From 1976 through 1984, 48 primary caesarean hysterectomies were performed in the Department of Obstetrics and Gynaecology of the Medical School of Hannover. The indications for the operation, the risk factors and the postoperative course were analysed and compared with a control group of patients with a Caesarean section. Caesarean hysterectomies had a higher incidence of excessive blood loss, blood transfusion and urinary tract injury, especially of the bladder. Based on this experience Caesarean hysterectomy should be performed if a valid indication is present. The operation cannot be recommended routinely for the purpose of sterilisation.