Menstrual pattern and intrauterine adhesions after transuterine suture for postpartum hemorrhage

To describe menstrual abnormalities and intrauterine adhesions within 5 years after a transuterine compression suture and uterine devascularization with hypogastric ligation.

Prospective clinical follow-up was conducted on 56 patients who underwent uterine devascularization with hypogastric ligation and transuterine suture. The main outcomes were to investigate intrauterine adhesions, menstrual pattern, and desire for subsequent pregnancy and fertility.

Among 56 cases, abnormal placental implantation was diagnosed in 30 (53.6%) (Group 1), and uterine atony was diagnosed in 26 (46.4%) (Group 2). Before pregnancy, while 2/24 patients in Group 1 and 2/23 patients in Group 2 had menstrual irregularities, after pregnancy 8/24 patients in Group 1 and 9/23 patients in Group 2 had menstrual irregularities (p = 0.03 and 0.01, respectively). Hysteroscopic examination revealed normal findings in 16 patients in Group 1 (66.6%) and 20 patients in Group 2 (86.9%) (p > or = 0.05). Among patients who had desired a future pregnancy, 2 of 4 patients (50%) in Group 1 and 4 of 5 patients (80%) in Group 2 subsequently had achieved successful pregnancies.

Transuterine compression suture and uterine devascularization with hypogastric ligation in managing postpartum hemorrhage appear to have achieved preserved fertility and, in most cases, menstrual regularity.