Effect of Rural Cesarean Delivery Complicate During Abdominal Hysterectomy

Résumé

Introduction: Cesarean delivery is a common mode of delivery in rural areas of Bangladesh. However, its long-term impact on subsequent gynecological surgeries, particularly abdominal hysterectomy, remains understudied in rural settings. This study aimed to investigate the association between previous cesarean deliveries and complications during subsequent abdominal hysterectomies in a rural Bangladeshi population. Methods & Materials: This prospective cohort study was conducted in a private practice hospital in Savar, Dhaka, Bangladesh, from January 2021 to January 2023. A total of 50 women undergoing abdominal hysterectomy were included, of whom 30 had a history of cesarean delivery. Intraoperative findings, including adhesion presence and severity, organ injury, and operative time, were documented. Postoperative outcomes were monitored for 30 days following surgery. Mediation analysis was performed to estimate the direct and indirect effects of previous cesarean delivery on complications. Results: Adhesions were found in 73.3% of women with a history of cesarean delivery compared to 25% in those without cesarean delivery (p<0.001). Organ injury occurred in 10% of women with previous cesarean delivery, with no cases in the non-cesarean group. Mediation analysis revealed that 72% of the effect of previous cesarean delivery on organ injury was direct, while 28% was mediated through adhesions. Postoperative infections were more common in women with previous cesarean delivery (23.3% vs. 5%, p = 0.089), although this difference did not reach statistical significance. Conclusion: Previous cesarean delivery is associated with an increased risk of complications during subsequent abdominal hysterectomy in rural settings, particularly adhesion formation and organ injury. The majority of this increased risk is directly attributable to the previous cesarean, rather than mediated through adhesions. These findings underscore the need for careful surgical planning, enhanced resources, and specialized training for gynecological surgeries in rural areas, especially for women with a history of cesarean delivery.