Can you get pregnant after hysterectomy surgery. What are the different types of hysterectomy procedures. How does a hysterectomy affect fertility and family planning. What are the alternatives to hysterectomy for various gynecological conditions. How long is the recovery process after a hysterectomy.

Understanding Hysterectomy: Definition, Types, and Reasons

A hysterectomy is a surgical procedure that involves the removal of the uterus. It’s a common surgery among women in the United States, second only to Cesarean sections. According to the Centers for Disease Control and Prevention, approximately half a million women undergo hysterectomies each year in the U.S.

There are three main types of hysterectomies:

• Total hysterectomy: Removal of the entire uterus and cervix
• Partial hysterectomy: Removal of the upper part of the uterus, leaving the cervix intact
• Radical hysterectomy: Removal of the uterus, cervix, surrounding tissue, and upper part of the vagina

Women undergo hysterectomies for various reasons, including:

• Uterine fibroids
• Endometriosis
• Uterine prolapse
• Abnormal vaginal bleeding
• Chronic pelvic pain
• Gynecologic cancers
• Adenomyosis

The Impact of Hysterectomy on Fertility and Pregnancy

Is pregnancy possible after a hysterectomy? The short answer is no. Once the uterus is removed, it’s impossible to carry a pregnancy. This is why many women who are considering a hysterectomy but still want children often delay the procedure until they’ve completed their families.

However, it’s important to note that a hysterectomy doesn’t always involve the removal of the ovaries. In cases where the ovaries are left intact, a woman may still produce eggs and hormones. This leads to an important question: Are there any alternatives for having children after a hysterectomy?

Options for Parenthood Post-Hysterectomy

While carrying a pregnancy is not possible after a hysterectomy, there are still options for individuals or couples who wish to have children:

1. Egg freezing before surgery: If the ovaries are to be removed during the hysterectomy, women can opt to freeze their eggs beforehand for future use with a gestational carrier.
2. Surrogacy: Using either the woman’s own eggs (if the ovaries were preserved) or donor eggs, a gestational carrier can carry the pregnancy.
3. Adoption: This provides an opportunity to parent and build a family without a biological connection.

Hysterectomy Techniques and Their Implications

The technique used for a hysterectomy can impact recovery time and potential complications. The main techniques include:

• Abdominal hysterectomy
• Laparoscopic hysterectomy
• Vaginal hysterectomy
• Robotic-assisted laparoscopic hysterectomy

Each technique has its own set of benefits and potential risks. For instance, an abdominal hysterectomy allows for better visualization of the pelvic organs but requires a longer recovery time. On the other hand, laparoscopic and vaginal hysterectomies are less invasive and generally allow for quicker recovery.

Recovery and Life After Hysterectomy

How long does it take to recover from a hysterectomy? The recovery period typically ranges from four to six weeks, depending on the type of procedure. During this time, patients are advised to avoid heavy lifting and strenuous activities.

Life after a hysterectomy can bring significant changes. These may include:

• Cessation of menstrual periods
• Relief from chronic pain or bleeding
• Changes in sexual function
• Emotional and psychological adjustments
• Potential onset of menopause (if ovaries are removed)

Alternatives to Hysterectomy: Exploring Other Options

Are there alternatives to hysterectomy for various gynecological conditions? Yes, depending on the specific condition, there may be alternative treatments available. These can include:

• Medications to manage symptoms
• Endometrial ablation for heavy bleeding
• Myomectomy for uterine fibroids
• Uterine artery embolization for fibroids
• Pelvic floor exercises for mild uterine prolapse

It’s crucial to discuss all available options with a healthcare provider to determine the best course of action for individual circumstances.

Hormonal Considerations Post-Hysterectomy

How does a hysterectomy affect hormonal balance? The impact on hormones largely depends on whether the ovaries are removed during the procedure. If the ovaries are left intact, they will continue to produce hormones, and the woman will not immediately enter menopause.

However, if both ovaries are removed (a procedure called bilateral oophorectomy), this will result in surgical menopause. This abrupt hormonal change can lead to symptoms such as:

• Hot flashes
• Night sweats
• Vaginal dryness
• Mood changes
• Decreased libido

In such cases, hormone replacement therapy may be recommended to manage these symptoms and protect against potential long-term health risks associated with early menopause.

Emotional and Psychological Impact of Hysterectomy

How does a hysterectomy affect a woman’s emotional well-being? The psychological impact of a hysterectomy can be significant and varies from woman to woman. Some women may experience a sense of loss or grief, particularly if they had hoped to have children in the future. Others may feel relief, especially if the surgery alleviates chronic pain or other debilitating symptoms.

Common emotional responses may include:

• Changes in body image
• Feelings of loss or sadness
• Anxiety about sexual function
• Relief from chronic symptoms
• Concerns about femininity or womanhood

It’s important for women undergoing hysterectomy to have access to emotional support and counseling if needed. Open communication with partners, family members, and healthcare providers can be crucial in navigating these emotional changes.

