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Objective: To describe the shock index (SI) distribution during the first 2 hours after delivery and to evaluate its performance when measured 15 and 30 minutes after delivery for predicting postpartum haemorrhage (PPH) occurrence in the general population of parturients after vaginal delivery. Design: Secondary analysis of a multicentre randomised controlled trial testing prophylactic administration of tranexamic acid versus placebo in addition to prophylactic oxytocin to prevent PPH. Setting: 15 French maternity units in 2015–2016. Sample: 3891 women with a singleton live fetus ≥35 weeks, born vaginally. Methods: For each PPH‐related predicted outcome, we calculated the area under the receiver operating characteristic curve (AUROC) values of the SI at 15 and 30 minutes after delivery and its predictive performance for SI cut‐off values of 0.7, 0.9 and 1.1. Main outcome measures: Quantitative blood loss ≥1000 ml (QBL ≥1000 ml) measured in a graduated collector bag and provider‐assessed clinically significant PPH (cPPH). Results: Prevalence of QBL ≥1000 ml and cPPH was respectively 2.7% (104/3839) and 9.1% (354/3891). The distributions of the SI at 15 and 30 minutes after delivery were similar with a median value of 0.73 and 97th percentile of 1.11 for both. The AUROC values of the 15‐minute SI for discriminating QBL ≥1000 ml and cPPH were respectively 0.66 (lower limit of the 95% confidence interval [LCI] 0.60) and 0.56 (LCI 0.52); and for the 30‐minute SI 0.68 (LCI 0.61) and 0.49 (LCI 0.43). Conclusions: The shock index at 15 and 30 minutes after delivery did not satisfactorily predict either QBL ≥1000 ml or clinical PPH. [ABSTRACT FROM AUTHOR]

Objective: To assess the incidence and risk factors for severe postpartum haemorrhage (PPH) in women with an anterior low‐lying or praevia placenta, prior caesarean and no prenatal suspicion of placenta accreta spectrum (PAS). Design: Population‐based study in 176 maternity units in France. Population: All women with anterior low‐lying (0–19 mm from the cervical internal os) or praevia placenta, diagnosed prospectively before birth, prior caesarean and no prenatal suspicion of PAS. Methods: Multivariable logistic regression to identify risk factors for severe PPH in the main population and after exclusion of women with PAS diagnosed only at birth. Main outcome measures: Severe PPH defined by a composite criterion either estimated blood loss of ≥1500 ml, transfusion of ≥4 or more units of packed red blood cells, embolisation or surgical treatment. Results: Of the 520 114 women constituting the source population, 230 (0.44/1000 women; 95% confidence interval [CI] 0.38–0.50) met the inclusion criteria. Severe PPH rate was 24.8% (95% CI 19.2–30.4) overall, 27.5% (95% CI 21.8–33.3) in women with placenta praevia and 15.4% (95% CI 10.7–20.0) in women with low‐lying placenta. PAS was diagnosed at birth in 22 women (9.9%; 95% CI 5.8–13.4), although previously unsuspected. After their exclusion, severe PPH incidence was 17.3% (95% CI 12.4–22.2). In multivariate analysis, the only factor associated with a higher severe PPH risk was placenta previa (aOR, 3.65; 95%CI, 1.20–15.8). Conclusion: Severe PPH is frequent among women with anterior low‐lying or praevia placenta and prior caesarean, even after exclusion of women with PAS. The risk of severe PPH for those with praevia is nearly twice that with low‐lying placenta. [ABSTRACT FROM AUTHOR]

