There is no standard definition for intraoperative hemorrhage. Each author who has reported a series of cases has used his or her own definition. The following represents a synthesis of the literature.

Intraoperative hemorrhage occurs when a patient requires a blood transfusion or loses more than 1 000 ml of blood during the operation. There is no preoperative anemia (hemoglobin less than 11) and no postoperative bleeding. No concurrent procedures are performed except for colporrhaphy, adnexectomy, or appendectomy.

Intraoperative hemorrhage has been reported to occur in 0.2%~3.7% of cases, with most studies reporting 1%~2% occurrence. The Collaborative Review of Sterilization (CREST) study reported intraoperative hemorrhage occurring at 0.2% for AH and 0.7% for VH. The study did not give a precise definition for what they considered intraoperative hemorrhage. The rate of transfusion associated with hysterectomy has been steadily decreasing in the past 10 years. The CREST study reported a transfusion rate of 13.29%, similar to Amerikia's rate of 12%. In the five largest series reported since 1985, the rate for blood transfusion accompanying hysterectomy has been reported at 1%~5%. In the late 1970's and early 1980's, the indications for transfusion were looser, and many patients received blood who would not receive it now. This predominantly is because of concern about human immunodeficiency virus and hepatitis C transmission.

The rate of transfusion for laparoscopic hysterectomy (LH) has been reported at 2.1%, of which two thirds were autologous transfusions. There could be some underreporting in this area. Intraoperative hemorrhage frequently forces the surgeon to convert a laparoscopic hysterectomy into an abdominal procedure. The case then might be considered as an abdominal hysterectomy and thus not reported in a series of laparoscopic hysterectomies.

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