Fertility after B-Lynch suture in a patient previously treated for acute myeloid leukaemia

Subsequent pregnancy outcome after uterine compression suture placement for postpartum hemorrhage

OBJECTIVE

To evaluate the subsequent obstetrical outcome in women who received a uterine compression suture.

METHODS

This is a retrospective cohort study of women who received a uterine compression suture for postpartum hemorrhage (PPH) between January 2009 and December 2018 and had a subsequent pregnancy at a tertiary care hospital in India. Women who had PPH but did not receive uterine compression sutures and had a subsequent pregnancy were taken as controls.

RESULTS

Sixty-two women had a subsequent pregnancy after uterine compression suture and were included in this study. There were no significant differences in the subsequent pregnancy outcome between the study and control groups. However, women with a history of uterine compression suture were found to have a higher incidence of dense omental adhesions (15% versus 2.8%; P < 0.001), more intrapartum blood loss (740.5 ± 491.8 ml versus 638.8 ± 194 ml; P = 0.02), and were more likely to need repeat uterine compression suture (6.7% versus 0%; P = 0.004).

CONCLUSION

Women who received uterine compression sutures had similar obstetrical outcomes in their subsequent pregnancy compared with those who did not receive a suture for PPH management. However, they had a higher risk of dense omental adhesions, repeat uterine compression suture application, and intrapartum blood loss.

Fertility after "only B-Lynch" suture: a case report and literature review

OBJECTIVE

A new fertility assessment after a B-Lynch suture without a concomitant uterine devascularization is proposed.

CASE REPORT

The case of a 37-year-old woman who experienced postpartum hemorrhage due to uterine atony during cesarean delivery of the previous pregnancy is reported. A B-Lynch brace suturing technique, not associated to any other hemostatic surgical procedure, was carried out. One year later and after an uncomplicated pregnancy of 39 weeks, the patient delivered a healthy infant by an elective cesarean section. Only omental adhesions were found on the anterior surface of the uterus as a consequence of the previous B-Lynch suture.

CONCLUSION

The B-Lynch hemostatic surgical procedure, alone, does not seem to have a negative impact on fertility. Additional clinical evidences in a greater case-series of patients are needed to assess the value of the method for fertility preservation.

Fertility rate and subsequent pregnancy outcomes after conservative surgical techniques in postpartum hemorrhage: 15 years of literature

OBJECTIVE

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

DESIGN

Systematic review of the literature.

SETTING

Not applicable.

PATIENT(S)

None.

INTERVENTION(S)

Review of MEDLINE, EMBASE, ScienceDirect, and the Cochrane Library.

MAIN OUTCOME MEASURE(S)

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.

RESULT(S)

Compressive sutures and vessel embolization may be considered life-saving procedures by achieving the best hemostatic 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(S)

Pelvic vessel embolization 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 fetal growth restriction and the latter by an increased risk of cesarean deliveries and PPH recurrence. Randomized trials would be desirable to define the best management of PPH.