Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage.
BACKGROUND
Hypogastric artery ligation is a therapeutic option for severe post-partum haemorrhage. Little is known about the outcomes of subsequent fertility and pregnancy. We studied these parameters in women who required hypogastric artery ligation for severe post-partum haemorrhage in our institution over a 13-year period.


METHODS
All patients who required hypogastric artery ligation for severe intractable post-partum haemorrhage from January, 1989 to April, 2001 were included. Data were retrieved from medical files and telephone interviews.


RESULTS
A total of 68 patients required hypogastric artery ligation during the study period. Seventeen patients had 21 pregnancies with 13 term deliveries, two ectopic pregnancies, three miscarriages, and three abortions. Twenty-eight patients did not want a new pregnancy and one patient refused the interview. Twenty-three (34%) patients were lost to follow up. None of the patients suffered subsequent infertility and pregnancy was achieved in <12 months once planned. Pregnancy outcomes were normal. Fifty-four percent had vaginal deliveries. Three patients suffered a threatened post-partum haemorrhage that was easily treated medically.


CONCLUSIONS
This is the largest reported series of pregnancies following hypogastric artery ligation. Hypogastric artery ligation for post-partum bleeding >1 l appears to be a safe procedure that does not impair subsequent fertility and pregnancy outcomes.
Nizard
J
J
Service de Gynécologie-Obstérique et Biologie de la Reproduction, Hôpital Antoine Béclère (AP-HP), Clamart cedex, France.
Barrinque
L
L
Frydman
R
R
Fernandez
H
H
D000328:Adult; D001158:Arteries / Q000000981:diagnostic imaging; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric; D005260:Female; D005298:Fertility; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007749:Labor Stage, Third; D008026:Ligation; D011184:Postoperative Period; D006473:Postpartum Hemorrhage / Q000503:physiopathology / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography; D014599:Uterus / Q000098:blood supply