Reply of the Authors

Abstract

We are writing in reply to the comments raised by Dr. Sentilhes on our recently published article (1Rathat G. Do Trinh P. Mercier G. Reyftmann L. Dechanet C. Boulot P. et al.Synechia after uterine compression sutures.Fertil Steril. 2011; 95: 405-409Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar). We much appreciate the remarks made by a team who have been working on surgical treatment to control severe postpartum hemorrhage and especially on uterine-sparing procedures (2Sentilhes L. Gromez A. Trichot C. Ricbourg-Schneider A. Descamps P. Marpeau L. Fertility after B-lynch suture and stepwise uterine devascularization.Fertil Steril. 2009; 91 (934.e5 Trinh 9)Google Scholar, 3Sentilhes L. Marpeau L. Descamps P. Does B-Lynch suture have hidden long-term effects?.Fertil Steril. 2010; 94: e62Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar). Our purpose was mostly to highlight the potential mid- and long-term effects of uterine compression sutures on fertility.Regarding vessel ligation procedures, we agree with the investigators on their analysis of the literature on the slightest impact on fertility (4O’Leary J.A. Pregnancy following uterine artery ligation.Obstet Gynecol. 1980; 55: 112-113PubMed Google Scholar, 5Fahmy K. Uterine artery ligation to control postpartum hemorrhage.Int J Gynaecol Obstet. 1987; 25: 363-367Abstract Full Text PDF PubMed Scopus (41) Google Scholar, 6Sentilhes L. Trichot C. Resch B. Sergent F. Roman H. Marpeau L. et al.Fertility and pregnancy outcomes following uterine devascularization for severe postpartum haemorrhage.Hum Reprod. 2008; 23: 1087-1092Crossref PubMed Scopus (77) Google Scholar, 7Nizard J. Barrinque L. Frydman R. Fernandez H. Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage.Hum Reprod. 2003; 18: 844-848Crossref PubMed Scopus (89) Google Scholar). We also believe that we should start with uterine artery ligation, which is much easier to perform.But, concerning the stepwise devascularization (8AbdRabbo S.A. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus.Am J Obstet Gynecol. 1994; 171: 694-700Abstract Full Text PDF PubMed Google Scholar), our thinking is quite different. This surgical process must absolutely be differentiated from Tsirulnikov’s triple ligation (9Tsirulnikov M.S. Ligation of the uterine vessels during obstetrical hemorrhages. Immediate and long-term results [author’s translation].J Gynecol Obstet Biol Reprod. 1979; 8: 751-753PubMed Google Scholar) or hypogastric artery ligation. The Tsirulnikov procedure (9Tsirulnikov M.S. Ligation of the uterine vessels during obstetrical hemorrhages. Immediate and long-term results [author’s translation].J Gynecol Obstet Biol Reprod. 1979; 8: 751-753PubMed Google Scholar) combines uterine artery ligation, round ligament ligation, and utero-ovarian ligament ligation, preserving ovarian vascularization by the integrity of the suspensory ligament of the ovary.In stepwise devascularization, as describe by AdbRabbo (8AbdRabbo S.A. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus.Am J Obstet Gynecol. 1994; 171: 694-700Abstract Full Text PDF PubMed Google Scholar), ovarian vascularization is interrupted by ligation: uterine artery and suspensory ligament of ovary. No studies have evaluated ovarian function by anti-Müllerian hormone plasma level or antral follicle count by ultrasound after this type of procedure, which, if anatomy was not to change, leads to ovarian ischemia. In addition, in a study by Sentilhes et al. (6Sentilhes L. Trichot C. Resch B. Sergent F. Roman H. Marpeau L. et al.Fertility and pregnancy outcomes following uterine devascularization for severe postpartum haemorrhage.Hum Reprod. 2008; 23: 1087-1092Crossref PubMed Scopus (77) Google Scholar), 2 of 12 patients (17%) had menopausal status after treatment by stepwise devascularization, as regularly described from AbdRabbo (8AbdRabbo S.A. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus.Am J Obstet Gynecol. 1994; 171: 694-700Abstract Full Text PDF PubMed Google Scholar) (uterine artery ligation and suspensory ligament of ovary ligation). Therefore, in our practice, we use the Tsirulnikov (9Tsirulnikov M.S. Ligation of the uterine vessels during obstetrical hemorrhages. Immediate and long-term results [author’s translation].J Gynecol Obstet Biol Reprod. 1979; 8: 751-753PubMed Google Scholar) procedure in the first attempt. In case of failure, we prefer hypogastric artery ligation to stepwise devascularization, because it preserves ovarian vascularization by the integrity of the suspensory ligament of ovary.Finally, we try uterine compression sutures, therefore if hemostatic hysterectomy is needed, ovarian function will still be preserved. We are writing in reply to the comments raised by Dr. Sentilhes on our recently published article (1Rathat G. Do Trinh P. Mercier G. Reyftmann L. Dechanet C. Boulot P. et al.Synechia after uterine compression sutures.Fertil Steril. 