that her pain will improve after
hysterectomy.

ABDOMINAL HYSTERECTOMY PROCEDURE

Abdominal hysterectomy is performed in a hospital setting, and

generally requires one to two hours in the operating room.
Patients are given general or spinal anesthesia plus sedation so
that they feel no pain. Heart rate, blood pressure, blood loss, and
respiration are closely observed throughout the procedure. After
surgery, patients are transferred to the recovery room (also
known as the post-anesthesia care unit) so that they can be
monitored while waking up. Most patients will then be transferred
to a hospital room, where they will spend one to two nights.

http://www.uptodate.com/patients/content/topic.do?topicKey=~pdRTabHHG6Ek4d

Pregnancy Complications: Uterine Atony

http://www.healthline.com/yodocontent/pregnancy/complications-delivery-uterine-atony.html

UTERINE ATONY

Ninety percent of all postpartum hemorrhages are caused by uterine atony-that

is, failure of the uterine muscles to contract normally after the baby and placenta
are delivered. The blood vessels supplying the placenta during pregnancy are
severed when the placenta separates from the wall of the uterus. The bleeding
that results from these severed vessels normally stops when the uterus
contracts, compressing the vessels. However, if the uterus doesn't contract
enough, the bleeding can continue. Significant blood loss can result from a
floppy, uncontracted uterus.

Factors that may prevent the muscles of the uterus from contracting include the
following:
  prolonged labor;
 the use of oxytocin (Pitocin) during labor;
 general anesthesia;
 twin or multiple births;
 increased amounts of amniotic fluid (polyhydramnios);
 delivery of a large baby;
 history of more than five pregnancies;
 abnormal labor (dystocia); and
 infection (chorioamnionitis).

In addition, fragments of placenta remaining in the uterus after delivery or benign

growths within the walls of the uterus (known as fibroids) can also prevent the
uterus from contracting normally.

A
After Delivery

Uterine atony is diagnosed after delivery when there is excessive bleeding and a
large, relaxed uterus. The doctor first rules out other potential causes of the
bleeding (tears in the vagina or cervix and fragments of the placenta remaining in
the uterus); these problems should be resolved if they are present. If the bleeding
continues, the uterus may be stimulated to contract with use ofmassage and
intravenous oxytocin. Many studies show this technique reduces postpartum
hemorrhage and the need for blood transfusions. If heavy bleeding from atony
occurs despite the use of oxytocin after delivery, then two additional medications
may be used to help control hemorrhage:

 Methylergonovine, a strong vasoconstrictor derived from ergot, is injected

into a muscle. It is not given to patients with preeclampsia or a history
of high blood pressure because it can cause high blood pressure.
 Prostaglandin F-2-alpha (Hemabate) is injected under the skin and also
directly into the uterus. Frequent side effects include diarrhea and
vomiting. It can cause bronchial constriction and is usually avoided in
patients with asthma.

Emergency surgery should be performed if atony persists despite these

measures to control the bleeding. This may be accomplished by tying off the
blood vessels that supply the uterus. If successful, this procedure should not
affect future pregnancies. In a more involved procedure, the doctor usesx-rays to
guide a small catheter through blood vessels in the mother's leg and into the
blood vessels supplying the uterus. These blood vessels are then injected with
gelatin sponge particles or spring coils to obstruct blood flow to the uterus.
Although successful control of hemorrhage has been reported with this
technique, the equipment necessary to perform it may not be available in most
emergency situations.

If bleeding persists in spite of all conservative measures to control it, a

hysterectomy (removal of the uterus) may be necessary.

What is a hysterectomy? http://www.medicinenet.com/hysterectomy/article.htm

A hysterectomy is a surgical procedure whereby the uterus (womb) is removed. Hysterectomy is
the most common non-obstetrical surgical procedure of women in the United States.

Why is a hysterectomy performed?

The most common reason hysterectomy is performed is foruterine fibroids The next most
common reasons are:

 abnormal uterine bleeding (vaginal bleeding),

 cervical dysplasia (pre-cancerous conditions of the cervix),

 endometriosis, and uterine prolapse (including pelvic relaxation).

Only 10% of hyster

Cesarean Section - How a Cesarean Section Is Done

Surgery preparation
Most cesarean sections are performed with epidural or spinal anesthesia, used to numb
sensation in the abdominal area. Only in an emergency situation or when an epidural or
spinal anesthesia cannot be used or is a problem would fast-acting general
anesthesia be used to make you unconscious for a cesarean birth.
The hospital may send you instructions on how to get ready for your surgery, or a nurse
may call you with instructions before your surgery.
In preparation for a cesarean section, your arms are secured to the table for your safety,
and a curtain is hung across your chest. A tiny intravenous (IV) tube is placed in your
arm or hand; you may be given a sedative through the IV to help you relax. A catheter is
inserted into your bladder to allow you to pass urine during and after the surgery. Your
upper pubic area may be shaved, and the abdomen and pubic area are washed with an
antibacterial solution. The incision site may be covered with an adhesive plastic sheet,
or drape, to protect the surgical area.
Before, during, and after a cesarean section, your blood pressure, heart rate, heart
rhythm, and blood oxygen level are closely monitored. You will also be given a dose of
antibiotics to prevent infection after delivery.
Cesarean procedure and delivery
Once the anesthesia is working, a doctor makes the cesarean incision through your
lower abdomen and uterus. See a picture of cesarean section incisions  . You may
notice an intense feeling of pressure or pulling as the baby is delivered. After delivering
your newborn through the incision, the doctor then removes the placentaand closes the
uterus and incision with layers of stitches.
Right after surgery, you will be taken to a recovery area where nurses will care for and
observe you. You will stay in the recovery area for 1 to 4 hours, and then you will be
moved to a hospital room. In addition to any special instructions from your doctor, your
nurse will explain information to help you in your recovery…,
www.webmd.com/.../cesarean-section-how-a-cesarean-section-is-done -

What Is a C-Section?

A C-section is the surgical delivery of a baby that involves making incisions in the
mother's abdominal wall and uterus. Generally considered safe, C-sections do have
more risks than vaginal births. Plus, you can come home sooner and recover
quicker after a vaginal delivery.

However, C-sections can help women at risk for complications avoid dangerous
delivery-room situations and can save the life of the mother and/or baby when
emergencies occur.

C-sections are done by obstetricians (doctors who care for pregnant women before,
during, and after birth) and some family physicians. Although more and more
women are choosing midwives to deliver their babies, midwives of any licensing
degree cannot perform C-sections..,.
kidshealth.org/parent/pregnancy_center/.../c_sections.html