Long-Term Health Considerations After Hysterectomy

What are the long-term health implications of a hysterectomy? While a hysterectomy can resolve many gynecological issues, it’s important to be aware of potential long-term health considerations:

• Increased risk of cardiovascular disease (if ovaries are removed before natural menopause)
• Potential for earlier onset of osteoporosis
• Changes in urinary function
• Possible impact on sexual function
• Reduced risk of certain cancers (such as ovarian cancer if ovaries are removed)

Regular follow-up care and a healthy lifestyle are important for maintaining overall health after a hysterectomy. This may include:

1. Regular check-ups with a healthcare provider
2. Bone density screenings (especially if ovaries were removed)
3. Cardiovascular health monitoring
4. Maintaining a balanced diet and regular exercise routine
5. Hormone replacement therapy if recommended by a doctor

Sexual Health After Hysterectomy

Many women have concerns about how a hysterectomy might affect their sexual health. While some women report improved sexual function due to the relief of symptoms like pain or heavy bleeding, others may experience changes such as:

• Decreased libido
• Changes in orgasm intensity
• Vaginal dryness (especially if ovaries are removed)
• Shortened vaginal length (in some cases)

These issues can often be addressed through open communication with healthcare providers and partners, as well as the use of lubricants, hormone therapy, or other treatments as recommended by a doctor.

Advancements in Hysterectomy Procedures

How have hysterectomy procedures evolved over time? Recent advancements in surgical techniques have led to less invasive procedures with faster recovery times. Some of these innovations include:

• Robotic-assisted laparoscopic hysterectomy: Offers precision and 3D visualization for the surgeon
• Single-incision laparoscopic hysterectomy: Minimizes scarring by using only one small incision
• Vaginal natural orifice transluminal endoscopic surgery (vNOTES): A scarless approach performed entirely through the vagina

These advancements aim to reduce recovery time, minimize pain, and improve cosmetic outcomes for patients undergoing hysterectomy.

Choosing the Right Procedure

The choice of hysterectomy procedure depends on various factors, including:

• The reason for the hysterectomy
• The size and shape of the uterus
• The presence of any other pelvic conditions
• The patient’s overall health
• The surgeon’s expertise

A thorough discussion with a healthcare provider is essential to determine the most appropriate approach for each individual case.

Life Changes and Adaptations Post-Hysterectomy

How does life change after a hysterectomy? While the absence of menstrual periods and the inability to become pregnant are obvious changes, there are other aspects of life that may require adaptation:

• Adjusting to a new body image
• Managing potential menopausal symptoms
• Adapting to changes in sexual function
• Exploring new family planning options if desired
• Focusing on overall health and wellness

Many women report an improved quality of life after hysterectomy, especially if they were experiencing debilitating symptoms before the surgery. However, it’s important to acknowledge that the adjustment period can vary for each individual.

Support Systems and Resources

Having a strong support system can be crucial for women undergoing and recovering from a hysterectomy. Useful resources may include:

• Support groups for women who have undergone hysterectomy
• Counseling services for emotional support
• Educational materials about post-hysterectomy care
• Online forums for sharing experiences and advice
• Pelvic floor physical therapy for recovery and rehabilitation

Healthcare providers can often provide referrals to these resources and support services.

Future Perspectives: Research and Innovations

What does the future hold for hysterectomy procedures and alternatives? Ongoing research and innovations in the field of gynecology continue to shape the landscape of hysterectomy and related treatments. Some areas of focus include:

• Development of even less invasive surgical techniques
• Advancements in uterine-sparing treatments for various conditions
• Improved hormone therapies for managing post-hysterectomy symptoms
• Research into regenerative medicine and tissue engineering
• Enhanced screening methods to potentially reduce the need for hysterectomies

These ongoing efforts aim to provide women with more options and improved outcomes when dealing with gynecological health issues.

The Role of Personalized Medicine

The concept of personalized medicine is becoming increasingly relevant in the field of gynecology. This approach takes into account individual genetic, environmental, and lifestyle factors to tailor treatments and interventions. In the context of hysterectomy, this could mean:

• More precise risk assessment for various gynecological conditions
• Customized treatment plans based on genetic profiles
• Targeted therapies that may reduce the need for surgical intervention
• Individualized post-operative care and hormone management

As research in this area progresses, it’s likely that treatment approaches for conditions currently managed with hysterectomy will become even more personalized and potentially less invasive.

Can you get pregnant after a hysterectomy? Plus, other things to know about hysterectomy surgery

A hysterectomy is the removal of the uterus. A total hysterectomy removes the entire uterus and cervix, while a partial hysterectomy means just the upper part of the uterus is removed. The surgery is usually done to address uterine fibroids, endometriosis, uterine prolapse, cancers, and other uterine problems. The procedure takes from one to three hours, and it takes about four to six weeks to recuperate.

What is a hysterectomy?

A hysterectomy is the surgical removal of the uterus. There are many medical conditions that are addressed by a hysterectomy, from pelvic pain and bleeding to cancers. There are different types of hysterectomies and several different surgical procedures for performing them, including some minimally-invasive techniques.

