title: Fertility rate and subsequent pregnancy outcomes after conservative surgical techniques in postpartum hemorrhage: 15 years of literature.
abstract: OBJECTIVE
  To investigate the most appropriate surgical technique for optimizing hemostasis and preservation of subsequent fertility after postpartum hemorrhage (PPH).
  
  
  METHODS
  Systematic review of the literature.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  None.
  
  
  METHODS
  Review of MEDLINE, EMBASE, ScienceDirect, and the Cochrane Library.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy. ginecologia_padova@libero.it
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.forename: Carlo
authors.initials: C
authors.lastname: Saccardi
authors.forename: Tito Silvio
authors.initials: TS
authors.lastname: Patrelli
authors.forename: Stefania
authors.initials: S
authors.lastname: Di Gangi
authors.forename: Elisa
authors.initials: E
authors.lastname: Breda
authors.forename: Simone
authors.initials: S
authors.lastname: Fagherazzi
authors.forename: Marco
authors.initials: M
authors.lastname: Noventa
authors.forename: Donato
authors.initials: D
authors.lastname: D'Antona
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Nardelli
mesh_terms: D005260:Female; D005298:Fertility; D059247:Fertility Preservation; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006489:Hemostatic Techniques / Q000009:adverse effects*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008026:Ligation; D006473:Postpartum Hemorrhage / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000009:adverse effects