Cesarean hysterectomy post-LSCS: From crisis to stabilization: Nursing care after cesarean hysterectomy

Amuthakani. V^1*, Angel Roselin S²

¹Senior Nursing supervisor, Kauvery Hospital, Tirunelveli, Tamil Nadu

²Deputy Nursing supervisor, Kauvery Hospital, Tirunelveli , Tamil Nadu

*Correspondence

Overview

A cesarean hysterectomy is the surgical removal of the uterus during or immediately after a cesarean section. It is usually performed for life threatening conditions such as

Placenta accreta spectrum (accreta, increta, percreta)
Uncontrolled postpartum hemorrhage (PPH)
Uterine rupture
Severe uterine infection or trauma.

The patient requires intensive postoperative nursing care because of the high risk of hemorrhage, infection, thromboembolism and psychological distress.

Case Presentation

Mother got admitted to a private hospital with complaints of abdominal pain with no leaking P/V and she was able to perceive fetal movements well. CTG was reactive. Pain was settled she kept on monitoring for the first two days.

USG	Study revealed single live uterine fetus of gestational 33 weeks 3 days,
Doppler	Normal study.
Previous history	Pre-eclampsia (antenatal period history was not clear)
Obstetrical score	P1L0

On 3^rd day of admission

On examination:

P/A – Uterus was 34 to 36 weeks

Acting mildly

Head unengaged, FH Good.

P/V – Cervix 50% effaced

OS admits 2 fingers, membranes +.

Head at – 3 stations.

At 10.30am CTG was Reactive and patient was able to perceive fetal movement well.12 Noon CTG was Reactive, and patient was monitored for progression of labor. Around 12.30 pm. There was sudden cessation of fetal cardiac activity. Expert USG by radiologist was done immediately and abruption was ruled out. While shifting for emergency LSCS, there was sudden fall in BP & saturation. Patient was resuscitated and intubation was done by anesthetists. Inotropes support started.

After resuscitation, the patient shifted to operation theatre and Emergency LSCS, proceeded to Caesarean hysterectomy. A fresh dead male fetus of weight around 2.8kg was delivered. Intra Op findings:Hemoperitoneum of 75ml was drained. Uterus was examined and found to be flabby and rent of size 3x 2 x0.5 was found in the posterior wall of uterus and there was active bleeding. Clots of about 200gms removed. Massive blood transfusion protocol followed. Complete hemostasis was achieved and abdominal cavities were closed in layers with an abdominal drain. Post Op visits PR -126/min, BP- 140/70 mmHg and urine output was drained. Patient was referred to our hospital for further management.

Emergency Room

Nursing management

On receiving

On examination: Patient on mechanical ventilation, sedated and paralyzed.

Initial Vital signs

Parameters	Findings
Blood pressure	Unrecordable
Heart rate	140b/mt
Respiratory rate	26 b/mt
SPO2	98% on Fio2- 50
Temperature	97.4 F
GCS	E1 Vt M3 T4

Immediate management

Criteria	Assessment/Intervention	Intervention
Triage	Identify obstetric emergencies and activate high-priority triage	Notified obstetrician, Blood Bank & ER consultant
Airway / Breathing	Assess airway patency Assess respiratory rate, SpO2 and chest movements	Supported with oxygen mask at 8–10 litres/min. Prepared for intubation; ET tube placed and airway entry was equal. FiO2: 50%–100%
Circulation	Assess pulse, BP, capillary refill time and blood loss	Inserted two large-bore IV lines (14G–16G). Started IV fluids and blood transfusion.
Disability	Assess level of consciousness (AVPU/GCS)	GCS: 8/15. Patient was in hypovolemic shock; BP unrecordable. Noradrenaline started: 130/80 mmHg in 2 ml/hr.
Exposure	Assess vaginal bleeding and overall condition	Warmer connected. Estimated blood loss with clots: 200 g; more than 1 litre.
Laboratory Investigation	Blood investigations	CBC, blood grouping & cross-matching, coagulation profile, fibrinogen, renal function, electrolytes and ABG. Hb: 5.9 g/dL; Fibrinogen: 190; Blood group: O+ve; INR: 1.05. Blood sample collected immediately and sent.
Hemorrhage Management	Activate massive transfusion protocol (MTP)	Transfused outside: 3 units whole blood, 4 FFB, 4 cryotherapy. In ER course of treatment: 2 units whole blood.
Monitoring	Continuous monitoring	BP, HR, RR and SpO2 every 15 minutes. Foley's output monitoring: 450 ml initially. Inj. Lasix started. RTA and drain connected.
Hospitalization Preparation	Prepare for critical care admission and a multidisciplinary team approach	High-risk consent obtained. Prepared for critical care admission and continuous monitoring with a multidisciplinary team approach.

