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Ultrasound detection of vault haematoma following vaginal hysterectomy
Author(s) -
Thomson A.J.M.,
Sproston A.R.M.,
Farquharson R.G.
Publication year - 1998
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1998.tb10055.x
Subject(s) - medicine , hysterectomy , blood transfusion , ultrasound , surgery , vaginal vault , prospective cohort study , population , hematoma , radiology , environmental health
Objective To assess whether ultrasound detection of vault haematoma can be used as a predictor of post‐ooperative morbidity following vaginal hysterectomy. Design Prospective observational study of consecutive cases of vaginal hysterectomy performed between 1991 and 1994. Sample Two hundred and twenty‐three women having undergone vaginal hysterectomy. Methods All women hadtransvaginal ultrasound examination by an independent observer on the third post‐operative day. Routine observations and clinical assessments were made by establishedmanagement protocol, by staff blinded to the ultrasound findings. Main out come measures Febrile morbidity; haemoglobin drop; need for blood transfusion; length of stay in hospital; re‐admission rate and length of stay. Results Of the 223 scanned women, 55 (25%) had a vault haematoma. This group was compared with the 168 women with no haematoma. Significant increases in febrile morbidity (31% vs 7%), post‐operative haemoglobin drop (2–5 g/dL vs 1.6 g/dL), need for blood transfusion (145% vs 1.2%), representation to hospital (25.5% vs 5.4%)and length of hospital stay (8.87 days vs 6.25 days) wereseen in the haematoma group. Conclusion Ultrasound detection of vault haematoma following vaginal hysterectomy is a commonfinding associated with increased febrile morbidity, need for blood transfusion, longer hospital stayand higher re‐admission rate. In view of increasing demand for early discharge, driven by purchasersand patients, post‐operative ultrasound identifies a high risk population and is both convenient andnoninvasive. To further reduce morbidity, it also offers the opportunity to perform a controlled trialof prophylactic antibiotics in this identified subset.