Publication:

Impact of previous caesarean section on outcomes of non-descent vaginal hysterectomy: a prospective comparative study

Background With rising caesarean section rates, an increasing number of women undergoing hysterectomy have a scarred uterus. Previous lower segment caesarean section (LSCS) is often considered a relative limitation for non-descent vaginal hysterectomy (NDVH) due to concerns regarding adhesions and bladder injury. This study aimed to prospectively compare perioperative outcomes of NDVH in women with and without prior LSCS.

Methods This prospective comparative observational study was conducted at a tertiary care centre from February 2024 to January 2025. Fifty women undergoing NDVH for benign indications were enrolled and divided into two groups: group A included women with previous lower segment caesarean section (LSCS) (n=10), and group B included women with no prior surgery (n=40). Operative time, estimated blood loss, intraoperative and postoperative complications, and conversion rates were compared. Statistical analysis was performed using the Mann–Whitney U test and Fisher’s exact test, with p<0.05 considered statistically significant.

Results Baseline demographic parameters were comparable between the two groups. Mean operative time was 43±6 minutes in LSCS group versus 49±7 minutes in control group (p=0.08). Mean blood loss was 85±20 ml versus 120±25 ml (p=0.06). Conversion rate was 10% versus 5% (p=0.52). One case in previous LSCS group required conversion due to dense anterior abdominal adhesions and positive Sheth’s sign, while two cases in no prior surgery group were converted due to large transverse diameter of uterus. No bladder or bowel injury occurred in either group. Prophylactic salpingectomy was feasible in the majority of cases in both groups.

Conclusions In this prospective cohort, previous LSCS was not associated with increased perioperative morbidity during NDVH. Larger studies are required to confirm these findings.