Hysterectomy is a common surgery, second only to Cesarean section among women in the United States. According to the Centers for Disease Control and Prevention, each year half a million women in the U. S. get hysterectomies. You can’t carry a pregnancy after a hysterectomy, so women sometimes wait (if possible) until they’ve completed their families before having the surgery.

Why do women get hysterectomies?

Uterine fibroids (noncancerous growths on the walls of the uterus) are the most common reason women get hysterectomies. But there are many other conditions hysterectomies are used to treat, including:

• Endometriosis (an overgrowth of tissue in the lining of the uterus)
• Uterine prolapse (when the uterus drops down into the vagina)
• Abnormal vaginal bleeding
• Chronic pelvic pain or severe pain with menstrual cycles
• Gynecologic cancer, such as cervical, ovarian, or uterine cancer
• Abnormalities, such as hyperplasia (an increase in the number of cells), that may lead to cancer
• Adenomyosis (a thickening of the uterus as tissue grows into the walls of the uterus)

Are there different types of hysterectomies?

Yes, there are three types of hysterectomies.

Total hysterectomy

The entire uterus and cervix are removed. This is the most common type of hysterectomy.

Partial hysterectomy

Also called a subtotal or supracervical hysterectomy, this is the removal of the upper part of the uterus. The cervix is not removed.

Radical hysterectomy

The uterus, cervix, tissue on both sides of the cervix, and the upper part of the vagina are removed. A radical hysterectomy may be done if you have or are suspected to have cancer. Sometimes a surgeon won’t know until they’re doing the surgery whether surrounding structures need to be removed. And sometimes they’re removed as a preventative measure (to prevent cancer, for example).

Most of the time, the fallopian tubes are removed along with the uterus. In some instances (because cancer is suspected, for example), one or both ovaries are removed as well. Both ovaries aren’t routinely removed however, because removing them will cause early menopause.

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Removing the ovaries is called oophorectomy, and removing the fallopian tubes is called salpingectomy. Surgery that removes the uterus, both Fallopian tubes, and both ovaries is called a hysterectomy and bilateral salpingectomy-oophorectomy.

Hysterectomy techniques

The technique your surgeon recommends will depend on why the surgery is being done as well as other factors – such as the size and shape of your vagina and uterus, how accessible your uterus is (because of pelvic adhesions, for example), how advanced your condition is, whether or not other procedures will be done at the same time, and surgeon preference. Sometimes the surgeon will change techniques after the surgery starts and they’re able to better see exactly what needs to be done. The goal is to maximize benefits and minimize risks of the surgery.

Abdominal hysterectomy

If you have an abdominal hysterectomy, your uterus is removed through an incision in your lower abdomen. The incision is six- to eight-inches long and made from your belly button to your pubic bone or across the top of your pubic hairline. Stiches or staples are used to close the incision.

The benefits of an abdominal hysterectomy are that it can be performed even if you have adhesions or a large uterus. This method also gives the surgeon a good view of your pelvic organs. It does have a higher risk of complications (such as infection, bleeding, blood clots, and nerve and tissue damage) than other hysterectomy techniques, however. And it takes longer to recover from an abdominal hysterectomy than a laparoscopic or vaginal hysterectomy. An abdominal hysterectomy is considered major surgery and usually requires a longer hospital stay.

Laparoscopic hysterectomy

Laparoscopic hysterectomy is done through small incisions in your abdomen. It’s considered a minimally invasive surgery. The surgeon inserts a laparoscope (a thin, lighted telescope) to examine your pelvic organs. Then your uterus is removed in small pieces through these incisions, through a larger incision in your abdomen, or through your vagina. If it’s removed through your vagina, it’s called a laparoscopic vaginal hysterectomy. You may go home the same day or the next day.

A laparoscopic hysterectomy takes longer than abdominal or vaginal surgery. And there’s increased risk of injury to the urinary tract and other organs. But laparoscopic technique has a lower risk of infection, results in less pain after the procedure, and requires a shorter hospital stay.

Robotic hysterectomy

A robotic hysterectomy is a type of minimally invasive laparoscopic hysterectomy. It’s performed by highly specialized gynecologic surgeons with a robot assistant. It can allow for more precision and higher magnification than traditional laparoscopy.

Vaginal hysterectomy

A vaginal hysterectomy is another type of minimally invasive hysterectomy. The uterus is removed through the vagina, with no abdominal incision. (There’s an internal incision, at the top of your vagina. Dissolvable stitches are used.) This method has the least complications and usually a shorter healing time than other methods. You may even go home the same day as the procedure.

If you have scar tissue or a very large uterus, a vaginal hysterectomy may not be an option for you.

When can you get a hysterectomy?

Because you’ll be unable to carry a pregnancy after a hysterectomy, if possible, you’ll want to postpone the surgery until after you’re finished with pregnancies. A hysterectomy is not reversible.

That said, hysterectomy is sometimes needed immediately – if you have uterine or ovarian cancer or if your uterus is hemorrhaging and can’t otherwise be stopped, for example.

You may also decide to get a hysterectomy to improve the quality of your life, and finding other ways (there are many!) to grow your family if desired. (See below.)

