Reproductive performance after conservative surgical treatment of postpartum hemorrhage

Objective: To evaluate the impact of bilateral internal iliac artery ligation (BIL), bilateral uterine artery ligation (BUAL), step-wise uterine devascularizafion (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 l], 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. (C) 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.