A recent Health-e News publication of a 20-year old Limpopo mother who alleges that doctors removed her womb without her knowledge or consent after childbirth, has raised questions about when an emergency hysterectomy may be necessary and what patients’ rights are. 

We asked Prof Leon Snyman, of the South African Society of Obstetricians and Gynaecologists (SASOG) and Head of Obstetrics and Gynaecology at Kalafong Provincial Hospital, to explain when this life-saving operation may be needed and what the law says about consent.

What is an emergency hysterectomy?

An emergency hysterectomy is the unscheduled surgical removal of the uterus or part of the uterus — usually during or immediately after childbirth — as a potential life-saving procedure. 

This will only happen when life-threatening complications arise that cannot be controlled by any other means. 

An emergency hysterectomy is a last-resort, life-saving operation, not a routine part of childbirth and never as part of a sterilisation procedure. 

When will an emergency hysterectomy be considered?

The most common reasons are uncontrollable bleeding (postpartum haemorrhage).

Doctors first attempt uterus-preserving measures which would include: 

• Medication to contract the uterus (tighten the womb)
• Uterine (womb) massage 
• Balloon tamponade (inflatable balloon to apply mechanical pressure) 
• Compression sutures (use of stitches)
• Other surgical techniques

Is removing the womb one of the first options doctors consider?

No. 

Hysterectomy is considered a last resort.

Hysterectomy is only performed when uterus-preserving measures fail or when the situation is too unstable to allow time for them.

When can doctors remove a woman’s womb without her consent?

In almost all planned operations, doctors must obtain informed consent before performing a hysterectomy.

However, during or shortly after childbirth, when a woman continues to lose large volumes of blood despite measures taken, and her vital signs show she is going into haemorrhagic shock (shock from severe blood loss), the surgical team has to act within minutes. 

At that point, continuing to try alternative measures risks the patient’s life, and hysterectomy becomes the safest option to stop the bleeding definitively and save the woman’s life.

Can a family member give consent for an emergency hysterectomy on behalf of the patient?

Yes, in limited circumstances.

If the patient is unable to consent, for example is she’s unconscious, the National Health Act allows an order of priority for legally authorised decision-makers to give consent on behalf of a patient. 

In order:

• a person mandated by the patient in writing,
• then a spouse or partner,
• then a parent, 
• then a grandparent, 
• then an adult child, then a brother or sister.

If the patient is a minor (under 18), a parent or legal guardian would give consent. 

But, if waiting to obtain that consent would place the woman’s life at greater risk, doctors may proceed with emergency treatment, including a hysterectomy, to save her life.

Do you have the right to ask questions and receive an explanation after an emergency hysterectomy?

Yes.

It is highly unlikely that your doctor will not explain that an emergency hysterectomy had to be performed, and explain the reasons why this decision was taken.

Even when an emergency hysterectomy had to be performed without prior consent, doctors still have a duty to explain what happened afterwards.

Patients should be told:

• Why the hysterectomy was necessary
• What doctors found during surgery
• What treatment was performed
• How it may affect future fertility and recovery
• What follow-up care and emotional support are available

This discussion should take place as soon as the patient is medically stable and able to understand the information.

Can I ask for my medical records?

Yes.

Patients have the right to request copies of their medical records, including the operation notes explaining why the hysterectomy was performed. 

These records can help patients understand what happened and may be important if they later seek a second medical opinion or legal advice.

What should I do if I believe my womb was removed unnecessarily?

If you believe a hysterectomy was performed without proper medical reason or without following the correct consent process, you can:

• Request your medical records.
• Lodge a complaint with the hospital.
• Report the matter to the Health Professions Council of South Africa (HPCSA).
• Contact the Office of Health Standards Compliance (OHSC).
• Seek independent legal advice if necessary.

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Prof Leon Snyman is Head of Obstetrics and Gynaecology at Kalafong Provincial Hospital, and Executive Council Member of the South African Society of Obstetricians and Gynaecologists (SASOG).