Is a hysterectomy ever used to stop postpartum bleeding?

Yes, in the case of postpartum hemorrhage, a hysterectomy may be done to stop the bleeding. But this is rarely necessary. (Your chances of needing one are higher if you have placenta previa or placenta accreta, or if you’ve had a previous c-section. )

There are other options for controlling postpartum bleeding. These include medication, stitches to repair tears, and a procedure called dilation and curettage (D&C) to remove the remaining placenta. Or a small balloon may be placed in your uterus, creating pressure against your uterine walls to compress blood vessels and encourage blood clotting.

It can be a life-saving measure but – because it results in the woman no longer being able to become pregnant – a hysterectomy is considered a last resort to stop postpartum bleeding.

What to expect during a hysterectomy

Your healthcare provider will prepare you for surgery by explaining the procedure and adjusting your medications, if necessary, beforehand. (If you’re taking blood thinners, such as aspirin or heparin, for example, you’ll probably need to stop taking them temporarily.)

You’ll have complete blood work done. You may also have a Pap test, an endometrial biopsy (to detect endometrial cancer or abnormal cells in the uterus), and a pelvic ultrasound, to examine the size of any fibroids, cysts, or polyps you may have.

You’ll have an IV for fluids and medications and a urinary catheter will be placed to collect your urine.

Depending on the type of procedure you’re having, you may be given general anesthesia (you’ll be asleep and a breathing tube will be placed) or regional anesthesia (through an epidural, and you’ll be awake through the procedure).

The procedure usually takes from one to three hours. How long it takes depends on the method being used for the surgery, the size of your uterus, what else is being removed, and any scarring you may have. After surgery, your doctor will close any incisions with staples, stitches, surgical glue, or steri-strips.

Hysterectomy side effects

After your hysterectomy, you’ll have both temporary and permanent side effects.

You may temporarily have:

• Pelvic and abdominal pain. You’ll be given pain medication to use for a few days, until the pain subsides.
• Redness, bruising, and swelling at the incision site for about a month if you had an abdominal hysterectomy.
• Numbness around the abdominal incision for a couple of months
• Vaginal bleeding and discharge for up to six weeks. You’ll use sanitary pads, not tampons.
• Gas and bloating for a few days (up to several weeks). A warm compress and gentle exercise may help.
• Constipation
• Problems emptying your bladder

You may also be feeling emotional about your hysterectomy, depending on how you feel about no longer being able to have children. Or you may be elated to be symptom free, if you’ve been suffering. It’s normal to have both feelings, whether separately or at the same time.

Permanent changes:

• You’ll no longer have menstrual periods after a hysterectomy. (Sometimes women who receive a subtotal hysterectomy continue to have a light period for a year because small amounts of the endometrial lining can remain.)
• Menopause. Ovaries aren’t commonly removed during a hysterectomy, but if both are removed, you’ll experience menopause and may have strong symptoms – such as hot flashes, vaginal dryness, sleep problems, and mood swings – right away. Talk with your provider about hormone replacement therapy to help with symptoms. If your ovaries weren’t removed, they may still make estrogen, but you may go into menopause a couple of years earlier than the average age of 52. Note: Because removing both ovaries (eliminating estrogen production) may put you at higher risk for bone loss, heart disease, and other conditions, doctors sometimes now recommend leaving one fallopian tube and one ovary, to allow your body to continue to make estrogen and delay the onset of an early menopause.
• Change in sexual feelings. Your sex life may improve, thanks to relief from pain and/or heavy vaginal bleeding. But if you’re having symptoms of menopause, you may have less interest in sex. Vaginal dryness may happen especially if your ovaries were removed. (A water-based lubricant or topical estrogen can help. Talk with your healthcare provider.)

Hysterectomy is considered a very safe surgical procedure. As with any surgery, though, there are possible complications (see below).  

What is the recovery process like after a hysterectomy?

Depending on the type of procedure you had, you’ll need to stay in the hospital for up to a few days after your hysterectomy. (Sometimes women go home the same day, other times – with a radical hysterectomy done for cancer, for example – women stay more than a couple of days.)

It typically takes four to six weeks to recover from abdominal surgery and three to four weeks to recover from vaginal or laparoscopic surgery. Your doctor will give you guidelines to follow for your recovery. They’re likely to include:

• Walk as soon as possible after surgery. After you get home, take short walks, increasing the distance each day. Moving will help prevent blood clots. (You may also be given medication to help prevent blood clots.)
• Get plenty of rest.
• Don’t lift objects over 10 pounds for at least four to six weeks.
• Don’t put anything into your vagina for four to six weeks.
• Don’t have intercourse for six weeks.
• You can take a shower, but don’t take a bath. Wash the incision with soap and water. Surgical strips will fall off on their own within a week, and stitches will dissolve in about six weeks. Staples will need to be removed by your healthcare provider.
• Wait to drive for few days if you’ve had vaginal or laparoscopic surgery and about two weeks after abdominal surgery, as long as you’re no longer taking pain narcotics.
• Wait four to six weeks to exercise.
• Stay home from work for three to six weeks, depending on your job and how well you’re healing.