Diagnosed

Surgical Procedure: Cesarean Hysterectomy

IUD/ pre-eclampsia
AKI- Resolved
Rhabdomyolysis – Resolving

Clinical Outcomes

Following aggressive fluid resuscitation and massive transfusion, the patient’s blood pressure gradually improved, airway stabilized following the intubation and urine output improved following loop diuretics. Emergency cesarean hysterectomy is a life-saving procedure when conservation measures fail to control severe obstetrics bleeding.

Prompt recognition of hemorrhagic shock, rapid activation of the massive transfusion protocol, timely fluid resuscitation and coordinated multidisciplinary teamwork are essential to improve maternal survival.

Investigation comparative table

S.no	Investigation parameters	13.07.2026	14.07.2026	15.07.2026	16.07.2026
1	HB	5.9	9.7	7.0	9.1
2	PCV	18.0	29.5	20.9	28.0
3	WBC	17,460	17400	11990	10750
4	Platelet count	113000	98500	105000	108500
5	ESR	38
6	CRP	25.53
7	Procalciton	7.01			62.45
8	Urea	55.68	68.67	103.17	133.04
9	Creatinine	2.07	2.96	3.53	3.83
10	Sodium	137.6	140.8	141.2	140.6
11	Potassium	6.00	3.72	3.51	3.96
12	Chloride	102.2		104.3
13	Bicarbonate	22.32		21.43	22.01
14	Sr.uric acid	7.92		8.40
15	LDH		2276.0		2722
16	SGOT	199.48		666.93
17	SGPT	102.90		405.66
18	Albumin	2.09		2.79
19	Globulin	2.45		1.96
20.	Sr.AI.phosphate	147	117.73		151.78`
21.	APTT	30			39
22.	INR	1.05	1.02	1.14	1.04
23.	TROP I	7.25
24.	Fibrinogen	190
25.	MgSo4	2.83
26.	Urine Spot Na+	59
27.	PH urine	6.5
28.	Urine PCR	P- 228/1, C-26.71, Ratio- 8.53
29.	Blood Group	O Positive
30.	Serology	Non-Reactive

ECHOCARDIOGRAM (14.07.2026)	Normal LV systolic and diastolic function. TR minimal. Sinus tachycardia during the study.
USG Abdomen & Pelvis (14.07.2026)	Bilateral mild pleural effusion. Abdominal wall seroma.
CT Scan Whole Abdomen (Plain) – 15.07.2026	Status post caesarean hysterectomy showing: • Bulky and heterogeneously hypodense bilateral recti muscles of anterior abdominal wall in the hypogastric region. • Large right rectus muscle hematoma with extraperitoneal hematoma in the hypogastric region (12.5 × 7.5 × 13.5 cm), extending across the midline onto the left side. • Ill-defined heterogeneously hypodense collection (8.0 × 4.3 × 5.5 cm) in the region of the uterine fossa – may suggest dead space/post-operative bed collection. • Mild free fluid noted in the abdomen and moderate free fluid noted in the pelvis. • Mild haemoperitoneum along the left lateral abdominal wall, perisplenic region and right iliac fossa. • Features of right pyelonephritis with mild hydroureteronephrosis and non-visualisation of the distal right ureter – ? resolving physiological right hydronephrosis due to mass effect by pelvic collections.
HRCT Chest (Plain Study) – 15.07.2026	Moderate diffuse cardiomegaly. Bilateral mild pleural effusion with fissural effusion and mild diffuse ground-glass opacification of bilateral lung parenchyma. Collapse consolidation of posterior segments of both upper lobes and posterior basal segments of both lower lobes with zones of subsegmental atelectasis in the lower lobes of both lungs. • Features of volume overload. • Consolidation patch with air bronchogram in posterior and lateral basal segments of the left lower lobe – ? due to aspiration.
Doppler Study of Both Lower Limb Venous (Bedside) – 16.07.2026	• No saphenofemoral or saphenopopliteal valve incompetence. • No evidence of perforator incompetence. • No evidence of acute deep venous thrombosis. • Moderate subcutaneous edema from distal thigh to dorsum of foot.
ECHOCARDIOGRAM (16.07.2026)	CHD – Acyanotic OS type of ASD with LT-RT shunt, more than 2:1. RA and RV dilated. TR (mild). Normal LV systolic function.

