Fertility rate and subsequent pregnancy outcomes after conservative surgical techniques in postpartum haemorrhage 15 years of literature
In conservative surgical treatment of PPH, pelvic vessel embolization and compressive sutures are associated not only with high rates of subsequent fertility but also with placental disorders, intrauterine growth restriction, cesarean delivery, and PPH recurrence.
Salvatore Gizzo, M.D., Carlo Saccardi, M.D., Tito Silvio Patrelli, M.D., Stefania Di Gangi, M.D., Ph.D., Elisa Breda, M.D., Simone Fagherazzi, M.D., Marco Noventa, M.D., Donato D’Antona, M.D., Giovanni Battista Nardelli, M.D.
Volume 99, Issue 7, Pages 2097-2107, June 2013
To investigate the most appropriate surgical technique for optimising hemostasis and preservation of subsequent fertility after postpartum haemorrhage (PPH).
Systematic review of the literature.
Review of MEDLINE, EMBASE, ScienceDirect, and the Cochrane Library.
Main Outcome Measures:
Comparison of the effectiveness of conservative surgical techniques, separately or together, with respect to success rate (ability to stop bleeding and preserve the uterus), fertility rate (subsequent pregnancies or the return of regular menstrual cycles), complication rate of the procedure, and the outcomes of subsequent pregnancies in terms of type of delivery and eventual delivery complications.
Compressive sutures and vessel embolisation may be considered life-saving procedures by achieving the best haemostatic efficacy. Data on restoration of menses and pregnancy rates after these procedures are limited by short-term follow-up and by the paucity of studies, especially for vascular ligation.
Pelvic vessel embolisation and compressive sutures are associated with high rates of restoration of regular menses and successive pregnancies, even if the former is burdened by an increased rate of placental disorders and foetal growth restriction and the latter by an increased risk of caesarean deliveries and PPH recurrence. Randomised trials would be desirable to define the best management of PPH.