Vaginal hysterectomy fails in women with narrow pubic arch

Vaginal hysterectomy is about four times more likely to fail in women with a narrow pubic arch than in others, according to a prospective cohort study of 75 women.

Researchers compared 25 failed vaginal hysterectomies with 50 successful procedures and examined such risk factors as age, parity, body weight, surgical indication, uterine size, presence of leiomyomata in the anterior lower uterine segment, previous pelvic surgeries, abdominopelvic adhesions, cervix location and length, narrow pubic arch, and intraoperative complications, such as bleeding requiring transfusion, visceral injury, nulliparity, and adnexal removal.

Of all the factors analyzed that gynecologists can assess preoperatively, only a narrow pubic arch increased the risk of failure of vaginal hysterectomy, about fourfold.

The authors concluded that it is prudent to choose abdominal hysterectomy without a trial of the vaginal approach in women with a narrow pubic arch.

Harmanli OH, Khilnani R, Dandolu V, et al. Narrow pubic arch and increased risk of failure for vaginal hysterectomy. Obstet Gynecol. 2004;104:697-700.