Objective: To evaluate the effect of bilateral hypogastric artery ligation (BHGAL) on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage.
Methods: Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study. The records of cases were obtained from the hospital database, retrospectively. Maternal demographic data, morbidities or complications associated with BHGAL surgery, any additional haemostatic interventional or surgical procedures, preoperative admission and lowest postoperative haematocrit-hemoglobin values, blood products given, type of anaesthesia, intensive care unit (ICU) and length of hospital stay were recorded. In cases without surgical sterilization, future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation. Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed.
Results: Sixty-eight patients with BHGAL surgery history were included in the study. 26 Of 37 cases (70%) that did not undergo surgical sterilization had a desire for pregnancy after the surgery. Six of these cases (23%) were diagnosed with secondary infertility. The fertility rate of these cases was 77%, and subsequent pregnancy was detected in 20 women. A total of 25 pregnancies, including first and second pregnancies, developed, and 15 of these pregnancies resulted in term delivery, six preterm births, one stillbirth, and three abortions.
Conclusions: The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems, and this surgery does not seem to adversely affect pregnancy outcomes. This is a tertiary center experience and cohort studies with large patient series are needed.
Conflict of interest statement
All authors declare no conflicts of interest.
Funding
The study received no extramural funding.
Authors' contributions
Gulcan OKUTUCU performed manuscript writing, data collection, and data analysis. Mehmet Siddik EVSEN carried out project development, visualization, reviewing, and editing. Nurullah PEKER performed literature search, reviewing, and editing. Senem YAMAN TUNC was responsible for literature search, and project development. Mehmet Sait ICEN performed literature search, data collection, and project development.
Publisher's Note
The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
| [1] |
Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Landon MB, Galan HL, Jauniaux ERM, et al. (eds.) Gabbe's obstetrics: Normal and problem pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2017, p. 406-407.
|
| [2] |
World Health Organization. WHO guidelines for the management of postpartum haemorrhage and retained placenta. Geneva: World Health Organization; 2009.
|
| [3] |
Committee on Practice Bulletins-Obstetrics. Practice bulletin No. 183: Postpartum hemorrhage. Obstet Gynecol 2017; 130(4):e168-e168. doi: 10.1097/A0G.0000000000002351.
|
| [4] |
Evsen MS, Sak ME, Soydinc HE, Basaranoglu S, Bakir C, Sak S, et al. Internal iliac artery ligation for severe postpartum hemorrhage. Ginekol Pol 2012; 83(9):665-668.
|
| [5] |
İçen MS, Findik FM, Akin Evsen G, Ağaçayak E, Yaman Tunç S, Evsen MS, et al. Hypogastric artery ligation in postpartum haemorrhage: A ten-year experience at a tertiary care centre. J Obstet Gynaecol 2021; 41(4):536-536. doi: 10.1080/01443615.2020.1755623.
|
| [6] |
Nizard J, Barrinque L, Frydman R, Fernandez H. Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage. Hum Reprod 2003; 18(4):844-844. doi: 10.1093/humrep/deg161.
|
| [7] |
Doumouchtsis SK, Nikolopoulos K, Talaulikar V, Krishna A, Arulkumaran S. Menstrual and fertility outcomes following the surgical management of postpartum haemorrhage: A systematic review. BJOG 2014; 121(4):382-382. doi: 10.1111/1471-0528.12546.
|
| [8] |
Gizzo S, Saccardi C, Patrelli TS, Di Gangi S, Breda E, Fagherazzi S, et al. Fertility rate and subsequent pregnancy outcomes after conservative surgical techniques in postpartum hemorrhage: 15 years of literature. Fertil Steril 2013; 99(7):2097-2097. doi: 10.1016/j.fertnstert.2013.02.013.
|
| [9] |
Republic of Turkey Ministry of Health General Directorate of Public Health, COVID-19 (SARS-CoV-2 infection) General Information. Epidemiology and diagnosis. [Online] Available from:https://covid19.saglik.gov.tr/Eklenti/39551/0/covid-19rehberigenelbilgilerepidemiyolojivetanipdf.pdf [Accessed 5th January 2022].
|
| [10] |
Hess JR. Massive blood transfusion. UpToDate. [Online] Available from:https://www.uptodate.com/contents/massive-blood-transfusion [Accessed 17th December 2021].
|
| [11] |
Definitions of infertility and recurrent pregnancy loss. Fertil Steril 2008; 90(Suppl 5): S60. doi: 10.1016/j.fertnstert.2008.08.065.
|
| [12] |
Sagarra M, Glasser ST, Stone ML. Ligation of the internal iliac vessels in the control of postpartum hemorrhage: Report of a case. Obstet Gynecol 1960; 15:698-701.
|
| [13] |
Papp Z, Tóth-Pál E, Papp C, Sziller I, Gávai M, Silhavy M, et al. Hypogastric artery ligation for intractable pelvic hemorrhage. Int J Gynecol Obstet 2006; 92(1):27-27. doi: 10.1016/j.ijgo.2005.08.022.
|
| [14] |
Tan P, Evsen MS, Soydinç HE, Sak ME, Ozler A, Turgut A, et al. Increased psychological trauma and decreased desire to have children after a complicated pregnancy. J Turk Ger Gynecol Assoc 2013; 14(1):11-11. doi: 10.5152/jtgga.2013.03.
|
| [15] |
Francois K. Postpartum hemorrhage. In: Foley MR, Strong TH, Garite TJ. (eds.) Obstetric intensive care manual. 5th ed. New York: McGraw-Hill Education; 2019, p. 33-50.
|
| [16] |
Hanulikova P, Krofta L, Vojtech J, Haslik L, Feyereisl J. Hypogastric artery ligation; Therapeutic option for patients with morbidly adherent placenta. Eur J Obstet Gynecol Reprod Biol 2019; 234: e57. doi: 10.1016/j.ejogrb.2018.08.280.
|
PDF
(670KB)
