Reproductive performance after conservative surgical treatment of postpartum hemorrhage

Abstract Objective To evaluate the impact of bilateral internal iliac artery ligation (BIL), bilateral uterine artery ligation (BUAL), step-wise uterine devascularization (SWUD), and B-Lynch on infertility, ovarian reserve, and pregnancy outcome. Methods The study included 168 infertile or pregnant...

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Bibliographic Details
Published in:International journal of gynecology and obstetrics 2014-03, Vol.124 (3), p.248-252
Main Authors: Rasheed, Salah M, Amin, Magdy M, Abd Ellah, Ahmed H, Abo Elhassan, Ahmed M, El Zahry, Mazen A, Wahab, Hala A
Format: Article
Language:English
Subjects:
Adult
Cross-Sectional Studies
Egypt - epidemiology
Female
Humans
Iliac Artery - surgery
Infertility
Infertility, Female - epidemiology
Ligation
Obstetrics and Gynecology
Postpartum Hemorrhage - surgery
Pregnancy
Pregnancy Complications - epidemiology
Pregnancy Outcome
Prevalence
Uterine Artery - surgery
Uterine-sparing procedures
Young Adult
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Summary:Abstract Objective To evaluate the impact of bilateral internal iliac artery ligation (BIL), bilateral uterine artery ligation (BUAL), step-wise uterine devascularization (SWUD), and B-Lynch on infertility, ovarian reserve, and pregnancy outcome. Methods The study included 168 infertile or pregnant patients—recruited at outpatient clinics in Egypt—who had previously undergone uterine-sparing surgery (BIL [group I], n = 59; SWUD [group II], n = 65); BUAL [group III], n = 2; and B-Lynch [group IV], n = 42). One-way analysis of variance was used to compare the prevalence of infertility, the status of ovarian reserve, and the prevalence and type of relevant maternal and/or fetal obstetric complications between the groups. Results Groups II and IV had the highest prevalences of infertility. The ovarian reserve was significantly lower in group II. Unexplained infertility was the predominant cause of infertility in group I, anovulation and premature ovarian failure in group II, and endometriosis and intrauterine adhesions in group IV. The frequency of obstetric complications, particularly placenta previa and preterm labor, was high in group IV. Conclusion Of the 4 procedures, BIL had the least deleterious effect on reproductive performance; SWUD increased the risk of premature ovarian failure, and B-Lynch increased the risks of endometriosis, intrauterine adhesions, placenta previa, and preterm labor.
ISSN:0020-7292
1879-3479
DOI:10.1016/j.ijgo.2013.08.018