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.

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Authors

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

Abstract

Objective:

To investigate the most appropriate surgical technique for optimising hemostasis and preservation of subsequent fertility after postpartum haemorrhage (PPH).

Design:

Systematic review of the literature.

Setting:

Not applicable.

Patient(s):

None.

Interventions:

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.

Results:

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.

Conclusion:

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.

Read the full text at: http://www.fertstert.org/article/S0015-0282(13)00270-7/fulltext


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Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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