Is uterine-sparing surgical management of persistent postpartum hemorrhage truly a fertility-sparing technique?

Devenir obstétrical après plicatures utérines dans le traitement de l’hémorragie de la délivrance : suivi à long terme de 40 cas

“…Pourtant d'autres techniques de contrô le de l'hé morragie de la dé livrance sont bien é valué es : Blanc et al en 2011 [10] rapportent 11 grossesses spontané es dont 10 mené es à terme sans complication obsté tricale (sur 23 patientes suivies) aprè s triple ligature vasculaire. Sentilhes et al dé crivent 13 naissances sur 13 femmes ayant né cessité une ligature des artè res uté rines lors d'une pré cé dente grossesse [16].…”

“…Ces techniques permettent de pré server l'uté rus dans 71 % à 100 % des cas [4][5][6]. Quelques cas de grossesses aprè s plicatures ont é té dé crits [7][8][9], mais la majorité des donné es concerne des grossesses faisant suite à des triples ligatures vasculaires [10]. Peu de donné es sont disponibles pour confirmer que la conservation uté rine permet une ré elle conservation de la fertilité .…”

Techniques to reduce blood loss during open myomectomy: a qualitative review of literature

“…Artery ligation before open myomectomy was compared in two prospective randomized studies with single tourniquet technique in reducing blood loss (18,19). Sapmaz et al, (19) reported no difference with respect to intraoperative blood loss and total operation time duration among 52 women randomly Although it has been reported that pregnancy can occur after uterine artery ligation (16,17,20), there are concerns about the impact of this technique on future fertility. In addition, it seems that the chronic hypovascularization following this kind of procedure could be directly involved in the pathogenesis of subsequent intrauterine adhesions (20).…”

Uterine-sparing surgical management of postpartum hemorrhage: is it always effective?

“…However, there is still no evidence to suggest that one method is better and should be preferred to the others [10]. We recently reported that the preservation of the uterus in women with PPH does not necessarily mean that fertility is preserved [11]. Women with PPH successfully managed by TUAL, whether or not complemented by HMSS, are therefore exposed to the risk of subsequent abnormalities of the uterine cavity, compromising fertility, particularly in cases of postpartum endometritis [11].…”

“…We recently reported that the preservation of the uterus in women with PPH does not necessarily mean that fertility is preserved [11]. Women with PPH successfully managed by TUAL, whether or not complemented by HMSS, are therefore exposed to the risk of subsequent abnormalities of the uterine cavity, compromising fertility, particularly in cases of postpartum endometritis [11]. A genuine indication for such conservative methods remains, therefore, debated.…”