In some instances, abdominal hysterectomy is indicated following delivery. When performed at the time of cesarean delivery, the operation is termed cesarean hysterectomy. If done within a short time after vaginal delivery, it is termedpospartum hysterectomy. Peripartum hysterectomy is a broader term that combines these two. In most cases, hysterectomy is total, but supracervical hysterectomy is an option. The adnexa are not usually removed. In most instances, a simple or type I hysterectomy is performed. However, for women with invasive cervical cancer, radical hysterectomy removes the uterus, parametrium, and proximal vagina to achieve tumor excision with negative margins. Also, for cases of placenta percreta that extend toward the pelvic sidewall, similar radical excision of the parametrium may be needed.
In the United States, the cesarean delivery rate rose from 4.5 percent in 1970 to 32.9 percent in 2009. Following this peak, the rate has trended slightly downward, and it was 32.0 percent in 2015 (Martin, 2017). Some indications for performing cesarean delivery are shown in Table
More than 85 percent of these operations are performed for four reasollSprior cesarean delivery, dystocia, fetal jeopardy, or abnormal fetal presentation. The latter three compose the main indications for primary cesarean delivery (Barber, 2011; Boyle, 2013).
The reasons for persistently significant cesarean rates are not completely understood, but some explanations include the following: 1.
Women are having fewer children, thus, a greater percentage of births are among nulparas, who are at increased risk for cesarean delivery.
2.
The average maternal age is rising, and older women, especially nulliparas, have a higher risk of cesarean delivery.
TABLE 30-1 . Some Indications for Cesarean Delivery
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3.
he use of electronic etal monitoring is widespread. This practice is associated with an increased cesarean delivery rate compared with intermittent fetal heart rate auscultation. Fetal distress accounts for only a minority of all cesareans. In many more cases, concern for an abnormal or "nonreassuring" fetal heart rate tracing prompts cesarean delivery.
4.
Most fetuses presenting breech are now delivered by cesarean.
5.
he frequency of operative vaginal delivery has declined.
6.
Rates of labor induction continue to rise, and induced labor, especially among nulliparas, raises the cesarean delivery rate.
7.
Obesi, which is a cesarean delivery risk, has reached epidemic proportions.
8.
Rates of cesarean delivery in women with preeclampsia have increased, whereas labor induction rates for these patients have declined.
9.
he rate of vaginal birth ater cesarean-BAC-has decreased from a high of 28 percent in 1996 and was 11 percent in 2014 (Hamilton, 2015).
10.
Elective cesarean deliveries are increasingly being performed for various indications that include maternal request, concern for pelvic loor injury associated with vaginal birth, and reduction of etal injury rates.
11.
Assisted reproductive technoloy is more widely used than in the past and is associated with greater cesarean delivery rates (Reddy, 2007).
12.
Mapractice litigation related to fetal injury during spontaneous or operative vaginal delivery continues to contribute to the present cesarean delivery rate.