Objectives  To identify women undergoing peripartum hysterectomy in the UK and to describe the causes, management and outcome of the associated haemorrhage. Design  A population‐based descriptive study using the UK Obstetric Surveillance System (UKOSS). Setting  All 229 hospitals with consultant‐led maternity units in the UK. Population  All women in the UK delivering between February 2005 and February 2006. Methods  Prospective case identification through the UKOSS monthly mailing. Main outcome measures  Rates with 95% CIs. Odds ratio estimates. Results  Three hundred and eighteen women underwent peripartum hysterectomy. The most commonly reported causes of haemorrhage were uterine atony (53%) and morbidly adherent placenta (39%). Women were not universally managed with uterotonic therapies. Fifty women were unsuccessfully managed with B‐Lynch or other brace suture prior to hysterectomy, 28 with activated factor VII and 9 with arterial embolisation. Twenty‐one percent of women suffered damage to other structures, 20% required a further operation and 19% were reported to have additional severe morbidity. Bladder damage was more likely in women with placenta accreta (OR 3.41, 95% CI 1.55–7.48) than in women with uterine atony. There were no significant differences in outcomes between women undergoing total or subtotal hysterectomy. Two women died; case fatality 0.6% (95% CI 0–1.5%). Conclusions  For each woman who dies in the UK following peripartum hysterectomy, more than 150 survive. The associated haemorrhage is managed in a variety of ways and not universally according to existing guidelines. Further investigation of the outcomes following some of the more innovative therapies for control of haemorrhage is needed.

A modified POP-Q in conscious ewes was established showing that the vaginal wall of parous animals has similar regions of weakness as do women and may be similarly related to parity. Ewes appear to be a representative preclinical model of human vaginal prolapse.

Backache is a common cause of morbidity among doctors and 50% of the obstetricians and gynaecologists suffering from this attribute it to work practice and posture. Occupational injuries remain poorly studied among obstetricians and gynaecologists and we have therefore tried to assess the extent and demographics of work-related injuries sustained during training by sending an eight-item questionnaire to 418 Registrar grade trainees in the London area. A low 23.2% response rate (97/418) was obtained, despite second questionnaires being sent to initial non-responders. Out of the 97 responders, 28 (28.7%) had suffered injuries at work at least once throughout their career. There was female preponderance in those reporting injuries, with a female to male ratio of 3:1. Of the 28 positive responders, 11 were UK graduates, 7 EU and the remaining 10 from Colombia, West Indies, India and Sudan. The mean age was 32.5 +/- 4.2 years, with 21 of the 28 (75%) being senior trainees (post-MRCOG). The injuries reported were: forearm (4); wrist (7); thumb (3); hands (1) shoulder and neck (9), ankle (1) and lower back (6). Of these, 18 sought medical help and received treatment for these injuries, which included long-term physiotherapy, although no-one required surgery. Eight were forced to take time off work, with a cumulative total of 80 days; one had to prolong her training by 3 months. Seven trainees sustained their injuries (e.g. ligamentous strain of wrist and scaphoid fracture) while performing caesarean sections, while forceps deliveries were the cause of six occupational injuries (e.g. ligamentous strain of sacroiliac joint). Work-related injuries can have adverse effects on training and workforce. Awareness of correct surgical techniques and adoption of ergonomic posture when performing procedures may help to minimise the risk of a work-related injury.