Effect of bilateral uterine artery ligation in cases of postpartum hemorrhage on ovarian reserve

Authors

  • Mohamed A. Abo Zaid Department of Obstetrics and Gynaecology, Faculty of Medicine-Tanta University, Tanta, Egypt
  • Ahmed M. Hagras Department of Obstetrics and Gynaecology, Faculty of Medicine-Tanta University, Tanta, Egypt
  • Mohamed M. Hefeda Department of Obstetrics and Gynaecology, Faculty of Medicine-Tanta University, Tanta, Egypt
  • Medhat S. Hwidy Department of Obstetrics and Gynaecology, Faculty of Medicine-Tanta University, Tanta, Egypt

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20230118

Keywords:

Hemorrhage, Postpartum, Ovarian blood flow, Ovarian reserve, Uterine artery ligation

Abstract

Background: Bilateral uterine artery ligation (BUAL) is a fertility-preserving procedure used in women experiencing postpartum hemorrhage (PPH). However, the long-term effects of this procedure on ovarian reserve remain unclear. Aim to investigate the effect of BUAL in cases of PPH on ovarian reserve,

Methods: This study was carried out at department of obstetrics and gynecology Tanta university on 40 patients divided into 2 groups: (The study group); included 20 patients underwent cesarean section with successful BUAL for intractable atonic PPH, (The control group); included 20 patients underwent cesarean section without BUAL; during a period between April 2020 and December 2021,

Results: There is no-significant difference between study and control group according to AMH (ng/ml), resistivity index (RI) and pulsatility index (PI) of right and left uterine artery and ovarian artery after 6 months of bilateral UAL,

Conclusions: Bilateral UAL had no negative effects on ovarian reserve or ovarian blood supply, so this treatment should be used as a fertility preservation technique to avoid hysterectomy in patients experiencing PPH.

References

Sebghati M, Chandraharan E. An update on the risk factors for and management of obstetric haemorrhage. Womens Health (Lond). 2017;13:34-40.

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;121:382-8.

Joshi VM, Otiv SR, Majumder R, Nikam YA, Shrivastava M. Internal iliac artery ligation for arresting postpartum haemorrhage. BJOG. 2007;114:356-61.

Hehenkamp WJ, Volkers NA, Broekmans FJ, de Jong FH, Themmen AP, Birnie E et al. Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy. Hum Reprod. 2007;22:1996-2005.

Kim CW, Shim HS, Jang H, Song YG. The effects of uterine artery embolization on ovarian reserve. Eur J Obstet Gynecol Reprod Biol. 2016;206:172-6.

O’Leary JL, O’Leary JA, uterine artery ligation for control of post CS PPH ObstetGynecol2015; 43:849-53.

Fleming R, Seifer DB, Frattarelli JL, Ruman J. Assessing ovarian response: Antral follicle count versus anti-Müllerian hormone. Reproductive Bio Med Online. 2015;31:486-96.

Jamil Z, Fatima SS, Ahmed K, Malik R, Jamil Z, Fatima SS et al. Anti-Mullerian hormone: Above and beyond conventional ovarian reserve markers. Disease Markers, Hindawi Publishing Corporation. 2016;2016:1-9.

Sebghati M, Chandraharan E. An update on the risk factors for and management of obstetric haemorrhage. Womens Health (Lond). 2017;13:34-40.

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;121:382-8.

Samy A, Ali MK, Abbas AM, Wahab HA, Wali AA, Hussien AH et al. Randomized controlled trial of the effect of bilateral uterine artery ligation during cesarean among women at risk of uterine atony. Int J Gynecol Obstetr. 2020;148(2):219-24.

Mohamed EH, Ahmed T, Ibraheim AE, Zakaria AE, Mohamed AA, Taha W. A Prospective Comparative Study between the Efficacy of Uterine Compression Sutures (B-Lynch) and Bilateral Uterine Artery Ligation for the Prevention of Atonic Postpartum Haemorrhage during Caesarean Section in High Risk Women. Med J Cairo University. 2018;86(9):3349-58.

Lin J, Lin F, Zhang Y. Uterine artery ligation before placental delivery during caesarean in patients with placenta previa accreta. Medicine. 2019;98:e16780.

Verit FF, Çetin O, Keskin S, Akyol H, Zebitay AG. Does bilateral uterine artery ligation have negative effects on ovarian reserve markers and ovarian artery blood flow in women with postpartum hemorrhage? Clin Experimental Reprod Med. 2019;46(1):30.

Yokota A, Nakai A, Oya A, Koshino T, Araki T. Changes in uterine and ovarian arterial impedance during the periovulatory period in conception and nonconception cycles. J Obstet Gynaecol Res. 2000;26:435-40.

Chang WC, Huang SC, Sheu BC, Shih JC, Hsu WC, Chen SY et al. Changes in uterine blood flow following laparoscopic myomectomy with or without uterine artery ligation on two- and three dimensional power Doppler ultrasound. Ultrasound Obstet Gynecol. 2009;33:221-7.

Yildirim Y, Gultekin E, Kocyigit A, Yilmaz C, Ertopcu K, Arioz DT. Color Doppler analysis of pelvic arteries following bilateral internal iliac artery ligation for severe postpartum hemorrhage. Int J Gynaecol Obstet. 2009;104:22-4.

Kaump GR, Spies JB. The impact of uterine artery embolization on ovarian function. J Vasc Interv Radiol. 2013;24:459-67.

Hu NN, Kaw D, McCullough MF, Nsouli-Maktabi H, Spies JB. Menopause and menopausal symptoms after ovarian artery embolization: a comparison with uterine artery embolization controls. J Vasc Interv Radiol. 2011;22:710-5.

Tsikouras P, Manav B, Koukouli Z, Trypsiannis G, Galazios G, Souftas D et al. Ovarian reserve after fibroid embolization in premenopausal women. Minim Invasive Ther Allied Technol. 2017;26:284-91.

McLucas B. Pregnancy following uterine artery embolization: an update. Minim Invasive Ther Allied Technol. 2013;22:39-44.

Kaplanoglu M, Karateke A, Un B, Gunsoy L, Baloglu A. Evaluation of uterine artery recanalization and doppler parameters after bilateral uterine artery ligation in women with postpartum hemorrhage. Int J Clin Exp Med. 2015;8:7823-9.

Downloads

Published

2023-01-25

Issue

Section

Original Research Articles