Objective To assess whether ultrasound detection of vault haematoma can be used as a predictor of post-ooperative morbidity following vaginal hysterectomy.

Design Prospective observational study of consecutive cases of vaginal hysterectomy performed between 1991 and 1994.

Sample Two hundred and twenty-three women having undergone vaginal hysterectomy.

Methods All women hadtransvaginal ultrasound examination by an independent observer on the third post-operative day. Routine observations and clinical assessments were made by establishedmanagement protocol, by staff blinded to the ultrasound findings.

Main out come measures Febrile morbidity; haemoglobin drop; need for blood transfusion; length of stay in hospital; re-admission rate and length of stay.

Results Of the 223 scanned women, 55 (25%) had a vault haematoma. This group was compared with the 168 women with no haematoma. Significant increases in febrile morbidity (31%vs7%), post-operative haemoglobin drop (2–5 g/dL vs1.6 g/dL), need for blood transfusion (145%vs1.2%), representation to hospital (25.5%vs5.4%)and length of hospital stay (8.87 days vs6.25 days) wereseen in the haematoma group.

Conclusion Ultrasound detection of vault haematoma following vaginal hysterectomy is a commonfinding associated with increased febrile morbidity, need for blood transfusion, longer hospital stayand higher re-admission rate. In view of increasing demand for early discharge, driven by purchasersand patients, post-operative ultrasound identifies a high risk population and is both convenient andnoninvasive. To further reduce morbidity, it also offers the opportunity to perform a controlled trialof prophylactic antibiotics in this identified subset.