Vaginal vault haematoma following hysterectomy at a tertiary referral hospital in South Africa

Background: Hysterectomy is the second most commonly performed surgical procedure among women of the reproductive age group, after caesarean section. Vault haematoma is a recognized complication of hysterectomy that may be associated with postoperative morbidity. Ultrasound examination of the vault is useful in the diagnosis of post hysterectomy vault haematoma as a cause for febrile morbidity. Objective: To determine the incidence and clinical significance of post hysterectomy vault hematomas in a South African Academic setting. Study Design: This was a prospective descriptive observational study. Materials and methods: Women aged 18 and above, scheduled for elective hysterectomy for benign indications were enrolled in the study after providing written informed consent. Transvaginal ultrasound scan was done at 48-72 hours post-operative and clinical notes were reviewed 3 months postoperatively. Results: Fifty patients were included in the study. The incidence of vault haematoma was 30%. The majority of patients (84%) underwent abdominal hysterectomy and the rest had laparoscopic and vaginal hysterectomy. There was no association between the occurrence of vault haematoma and postoperative morbidity. In addition, there was no difference in the occurrence of vault haematoma and the level of the surgeon's experience. Conclusion: Vault haematoma is a common finding following elective hysterectomy for benign gynaecological indications at a South African tertiary hospital. Patients with vault haematomas are mostly asymptomatic. There is no association between the presence of a vault haematoma and postoperative morbidity.