2011; 95: 405-409Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar). We much appreciate the remarks made by a team who have been working on surgical treatment to control severe postpartum hemorrhage and especially on uterine-sparing procedures (2Sentilhes L. Gromez A. Trichot C. Ricbourg-Schneider A. Descamps P. Marpeau L. Fertility after B-lynch suture and stepwise uterine devascularization.Fertil Steril. 2009; 91 (934.e5 Trinh 9)Google Scholar, 3Sentilhes L. Marpeau L. Descamps P. Does B-Lynch suture have hidden long-term effects?.Fertil Steril. 2010; 94: e62Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar). Our purpose was mostly to highlight the potential mid- and long-term effects of uterine compression sutures on fertility. Regarding vessel ligation procedures, we agree with the investigators on their analysis of the literature on the slightest impact on fertility (4O’Leary J.A. Pregnancy following uterine artery ligation.Obstet Gynecol. 1980; 55: 112-113PubMed Google Scholar, 5Fahmy K. Uterine artery ligation to control postpartum hemorrhage.Int J Gynaecol Obstet. 1987; 25: 363-367Abstract Full Text PDF PubMed Scopus (41) Google Scholar, 6Sentilhes L. Trichot C. Resch B. Sergent F. Roman H. Marpeau L. et al.Fertility and pregnancy outcomes following uterine devascularization for severe postpartum haemorrhage.Hum Reprod. 2008; 23: 1087-1092Crossref PubMed Scopus (77) Google Scholar, 7Nizard J. Barrinque L. Frydman R. Fernandez H. Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage.Hum Reprod. 2003; 18: 844-848Crossref PubMed Scopus (89) Google Scholar). We also believe that we should start with uterine artery ligation, which is much easier to perform. But, concerning the stepwise devascularization (8AbdRabbo S.A. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus.Am J Obstet Gynecol. 1994; 171: 694-700Abstract Full Text PDF PubMed Google Scholar), our thinking is quite different. This surgical process must absolutely be differentiated from Tsirulnikov’s triple ligation (9Tsirulnikov M.S. Ligation of the uterine vessels during obstetrical hemorrhages. Immediate and long-term results [author’s translation].J Gynecol Obstet Biol Reprod. 1979; 8: 751-753PubMed Google Scholar) or hypogastric artery ligation. The Tsirulnikov procedure (9Tsirulnikov M.S. Ligation of the uterine vessels during obstetrical hemorrhages. Immediate and long-term results [author’s translation].J Gynecol Obstet Biol Reprod. 1979; 8: 751-753PubMed Google Scholar) combines uterine artery ligation, round ligament ligation, and utero-ovarian ligament ligation, preserving ovarian vascularization by the integrity of the suspensory ligament of the ovary. In stepwise devascularization, as describe by AdbRabbo (8AbdRabbo S.A. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus.Am J Obstet Gynecol. 1994; 171: 694-700Abstract Full Text PDF PubMed Google Scholar), ovarian vascularization is interrupted by ligation: uterine artery and suspensory ligament of ovary. No studies have evaluated ovarian function by anti-Müllerian hormone plasma level or antral follicle count by ultrasound after this type of procedure, which, if anatomy was not to change, leads to ovarian ischemia. In addition, in a study by Sentilhes et al. (6Sentilhes L. Trichot C. Resch B. Sergent F. Roman H. Marpeau L. et al.Fertility and pregnancy outcomes following uterine devascularization for severe postpartum haemorrhage.Hum Reprod. 2008; 23: 1087-1092Crossref PubMed Scopus (77) Google Scholar), 2 of 12 patients (17%) had menopausal status after treatment by stepwise devascularization, as regularly described from AbdRabbo (8AbdRabbo S.A. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus.Am J Obstet Gynecol. 1994; 171: 694-700Abstract Full Text PDF PubMed Google Scholar) (uterine artery ligation and suspensory ligament of ovary ligation). Therefore, in our practice, we use the Tsirulnikov (9Tsirulnikov M.S. Ligation of the uterine vessels during obstetrical hemorrhages. Immediate and long-term results [author’s translation].J Gynecol Obstet Biol Reprod. 1979; 8: 751-753PubMed Google Scholar) procedure in the first attempt. In case of failure, we prefer hypogastric artery ligation to stepwise devascularization, because it preserves ovarian vascularization by the integrity of the suspensory ligament of ovary. Finally, we try uterine compression sutures, therefore if hemostatic hysterectomy is needed, ovarian function will still be preserved. Which surgery should be the first-line uterine-sparing procedure to control severe postpartum hemorrhage?Fertility and SterilityVol. 95Issue 8PreviewWe read with great interest the case series reporting by Rathat et al. (1), which highlights the risk of synechia after uterine compression suture. The investigators concluded that “even though ligation techniques require more surgical experience, we think that they should be the first choice for surgical management” (1). We could not agree more with them as we have been attempting to alert physicians to the possible hidden midterm or long-term effects of uterine compression sutures (2–6), in particular in publishing our algorithm for management of postpartum hemorrhage (2, 7, 8), while these procedures were adopted promptly throughout the world. Full-Text PDF