Contact your doctor right away if you have any of the following warning signs of problems after your surgery:

• Fever over 100 degrees F
• Bleeding or swelling at the incision site, opening of the incision
• Bright red vaginal bleeding
• Increasing pain or pain that doesn’t improve with pain medication
• Difficulty urinating or having a bowel movement, or frequent urination
• Nausea, vomiting, abdominal pain, diarrhea
• Persistent, severe pain that doesn’t respond to pain killers
• Pain during intercourse (after the six weeks have passed)
• Coughing up blood
• Shortness of breath or trouble breathing
• No bowel movement for 3 days or longer

Can you get pregnant after a hysterectomy?

You cannot carry a pregnancy after a hysterectomy. It’s possible – though rare – to get pregnant after a hysterectomy if you have a cervix. But it’s not possible to carry the pregnancy because there’s no uterus to house the baby.

If you did get pregnant, the fertilized egg would implant someplace else, most likely in a fallopian tube, resulting in an ectopic pregnancy. Ectopic pregnancy after hysterectomy is pretty rare, but it’s a medical emergency, potentially causing a rupture and life-threatening hemorrhaging.

If you want to grow your family after having a hysterectomy, you have some options. You may want to consider adoption or a surrogate implantation. You can use your eggs for the implantation (harvested before your hysterectomy or – if your ovaries aren’t removed – afterwards). Or your male partner can provide sperm for the surrogate pregnancy, using a donor egg or the surrogate’s egg. And if you have a female partner, she can carry a pregnancy using her egg.

Talk to other other women who have had hysterectomies in our BabyCenter Community group.

Cervical stump pregnancy 6 years after subtotal hysterectomy: a case report | Journal of Medical Case Reports

• Case report
• Open Access
• Published: 08 May 2019

• Dawud Muhammed Ahmed¹,
• Abebe Assaye Fetene¹,
• Eyaya Misgan Asres¹,
• Amsalu Worku Mekonnen¹ &
• …
• Hailu Gashe Mamuye² 

Journal of Medical Case Reports
volume 13, Article number: 135 (2019)
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Abstract

Background

Pregnancy following hysterectomy is very rare and may lead to significant morbidity, especially when diagnosis is delayed.

Case presentation

A 32-year-old G3P3002 African woman presented with increasing abdominal distension and 1 day of worsening abdominal pain and vomiting. Her previous pregnancy had ended 6 years prior with a stillborn baby delivered by Cesarean hysterectomy after laboring at home for 1 day. At the time of current presentation, this patient was confused and irritable, with an undetectable blood pressure, tachycardia, labored breathing, and a distended and tender abdomen. Urine human chorionic gonadotropin was positive and a transabdominal ultrasound showed significant intraperitoneal fluid collections and a singleton, viable pregnancy consistent with 13 weeks of gestation. A diagnosis of hypovolemic shock secondary to ruptured ectopic pregnancy was made, and she underwent emergency laparotomy. Intraoperative findings included 4.5 liters of hemoperitoneum and a cervical stump pregnancy with active bleeding from a partially detached placental site.

Conclusion

Any reproductive-aged woman with at least one ovary and a means for sperm to meet egg should be screened for pregnancy if she presents with an acute abdomen or abdominal or pelvic pain.

Peer Review reports

Background

While a complete uterus is the typical site of gestation, it is not absolutely necessary for fertilization and implantation. Ectopic pregnancies are most commonly found in the fallopian tubes or on peritoneal surfaces in the pelvis, including on the ovaries and omentum [1]. Pregnancy after hysterectomy is extremely rare, with the first case of ectopic pregnancy after hysterectomy reported by Wendler in 1895 [2,3,4]. To the best of our knowledge, there are only 72 cases of post-hysterectomy ectopic pregnancy reported in the world literature [3].

Case presentation

A 32-year-old G3P3002 African woman came from Yifag Kebele, Amhara Region, to Felege Hiwot referral hospital in Bahir Dar, Northwest Ethiopia in July 2016. She presented with abdominal pain and intractable vomiting of 1 day’s duration. She was also unable to pass feces and flatus and had developed progressive abdominal distension. She had a past medical history notable only for chronic gastritis for which she took unspecified medications and a past surgical history notable for a Cesarean hysterectomy after an intrauterine fetal demise during labor. As she had been told that her uterus was removed, she did not use contraception and had no menses. She was admitted to our surgical ward with a diagnosis of small bowel obstruction due to presumed post-operation adhesions and possible incisional hernia. She also had severe anemia and was resuscitated with 2 liters of normal saline and transfused with 2 units of blood. A plan was made to correct the hernia once she was stabilized. After 2 days in our hospital, however, her condition worsened and a consultation was made to Obstetrics and Gynecology for further evaluation.

