Menstrual, fertility and psychological impacts after uterine compression sutures for postpartum hemorrhage: a prospective cohort study

Objective: To evaluate subsequent menstrual, fertility and psychological outcomes after uterine compression sutures. Design: Prospective cohort study Setting: Tertiary obstetric unit (6000 deliveries per year) Population: Women with primary postpartum hemorrhage successfully treated with uterine compression sutures (n=80). Methods: Women were followed-up in postnatal clinic for two years after delivery. Subsequent pregnancies were identified by territory-wide computer registry and telephone interviews. Women with postpartum hemorrhage treated with uterotonic agents only were chosen as controls. Main outcome measures: Prevalence of menstrual abnormality, adverse pregnancy outcome and psychological disturbance. Results: In our cohort, 87.9% of women had return of menses within six months. Two Asherman’s syndrome were diagnosed. Majority of women had similar menstrual patterns as before. Among 23 subsequent pregnancies, no significant difference in outcome was demonstrated. However, more omental or bowel adhesion (37.5% vs 8.8%, p=0.007), recurrence of hemorrhage (68.8% vs 7.5%, p<0.001) and repeat compression sutures (12.5% vs 0%, p=0.024) were seen in women with previous compression sutures. Over half of the couple declined future fertility with 38.2% of women recalled unpleasant memory and 22.1% reported life-long adverse impact especially tokophobia. Conclusion: Women with history of uterine compression sutures had similar menstrual and pregnancy outcomes compared to those who did not have sutures. However, they had higher risk of visceral adhesion, recurrence of hemorrhage and repeat compression sutures next pregnancy. Couple was more susceptible to negative emotional impact. Keywords: Uterine compression sutures, B-lynch suture, Hayman suture, Cho suture, pregnancy, menstruation, fertility, psychological impact.