Bilateral Uterine Artery Ligation After Intrapartum or Postpartum Hemorrhage on Ovarian Reserve Markers and Pregnancy Outcome

Study Overview
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Brief Summary
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The aim of this study is to assess the possible negative effects of uterine artery ligation on ovarian reserve markers and subsequent pregnancy outcomes

Detailed Description
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One of the most common surgical methods for preserving fertility is uterine artery ligation. It is simple to do and effective at reducing Postpartum hemorrhage after delivery . Additionally, it is rather safe and permits future childbearing for the patients.

Official Title
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The Effect of Bilateral Uterine Artery Ligation After Intrapartum or Postpartum Hemorrhage on Ovarian Reserve Markers and Pregnancy Outcome

Conditions
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Bilateral Uterine Artery Ligation, Intrapartum or Postpartum Hemorrhage, Ovarian Reserve Markers, Pregnancy Outcome

Intervention / Treatment
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* Procedure: Bilateral uterine artery ligation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 120 females aged from 20 to 35 years old with Postpartum hemorrhage or intrapartum hemorrhage after cesarean section did not respond to medical therapy performed successful bilateral uterine artery ligation for hemorrhage management. Exclusion Criteria: The presence of male factor or tubal factor. Hypertension, autoimmune disease, morbid obesity, absence of lactation diabetes millets, vascular disease, smoking or the use of alcohol. The presence of additional surgery or medical disease. Detection of a uterine anomaly, history of intrauterine growth restriction in previous pregnancies. Usage of a hormonal therapy through the research.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| control group<br>underwent normal cesarean section without Postpartum hemorrhage after delivery | Procedure: Bilateral uterine artery ligation<br>* Bilateral UAL was done 2 cm under the Kerr incision (lower segment transverse). A 2-Vicryl absorbable suture (Ethicon, Neuilly-surSeine, France) was introduced from the anterior to posterior views of the myometrium 2-3 cm medial to the descending part of the uterine vessels within an avascular area in the broad ligament and tied. Following the surgery, the uterine tone and hemorrhage were managed.<br>|
| case group<br>cases underwent bilateral uterine artery ligation after Postpartum hemorrhage or Intrapartum hemorrhage after cesarean section. | Procedure: Bilateral uterine artery ligation<br>* Bilateral UAL was done 2 cm under the Kerr incision (lower segment transverse). A 2-Vicryl absorbable suture (Ethicon, Neuilly-surSeine, France) was introduced from the anterior to posterior views of the myometrium 2-3 cm medial to the descending part of the uterine vessels within an avascular area in the broad ligament and tied. Following the surgery, the uterine tone and hemorrhage were managed.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ovarian reserve by anti-mullerian hormone | Anti-mullerian hormone (AMH) level will be determined using a two-sided immunoassay that will be enzymatically amplified (ELISA). AMH was recorded at 6, 12 and 24 months after bilateral uterine artery ligation. | 24 months after bilateral uterine artery ligation. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ovarian reserve by follicle stimulating hormone | follicle stimulating hormone (FSH) level will be determined using a two-sided immunoassay that will be enzymatically amplified (ELISA). FSH was recorded at 6, 12 and 24 months after bilateral uterine artery ligation. | 24 months after bilateral uterine artery ligation. | 
| Ovarian reserve by antral follicle counts | antral follicle counts were recorded at 6, 12 and 24 months after bilateral uterine artery ligation. | 24 months after bilateral uterine artery ligation. | 
| Percent of subsequent pregnancy cases | patients were asked about their desire for pregnancy in the future The data of subsequent pregnancy cases following bilateral UAL primary were recorded and follow-up was done at 6, 12 and 24 months after BUAL. | 24 months after bilateral uterine artery ligation. |