On physical examination at the time of consultation, she was confused and irritable, with an undetectable blood pressure and a thready pulse of 132. She had labored breathing, pale conjunctiva, and a distended abdomen with a palpable mass below the midline surgical scar. An abdominal examination also revealed a fluid wave and hypoactive bowel sounds. Laboratory testing showed a white blood cell count of 12.9 × 10³ with 88.4% neutrophils and hemoglobin of 5.8 g/dl. Urine human chorionic gonadotropin (hCG) was positive. A transabdominal ultrasound showed a normal liver, spleen, pancreas, and kidneys. There was a significant debris-filled intraperitoneal fluid collection, especially on the right side of her abdomen, with a deepest pocket measuring 5 cm. No lymphadenopathy was seen. A singleton, viable pregnancy was identified measuring 13 weeks of gestational age with no gross abnormality and adequate amniotic fluid.

The Obstetrics and Gynecology team diagnosed hypovolemic shock secondary to ruptured ectopic pregnancy, and our patient was taken to the operating room for a laparotomy. Intraoperative findings included 4. 5 liters of hemoperitoneum, a cervical stump pregnancy with well-formed fetus and intact gestational sac, and active bleeding from partially detached placental site. While the left ovary appeared normal, the right ovary and both fallopian tubes were absent.

The ectopic gestation was clamped at its base and resected from the cervical stump. Bleeding sites were ligated to ensure hemostasis. Our patient was deemed too unstable for trachelectomy. Her abdomen was irrigated with warm saline and the incision closed in layers. She was transferred to our intensive care unit (ICU) for aggressive volume resuscitation with 8 liters of normal saline and 5 units of blood, and a dopamine drip was initiated to assist with blood pressure control. After 2 hours, her blood pressure had stabilized and she was discharged 9 days later. On follow-up at fourth week post-operation, she was healing well and had hemoglobin of 11 g/dl.

Discussion and conclusions

Pregnancy after hysterectomy can follow any type of hysterectomy (total or supracervical) and any approach (abdominal, laparoscopic, or vaginal), but the highest risk is with supracervical hysterectomies [3, 5]. Pregnancies after hysterectomy can take one of two forms: early and late presenting.

Early presentation

Among 72 reported cases worldwide, 30 occurred because of unrecognized luteal phase pregnancies that were in transit to the endometrial cavity. These are considered early presenting post-hysterectomy pregnancies. The other possibility in this category is that sperm were present within the fallopian tube when the hysterectomy was performed.

Late presentation

Late-presenting pregnancies develop as a result of a communication between the vagina and the peritoneal cavity. The location of these ectopic pregnancies after hysterectomy depends on the type of hysterectomy performed and the presence or absence of a residual cervix [3]. Of these cases, 50% have followed vaginal hysterectomy [2].

Our case was a late-presenting ectopic pregnancy following supracervical hysterectomy, probably from excess residual tissue. This is probably the third case of cervical stump pregnancy next to the two cases reported by McDaniel and Gullo in 1968 [6]. The interval of time between hysterectomy and ectopic pregnancy for our patient was 6 years, and this contributed to delay in seeking medical care and to late diagnosis. Such pregnancies have been reported from 2 months to 12 years after hysterectomy [1, 4]. Delay in diagnosis and treatment is the leading cause of complication and death from ectopic pregnancies [4]. In fact, our patient was close to death by the time the diagnosis was made.

Prevention

Elective hysterectomies should be done in the pre-ovulatory phase of the menstrual cycle or after effective contraception to avoid early occurring post-hysterectomy ectopic pregnancies [2, 3]. In supracervical hysterectomy, removing as much tissue as possible will decrease the risk of ectopic pregnancy [5, 7]. In our case, our patient’s unstable condition precluded trachelectomy, and our main goal was to secure hemostasis and shorten anesthesia time. In 1921, McMillan and Dunn reported the case of an 18-year-old patient who experienced two pregnancies following hysterectomy [1]. The first pregnancy occurred 18 months after subtotal hysterectomy. The second pregnancy 17 months later resulted in the death of the patient from hemorrhage [1]. While unlikely, we understand that our patient may develop a second ectopic pregnancy in the future and are considering an elective trachelectomy to prevent this.

Conclusion

While rare, post-hysterectomy ectopic pregnancy can occur and should be considered when a woman presents with abdominal pain and bleeding early or late after hysterectomy.

Abbreviations

hCG:

Human chorionic gonadotropin

ICU:

Intensive care unit

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Acknowledgements

We would like to thank the patient and staff of Felege Hiwot referral hospital who were involved in the management of the case.

Funding

None.

Availability of data and materials

The relevant raw data and materials described in the manuscript are available from the corresponding author on reasonable request.

Author information

Authors and Affiliations

1. Bahir Dar University, Bahir dar, Ethiopia

   Dawud Muhammed Ahmed, Abebe Assaye Fetene, Eyaya Misgan Asres & Amsalu Worku Mekonnen

2. Funeteselam General Hospital, Finote Selam, Ethiopia

   Hailu Gashe Mamuye

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1. Dawud Muhammed Ahmed

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Contributions

AWM and HGM took history and physical examinations. DMA, AAF, and HGM did the operation. DMA wrote the manuscript. All authors read, reviewed, and approved the manuscript before submission.

Corresponding author

Correspondence to
Dawud Muhammed Ahmed.