Day 1: (Critical care stabilization)

Admitted in critical care unit, obtained nephrology opinion on view of AKI.
Hemodynamics gradually improving.
On Mechanical ventilator – FiO2 – 50% 100% planned for weaning with NIV support with next 24 hours.
ABG- PH-7.3 PCo2- 34 PO2- , Lac-322 10.4- HCo3 17.9 K+ – 6 hyperkalemia correction was given.
Albumin started in the view to improving the urine output.
Continuous monitoring of vital signs.
Blood transfusion was completed according to laboratory results.
Norad supported. Rotem was sent.
Rotational thromboelastometry (ROTEM) is a rapid point-of-care test used to evaluate whole blood clotting.
Intravenous fluids adjusted based on urine output and blood pressure.
Vasopressors gradually reduced blood pressure stabilized.
Pain management initiated.
Serial laboratory investigations repeated.
Surgical wound inspected.
Chest physiotherapy and deep breathing exercises encouraged.

Day 2 to 3:

Extubated, able to tolerate the NIV within 4 hours, the mother was able to have normal SpO2 of 100 % in the room air.
Output was improved.
Ambulation increased. Urine output normal. Shifted to ward.

Day 7th

Foley’s catheter removed. Mother were able to be voided, Encouraged for ambulation.
Venous thromboembolism prevention measures continued.
Psychological support is provided regarding hysterectomy.
Continued and convert all the medication orally.
Hemoglobin and coagulation profile reassessed.
Nutritional assessment and high protein diet started.
Counselling provided regarding postoperative recovery.
Wound healthy. Drain tube removed.
Preparing the patient for the discharge process and home care management.

On discharge conditions: General condition good, Renal parameters- Resolving

Parameters	Findings
Blood pressure	120/90
Heart rate	98/ b/mt
Respiratory rate	20 b/mt
SPO2	100%
Temperature	98.4 F
GCS	15/15

Discharge medicine

S.No	Drug Name	Strength	Frequency	Days
1	Tab.Rantac	150mg	1-0-0-1	1 week
2	Tab.Nicardia Retard	10mg	1-1-0-1	1 week
3	Tab.Shelcal	500mg	1-0-0-1	3 months
4	Tab.Lasix	40mg	1½-0-1½-0	1 week
5	Tab. Renerve Plus		1-0-0-0	1 week
6	Tab Mg D3		1-0-0-1	1 week
7	Tab. Prolomet XL	25mg	1-0-0-1	1 week
8	Tab. Folic acid	5mg	1-0-0-0	1 week
9	Tab.Livogen Z		1-0-0-1	1 month
10	Syp.Clearuti	10ml	0-0-10ml	1 week
11.	Tab.Chymoral Forte		1-0-0-1	5 days

Conclusion

Emergency cesarean hysterectomy is a life-saving procedure in severe obstetric emergencies. Early recognition, prompt surgical intervention, timely blood transfusion, multidisciplinary teamwork, and comprehensive nursing care were crucial in achieving a successful recovery. The patient was discharged in stable condition with a healthy wound, improving renal function, and appropriate follow-up care.

Cesarean hysterectomy post-LSCS: From crisis to stabilization: Nursing care after cesarean hysterectomy

Cesarean hysterectomy post-LSCS: From crisis to stabilization: Nursing care after cesarean hysterectomy

Amuthakani. V1*, Angel Roselin S2

Nightingale Journals

Amuthakani. V^1*, Angel Roselin S²