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A report from #BlueJC: Fertility implications following the surgical management of postpartum haemorrhage

Paper discussed:

Doumouchtsis S, Nikolopoulos K, Talaulikar VS, Krishna A, Arulkumaran S. Menstrual and fertility outcomes following surgical management of postpartum haemorrhage: a systematic review. BJOG 2014;121:382–388.

Location: Twitter and RCOG Annual Academic Conference 2013 Number of participants: 21

Start date of journal club: 16 December 2013 Number of tweets: 88

Paper summary

Participants Women who had severe postpartum haemorrhage (PPH), defined as estimated blood loss of more than 1 litre
Intervention Radiological or conservative surgical interventions for severe PPH
Comparison Not applicable
Outcomes Menstrual and fertility outcomes
Study design Systematic review of observational studies
Findings Most women do not have long-term adverse menstrual and fertility outcomes. Complications of infection and synechiae have been described after uterine compression techniques

Research literacy

Adequacy of search strategy

Twenty-eight studies were quoted in this review. The search strategy was comprehensive with no language restriction. References of the included studies were also screened for further eligible studies.

Controversies
Details of the included studies were not comprehensive

The review did not assess quality of the studies included, although a brief description of the type of study was available on the supplementary tables electronically. Similar systematic reviews should include quality assessment of the included studies (Sanderson S, Tatt ID, Higgins JP. International Journal of Epidemiology 2007;36:666–76). It was unclear whether data extracted from the included studies were prospectively or retrospectively collected. Moreover, no potential confounders were examined. This has made interpretation of the validity of reported results difficult.

Differences in fertility outcomes between studies and techniques

A trend towards lower pregnancy rates after uterine artery embolisation (UAE) than with surgical ligation was observed. The reason behind the observed differences is unclear. However, a randomised controlled trial comparing UAE and surgical ligation for severe PPH will require 850 participants.

Take home messages

This review confirmed pregnancy could be achieved in a high proportion of patients after conservative surgical management of PPH. However, potential differences in fertility outcomes between different techniques and other confounders have yet to be thoroughly investigated. The strength of the evidence was limited by the quality and power of the available studies.

Acknowledgements

We are grateful for all contributions to this journal club. Storify summary and a list of contributors can be viewed at http://bit.ly/1cGv2PW. The Altmetric summary of the discussed paper can be viewed at http://bit.ly/197Ft4l.

  • EYL Leung & JP Daniels

  • Women's Health Research Unit, Queen Mary, University of London, London, UK

  • Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK

About #BlueJC: Regular #BlueJC starts on the last Wednesday of each month (except December). For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Further information is available on www.BJOG.org. Follow @BlueJCHost on Twitter to receive update #BlueJC news. Queries should be sent to bjog@rcog.org.uk or @BlueJCHost.