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The quality improvement and research committee of Felege Hiwot referral hospital gave us the ethical clearance to publish this case report.

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Written informed consent for publication of this case report and any accompanying images was obtained from the patient. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

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The authors declare that they have no competing interests.

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About this article

Surgery to remove the uterus. What’s next for the woman?

Many thanks to the ophthalmologist Irina Dmitrievna Kasheva, surgeon Georgy Sergeevich Bogdanov. Cataract and glaucoma of both eyes. The right eye was operated on, the lens was replaced on 14.04.2023. Everything is fine. May God grant them health, patience, all the best. 05/26/2023. I will definitely leave a review.

Evgeny

I went to the clinic for an eye examination, the appointment was conducted by Terentyeva AA – I was very pleased with the appointment.
Before the appointment, they offered to check my vision for myopia and farsightedness, with the results of the diagnosis, they took me to the doctor, told me all the problems that bother me. The doctor listened to me carefully, asked a number of clarifying questions and ordered an additional examination. I was very pleased that all the examinations were made on the day of the visit immediately during the appointment. The diagnosis was made – Anastasia Alexandrovna explained the essence of the diagnosis in great detail, gave detailed recommendations. If it were possible to give points, then definitely 10 out of 10!!! Thank you very much

Marina

I applied for a preventive examination, I liked the communication with Dr. Koroleva K.V. A very attentive doctor, she explained everything, calmed down. They measured the eye pressure, gave recommendations. Thank you. There was no queue, the appointment was made by appointment.

Olga

I have been seeing a gynecologist Viktoria Orlova for about 3 years now. It’s a miracle! I moved to another city, but still every time I guess, so that upon arrival in Nizhny I come for a scheduled inspection. And how many times I needed to consult, I probably won’t count – the doctor is always on the phone and there were force majeure when I don’t know what I would do without Viktoria Vladimirovna.
And I just have to say to those who are afraid to do the HSG (just like I was afraid after reading articles on the Internet) – it does not hurt at all. The stomach will pull for a few minutes, as in the first days of menstruation, and that’s it. Taking a normal smear is even more unpleasant)
I can’t speak for other doctors of the clinic – I am faithful to my doctor and have never been to anyone else), but I vouch for my doctor. In recent years, I feel calm and confident in terms of women’s health thanks to V.V. Orlova. And this is the only doctor out of five in other clinics in the city that I went to, who was able to pick up such hormones for me, the consequences of which I don’t feel – I don’t go crazy, I don’t get fat. And until I came to the clinic, I took a lot of pills

Svetlana

On June 16, I had a consultation with a cardiologist Larisa Mikhailovna Lokonova. I left with the full feeling that this is how all doctors should treat you: they will listen to you, carefully look at all your tests, give competent advice, recommend treatment. Thanks to Larisa Mikhailovna, people like her strengthen faith in our medicine.

Valentina June 23, 2022

I thank your center and doctor Yulia Valerievna Gogleva for prompt help! Recently, I had an eye injury, and during the examination after it, they found that the retina is very thin, I was lucky that the injury did not lead to its rupture. Nevertheless, I was strongly recommended to strengthen it with a laser, because after some time, especially given the injury, it could begin to tear. Yulia Valerievna showed me all the pictures, clearly explained how things were going, and performed a laser operation on me. By the way, it is quite comfortable to carry. Thanks again for your timely help!

Sergey

Hello! In April, I went through examinations, as I am pregnant, and also went to the ophthalmologist, and I was diagnosed with retinal dystrophy. Accordingly, there was a great danger of her rupture during childbirth, this issue had to be resolved. I turned to your doctor Terentyeva A.A., and at the appointment she told me that special laser surgeries are being carried out to strengthen the retina (which I didn’t even know about before), and that in my case the operation would remove the risk of such a rupture. Of course, I did not think long about making a decision, and I came to A.A. on this laser reinforcement. I did an operation on my eyes for the first time, and I didn’t even think that I would encounter this, I was very worried. But I was surprised how simple the operation was, I imagined everything much more painful and longer 🙂 As a result, after the operation, my retina was checked again, and there is no longer a risk of damaging it during childbirth. Thank you very much to your doctor and your clinic for helping me finally resolve this issue, because of which I was really very nervous)

Olga

In your clinic, we performed laser cataract surgery on my father. Thanks to your doctor – Dozorova Irina Pavlovna for the approach and quality of the operation. Everything was done quickly and clearly. The father no longer complains about his vision, he sees well. Your center was recommended by a friend of my wife, and we were very pleased with the choice.

Mikhail

A little over a month ago we faced a problem – my grandmother lost her eyesight after cataract surgery, which we performed on her 4 years ago. She was diagnosed with a secondary cataract and needed surgery. Your clinic was advised to us by an ophthalmologist at the clinic, and we decided not to look for other options, especially since the operation had to be carried out as quickly as possible, my grandmother began to see really very badly. We got an appointment with E. N. Shabalina, a very attentive doctor, I also noted a good attitude towards my grandmother, because she herself was very nervous and afraid of doctors, but everything went well. At the reception, Elena Nikolaevna appointed the day of the operation in about a week. The operation was laser-assisted, so it was easy, now my vision has fully recovered, there are no complaints from my grandmother, and we are glad that we nevertheless turned to you!

