[Vaginal hysterectomy in non-prolapsed uterus]. / Vaginal hysterektomi ved non-prolaberet uterus.

INTRODUCTION: There is an increasing number of methods available for removing the uterus, but no multicentre, randomised, clinical trials are available to show which type of operation ensures the best outcome for the patient. The charts of 207 vaginal hysterectomies were reviewed in this descriptive study. The aim was to examine whether vaginal hysterectomy might be an alternative for a group of patients. MATERIAL AND METHODS: Only patients with a previous, vaginal birth were entered in the study (four patients had not given birth). A uterus weight of 500-600 g was the upper limit set by our group for the use of the vaginal route. Patient characteristics, data from the operations, complications, and histological examinations of the uterus were analysed. RESULTS: The mean operation time was 61 min (95% CI 58-64 min), range 25-115 min. The difference between preoperative and postoperative haemoglobin was 1.1 mmol/l (95% CI 1.0-1.2 mmol/l). The mean length of hospital stay was 2.9 days (95% CI 2.7-3.1 days). The complications were 1) febrile morbidity; 17 (8%) (95% CI 4-12%); 2) urinary tract injury, 3 (2%) (95% CI 0-3%); 3) unforeseen need for major surgery (including conversion to abdominal hysterectomy), 3 (2%) (95% CI 0-3%). DISCUSSION: In some patients, vaginal hysterectomy is a good alternative.

Changes in hygienic procedures reduce infection following caesarean section.

Infection following emergency Caesarean section was reduced significantly by changing certain hygienic procedures, i.e. cutting instead of shaving abdominal hair, reducing vaginal examinations prior to operation, swabbing the external genitalia with aqueous chlorhexidine gluconate, minimizing the traffic in the operating theatre and abandoning peroperative dilatation of the cervix. Wound infection was reduced from 5.6% to 5.1% and endometritis from 14.3% to 4.4%.