Human Reproduction, Vol. 18, No. 10, 2236-2237,
October 2003
© 2003 European Society of Human Reproduction and Embryology
Pelvic artery ligation or embolization and fertility and pregnancy
Service de Gynécologie-Obstétrique, Hôpital A.Béclère, 157, Rue de la Porte de Trivaux, 92140 Clamart cedex, France E-mail: herve.fernandez{at}abc.ap-hop-paris.fr
Dear Sir,
Thank you for the interest about our two papers concerning conservative treatment for severe post-partum haemorrhage and subsequent fertility (Nizard et al., 2003
; Salomon et al., 2003).
Obviously, one-third of these patients were referred for management of the post-partum haemorrhage. The definition used for untractable haemorrhagia was anaemia (Hb <70 g/l) associated with unstable haemodynamic state and the obstetricians’ decision that local measures were unlikely to control the haemorrhage. After embolization or artery ligation, if the transvaginal bleeding was dropwise type, we did not transfuse even if the Hb level was <70 g/l.
Moreover, it is not amazing that in a university centre, one senior surgeon performed artery ligation. Indeed, it is the only solution to teach new surgical techniques to residents and other gynaecological surgeons. The absence of liability of some senior surgeons is probably the reason that some new technologies do not develop. This criticism is rather unfortunate.
In spite of the long time between the procedure and the follow-up, which explains the number lost to follow-up, there is no bias in the data concerning the types of pregnancy that occurred.
These two articles do not reach definitive conclusions about the best management of post-partum haemorrhage. If the efficacy seems similar to absence of consequence on fertility, the recurrence of severe haemorrhage after embolization is amazing. Further studies are needed to assess this risk of recurrence.
References
Nizard, J., Barrinque, L., Frydman, R. and Fernandez, H. (2003) Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage. Hum. Reprod., 18, 844–848.
Salomon, L.J., de Tayrac, R., Castaigne-Meary, V., Audibert, F., Musset, D., Ciorascu, R., Frydman, R. and Fernandez, H. (2003) Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study. Hum. Reprod., 18, 849–852.
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