ULTRASOUND DETECTION OF VAULT HEMATOMA FOLLOWING VAGINAL HYSTERECTOMY

Objective To assess whether ultrasound detection of vault haematoma ca n be used as a predictor of post-operative morbidity following vaginal hysterectomy. Design Prospective observational study of consecutive c ases of vaginal hysterectomy performed between 1991 and 1994. Sample T wo hundred and twenty-three women having undergone vaginal hysterectom y. Methods All women had transvaginal ultrasound examination by an ind ependent observer on the third post-operative day. Routine observation s and clinical assessments were made by established management protoco l, by staff blinded to the ultrasound findings. Main outcome measures Febrile morbidity; haemoglobin drop; need for blood transfusion; lengt h of stay in hospital; re-admission rate and length of stay. Results O f the 223 scanned women, 55 (25%) had a vault haematoma. This group wa s 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 (14.5% vs 1.2%), repre sentation to hospital (25.5% vs 5.4%) and length of hospital stay (8.8 7 days vs 6.25 days) were seen in the haematoma group. Conclusion Ultr asound detection of vault haematoma following vaginal hysterectomy is a common finding associated with increased febrile morbidity, need for blood transfusion, longer hospital stay and higher re-admission rate. In view of increasing demand for early discharge, driven by purchaser s and patients, post-operative ultrasound identifies a high risk popul ation and is both convenient and noninvasive. To further reduce morbid ity, it also offers the opportunity to perform a controlled trial of p rophylactic antibiotics in this identified subset.