Does uterine artery ligation, performed because of a severe postpartum hemorrhage, alter fertility?

To the Editor:

We read with interest the case series report by Blanc et al. that highlights the risk of synechia after uterine-sparing procedures (1). The authors concluded that their “results suggest that triple ligation (TUAL), with or without haemostatic multiple square suturing (HMSS), exposes patients to the risk of subsequent abnormalities of the uterine cavity.” (1).

Regarding HMSS, we could not agree more with the authors, as we have been attempting to alert physicians to the possible hidden mid-term or long-term effects of uterine compression sutures (2–6), although these procedures were adopted promptly throughout the world.

Which surgery should be the first-line uterine-sparing procedure to control severe postpartum hemorrhage?

To the Editor:

We read with great interest the case series reported by Rathat et al, which highlights the risk of synechia after uterine compression suture (1). The authors 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 the authors, as we have been attempting to alert physicians to the possible hidden mid-term or long-term effects of uterine compression sutures (2–6), in particular in publishing our algorithm for management of postpartum hemorrhage (2, 7-8), whereas these procedures were adopted promptly throughout the world. In fact, to our knowledge, vessel ligation including uterine and/or hypogastric artery ligation seems to have no or limited impact on subsequent fertility (7). Nevertheless, we would like to highlight that surgical procedures involving uterine artery ligation (UAL), such as stepwise uterine devascularization or triple ligation (2, 4-5, 7-8), must absolutely be differentiated from hypogastric artery ligation (HAL), whereas many authors unfortunately pool these two procedures in the same entity of “vessel” (9) or “techniques” ligation (1).

Does B-Lynch suture have hidden long-term effects?

To the Editor:

We read with great interest the case reported by Goojha et al. (1), and we could not agree more with the authors regarding the necessity to adequately assess subsequent fertility following B-Lynch suture.