Nika

Thanks to your clinic and your doctor Irina Pavlovna for helping my mother regain normal vision!!! It worsened so much that we could not even pick up glasses, they simply stopped helping, it turned out that everything was due to cataracts. Irina Pavlovna performed the operation, the doctor herself is very friendly, it was very pleasant at her appointments. Mom is overjoyed that she can see well again, and that it was not so difficult to achieve this!

Inga

Surgery to remove the uterus

Many thanks to the ophthalmologist Irina Dmitrievna Kasheva, the surgeon Georgy Sergeevich Bogdanov. Cataract and glaucoma in both eyes. The right eye was operated, the lens was replaced on 14.04.2023. Everything is fine. God bless them with health, patience, all the best. An operation was scheduled for the left eye on May 26, 2023. I will definitely leave a review.

Evgeny

I went to the clinic for an eye examination, the appointment was conducted by Terentyeva AA – I was very pleased with the appointment.
Before the appointment, they offered to check my vision for myopia and farsightedness, with the results of the diagnosis, they took me to the doctor, told me all the problems that bother me. The doctor listened to me carefully, asked a number of clarifying questions and ordered an additional examination. I was very pleased that all the examinations were made on the day of the visit immediately during the appointment. The diagnosis was made – Anastasia Alexandrovna explained the essence of the diagnosis in great detail, gave detailed recommendations. If it were possible to give points, then definitely 10 out of 10!!! Thank you very much

Marina

I applied for a preventive examination, I liked the communication with Dr. Koroleva K.V. A very attentive doctor, she explained everything, calmed down. They measured the eye pressure, gave recommendations. Thank you. There was no queue, the appointment was made by appointment.

Olga

I have been seeing a gynecologist Viktoria Orlova for about 3 years now. It’s a miracle! I moved to another city, but still every time I guess, so that upon arrival in Nizhny I come for a scheduled inspection. And how many times I needed to consult, I probably won’t count – the doctor is always on the phone and there were force majeure when I don’t know what I would do without Viktoria Vladimirovna.
And I just have to say to those who are afraid to do the HSG (just like I was afraid after reading articles on the Internet) – it does not hurt at all. The stomach will pull for a few minutes, as in the first days of menstruation, and that’s it. Taking a normal smear is even more unpleasant)
I can’t speak for other doctors of the clinic – I am faithful to my doctor and have never been to anyone else), but I vouch for my doctor. In recent years, I feel calm and confident in terms of women’s health thanks to V.V. Orlova. And this is the only doctor out of five in other clinics in the city that I went to, who was able to pick up such hormones for me, the consequences of which I don’t feel – I don’t go crazy, I don’t get fat. And until I came to the clinic, I took a lot of pills

Svetlana

On June 16, I had a consultation with a cardiologist Larisa Mikhailovna Lokonova. I left with the full feeling that this is how all doctors should treat you: they will listen to you, carefully look at all your tests, give competent advice, recommend treatment. Thanks to Larisa Mikhailovna, people like her strengthen faith in our medicine.

Valentina June 23, 2022

I thank your center and doctor Yulia Valerievna Gogleva for prompt help! Recently, I had an eye injury, and during the examination after it, they found that the retina is very thin, I was lucky that the injury did not lead to its rupture. Nevertheless, I was strongly recommended to strengthen it with a laser, because after some time, especially given the injury, it could begin to tear. Yulia Valerievna showed me all the pictures, clearly explained how things were going, and performed a laser operation on me. By the way, it is quite comfortable to carry. Thanks again for your timely help!

Sergey

Hello! In April, I went through examinations, as I am pregnant, and also went to the ophthalmologist, and I was diagnosed with retinal dystrophy. Accordingly, there was a great danger of her rupture during childbirth, this issue had to be resolved. I turned to your doctor Terentyeva A.A., and at the appointment she told me that special laser surgeries are being carried out to strengthen the retina (which I didn’t even know about before), and that in my case the operation would remove the risk of such a rupture. Of course, I did not think long about making a decision, and I came to A.A. on this laser reinforcement. I did an operation on my eyes for the first time, and I didn’t even think that I would encounter this, I was very worried. But I was surprised how simple the operation was, I imagined everything much more painful and longer 🙂 As a result, after the operation, my retina was checked again, and there is no longer a risk of damaging it during childbirth. Thank you very much to your doctor and your clinic for helping me finally resolve this issue, because of which I was really very nervous)

Olga

In your clinic, we performed laser cataract surgery on my father. Thanks to your doctor – Dozorova Irina Pavlovna for the approach and quality of the operation. Everything was done quickly and clearly. The father no longer complains about his vision, he sees well. Your center was recommended by a friend of my wife, and we were very pleased with the choice.

Mikhail

A little over a month ago we faced a problem – my grandmother lost her eyesight after cataract surgery, which we performed on her 4 years ago.