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We read with interest the comments of Dr Laird and would agree that the decision to perform a hysterectomy (not hysterectomize!) on a 19-year-old is not one to be taken without full consideration. Unfortunately, a general anaesthetic was used but this was at the patient's request and in retrospect, having the patient awake during such an ordeal may have been psychologically traumatic, the obtaining of objective consent far from possible.

Dr Laird fails to appreciate the sequence of events leading to the delivery of the baby, otherwise he will appreciate that the incisions inflicted, first through the anterior vagina, then the posterior vagina and finally transversely through the fundus of the uterus were far from‘delineated.’The anatomy only became clear after delivery, by which time the uterus was not attached to the vagina (it having been completely circumcized) and the integrity mentioned would have been following reattachment. The decision to proceed to hysterectomy was taken by the patient's own consultant (S. M. W.) but only after a second consultant had been called into theatre in order to discuss the pathological findings. Although taken into consideration, the ‘tumour’ played only a small part in the decision and at no time was malignancy suspected. Frozen section if available would not have helped.

Having made sure that our patient had a live healthy baby, our main concern was the health of the mother with a worsening renal condition, whilst reducing immediate morbidity and guarding against obstetric disasters in the future. Hysterectomy offered the only solution and any obstetrician in the same position would have difficulty in finding a safe alternative, despite the unfortunate effect of leaving a f 9-year-old without a uterus.

Dr Laird, in his comments, shows a singular lack of concentration on the issues involved or insight into the considerable discussions that occurred before such decisions were made.