Definition and Overview
Hysterotomy is a surgical procedure that involves making an incision in the uterus to remove uterine contents. It can be performed for various reasons including caesarian section, foetal surgery, delayed abortion, and a range of gynaecological procedures. It is different from hysterectomy, which refers to the complete or partial removal of the uterus (commonly known as the womb) with or without the other organs of the female genital tract. However, hysterotomy can be a part of hysterectomy.
Unlike hysterectomy wherein the surgeon can make the incision either in the abdomen or the vagina to access the uterus, hysterotomy is performed exclusively via the abdomen. The incision is generally smaller when compared to the one used in hysterectomy. Both procedures can be performed under general anaesthesia.
Hysterotomy is the widely preferred technique for open foetal surgery. It is also the operation of choice if the uterus needs to be operated on during pregnancy or if a woman decides to abort the foetus after the first trimester. If the procedure is to be performed for delayed abortion, it is done the same way as caesarian section.
Who Should Undergo and Expected Results
Also called uterotomy, hysterotomy refers to an incision in the uterus. This type of incision can be used in a number of medical procedures including foetal surgery, caesarian section, and delayed abortion or abortion performed past the first trimester. It can also be indicated in the event of haemorrhage in the second trimester and in cases of a failed induction following previous uterine surgery.
Hysterotomy is a major surgical procedure. It becomes necessary when certain medical conditions require doctors to access the uterus or the foetus inside it. It is typically a part of the process if corrective measures have to be taken long before the foetus is to be delivered. The goal of this type of surgery is to allow the foetus to remain in the uterus until such time that it has matured enough that it can be safely delivered.
Common conditions that require foetal surgeries that can be performed via hysterotomy include:
- Neural tube defects, such as myelomeningocele
- Congenital cystic adenomatoid malformation
- Congenital heart disease
- Congenital diaphragmatic hernia
- Foetal tumours
- Sacrococcygeal teratoma
- Pulmonary sequestration
- Urinary tract obstruction
- Twin to twin transfusion syndrome (TTTS)
Due to recent advancements in the field of foetal surgery, some procedures can now be performed using minimally invasive techniques. These methods use a fibreoptic scope to access the uterus through small incisions to correct congenital malformations. Although these methods do not require major incisions and are less traumatic compared to an open foetal surgery, they are not applicable in all cases.
How is the Procedure Performed?
Prior to hysterotomy, patients undergo various tests to ensure that they qualify for the procedure. Doctors also ensure that hysterotomy is the only available treatment method that can be used. As much as possible, the procedure is considered as the last resort due to the number of serious risks associated with it.
If hysterotomy is going to be performed as part of a foetal surgery, various diagnostic tests will be performed prior to the operation. These include ultrasound, chorionic villus sampling, and amniocentesis, among others. The condition of the foetus will also be assessed to ensure that it is eligible for surgery.
Meanwhile, if hysterotomy is going to be performed for a scheduled caesarian section, the patient will undergo blood tests in preparation for blood transfusion should it become necessary during the procedure. Other tests may be performed depending on the circumstances that surround the patient’s condition.
To perform hysterotomy, the patient is administered with general or regional anaesthesia; the latter numbs only the lower part of the body. This means that the patient is awake during the procedure. This can be used for caesarian section. Meanwhile, if general anaesthesia is used, the patient will be asleep throughout the procedure. The doctor will then make a horizontal or vertical incision in the abdominal wall. More incisions will be made, layer by layer, through the fatty and connective tissue so the abdominal muscle can be separated, allowing the surgeon to access the abdominal cavity. This is followed by making a uterine incision typically across the lower part of the uterus. Once the surgeon gains access to the uterus, the surgery can be performed.
Possible Risks and Complications
Hysterotomy is a major surgical operation that is associated with a number of serious risks and complications. One major concern is that it can trigger labour in pregnant women. Other potential risks include:
- Pulmonary embolism
- Allergic reaction to anaesthesia
- Rupture of the operation scar in a future pregnancy
Kulier R, Fekih A, Hofmeyr GJ, Campana A. Surgical methods for first trimester termination of pregnancy. Cochrane Database of Syst Rev. 2001, Issue 4. Art. No.: CD002900. DOI: 10.1002/14651858. CD002900.
Lalitkumar S, Bygdeman M, Gemzell-Danielsson K. Mid-trimester induced abortion: a review. Hum Reprod Update. 2007;13(1):37-52. 3. Goyal V. Uterine rupture in second-trimester misoprostol-induced abortion after cesarean del