Gynaecological surgical procedures may result in complications that present in a similar manner to emergencies in early pregnancy. Some of the more common procedures are described below. A thorough patient history will guide the practitioner in differentiating between complications in early pregnancy and complications post‐surgery. Generally, the complications of gynaecological surgery are similar to those of any type of surgery.

15.1 Hysterectomy

Hysterectomy is performed for a variety of reasons including treatment of fibroids, endometriosis, chronic pelvic pain and cancer of the uterus, cervix or ovaries (NICE, 2007). The condition will dictate the type or extent of surgery required:

• Total hysterectomy: the uterus and cervix are removed (most common)
  
• Subtotal hysterectomy: the main body of the uterus is removed but the cervix is left in place
  
• Total hysterectomy with bilateral salpingo‐oophorectomy: the uterus, cervix, fallopian tubes and ovaries are removed
  
• Radical hysterectomy: the uterus and surrounding tissues are removed including the fallopian tubes, part of the vagina, ovaries, lymph glands and omentum (NHS Choices, 2014)

There are three ways in which hysterectomy may be performed:

• Abdominal hysterectomy: this is performed through an incision made in the lower abdomen, usually horizontally above the pubic hair line, but may occasionally be via a vertical incision
  
• Vaginal hysterectomy: the uterus is removed via an incision made at the top of the vagina. This type of procedure generally allows for faster healing
  
• Laparoscopic hysterectomy: the uterus is removed through several small incisions in the abdomen. This is sometimes combined with a vaginal approach

Recovery following laparoscopic and vaginal procedures is generally more rapid than following abdominal procedures. Patients will usually be fully mobile (although not fully recovered) within 1 week of laparoscopic and vaginal procedures. Full mobility often takes 2 weeks or more following an abdominal approach. It is normal to experience some bleeding, discharge and discomfort for several weeks following hysterectomy. However, bleeding near the vaginal vault may accumulate and may present with signs of infection and heavy, offensive bleeding or discharge.

Complications may occur with all types of hysterectomy. Early potential complications include trauma to blood vessels (haemorrhage requiring blood transfusion: 23:1000 women), bowel perforation (4:10 000 women) or bladder perforation (7:1000 women), which are more common with a laparoscopic approach (NICE, 2007; RCOG, 2009b). Frequent complications (which are more likely to be seen following discharge from hospital) include pelvic infection (2:1000 women), wound infection, urinary tract infection, wound haematoma and thromboembolic disorders (4:1000 women) (RCOG, 2009b).

15.2 Laparoscopy

Laparoscopy is performed as an investigative procedure, for example for pelvic pain or for treatment of gynaecological problems, including salpingectomy for ectopic pregnancy. It is important to be aware that, in some units, patients are discharged home the same day as surgery, even following hysterectomy, so it is vitally important not to assume that a patient discharged home the same day has only had minor surgery.

Carbon dioxide gas is introduced into the abdomen to allow better visibility via the laparoscope, which is passed into the abdomen usually via an incision at the umbilicus. This gas is slowly absorbed but can be uncomfortable post‐surgery (NHS Choices, 2015b).

If blood vessel damage occurs, it is usually seen and corrected at the time of surgery. However, accidental damage to a loop of bowel may not be seen. Patients may be discharged home and present with increasing abdominal pain, infection or peritonitis any time from 1 to 5 days following laparoscopic surgery.