Objective: To compare the management and outcomes of women with placenta accreta spectrum (PAS) in France and the UK. Design: Two population‐based cohorts. Setting: All obstetrician‐led hospitals in the UK and maternity hospitals in eight French regions. Population: A cohort of 219 women with PAS in France and a cohort of 154 women with PAS in the UK. Methods: The management and outcomes of women with PAS were compared between the UK and France. Main outcome measures: Median blood loss, severe postpartum haemorrhage (≥3 l), postpartum infection and damage to surrounding organs. Results: The management of PAS differed between the two countries: a larger proportion of women with PAS in the UK had a caesarean hysterectomy compared with France (43% vs 26%, p < 0.001), whereas in France a larger proportion of women with PAS received a uterus‐preserving approach compared with the UK (36% vs 19%, p < 0.001). The total median blood loss in the UK was 3 l (IQR 1.7–6.5 l), compared with 1 l (IQR 0.5–2.5 l) in France; more women with PAS had a severe postpartum haemorrhage (PPH) in the UK compared with women with PAS in France (58% vs 21%, p < 0.001) [Correction added on 06 May 2022, after first online publication: '24 hour' has been changed to 'total' in the preceding sentence]. There was no difference between the UK and French populations for postpartum infection or organ damage. Conclusions: The UK and France have very different approaches to managing PAS, with more women in France receiving a uterine‐conserving approach and more women in the UK undergoing caesarean hysterectomy. A life‐threatening haemorrhage was more common in the UK than in France, which may be the result of differential management and/or the organisation of the healthcare systems. In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France. In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France. In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France. Linked article: This article is commented on by Amarnath Bhide, pp. 1686 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17170. [ABSTRACT FROM AUTHOR]

Introduction: Management options for women with placenta accreta spectrum (PAS) comprise termination of pregnancy before the viable gestational age, leaving the placenta in situ for subsequent reabsorption of the placenta or delayed hysterectomy, manual removal of placenta after vaginal delivery or during cesarean section, focal resection of the affected uterine wall, and peripartum hysterectomy. The aim of this observational study was to describe actual clinical management and outcomes in PAS in a large international cohort.Material and Methods: Data from women in 15 referral centers of the International Society of PAS (IS-PAS) were analyzed and correlated with the clinical classification of the IS-PAS: From Grade 1 (no PAS) to Grade 6 (invasion into pelvic organs other than the bladder). PAS was usually diagnosed antenatally and the operators performing ultrasound rated the likelihood of PAS on a Likert scale of 1 to 10.Results: In total, 442 women were registered in the database. No maternal deaths occurred. Mean blood loss was 2600 mL (range 150-20 000 mL). Placenta previa was present in 375 (84.8%) women and there was a history of a previous cesarean in 329 (74.4%) women. The PAS likelihood score was strongly correlated with the PAS grade (P < .001). The mode of delivery in the majority of women (n = 252, 57.0%) was cesarean hysterectomy, with a repeat laparotomy in 20 (7.9%) due to complications. In 48 women (10.8%), the placenta was intentionally left in situ, of those, 20 (41.7%) had a delayed hysterectomy. In 26 women (5.9%), focal resection was performed. Termination of pregnancy was performed in 9 (2.0%), of whom 5 had fetal abnormalities. The placenta could be removed in 90 women (20.4%) at cesarean, and in 17 (3.9%) after vaginal delivery indicating mild or no PAS. In 34 women (7.7%) with an antenatal diagnosis of PAS, the placenta spontaneously separated (false positives). We found lower blood loss (P < .002) in 2018-2019 compared with 2009-2017, suggesting a positive learning curve.Conclusions: In referral centers, the most common management for severe PAS was cesarean hysterectomy, followed by leaving the placenta in situ and focal resection. Prenatal diagnosis correlated with clinical PAS grade. No maternal deaths occurred. [ABSTRACT FROM AUTHOR]

Objective: To evaluate prenatal ultrasound parameters as prognostic factors for complex and vanishing gastroschisis.Methods: Retrospective multicentre study of 200 gastroschisis over 13 years (2000-2013). Collection of prenatal ultrasound evaluation on maternal and fetal growth parameters, intra- and extra-abdominal bowel and stomach dilation, abdominal wall defect diameter and changes in bowel appearance. Correlation of these factors with the presence of mechanical intestinal complications at birth, named 'complex gastroschisis'.Results: Fifty-two patients (26%) had complex gastroschisis (CG), including ten vanishing gastroschisis. The presence of intra-abdominal bowel dilation at the second (T2) or third (T3) trimester ultrasound was predictive for CG, with odds ratios at 6.69 (95%CI 2.41-18.55) and 4.72 (95%CI 2.16-10.28), respectively, with a cut-off value at the last examination of >19 mm. A small abdominal wall defect diameter was also predictive for CG, with cut-off values of <9.2 mm at T2 and <12.5 mm at T3. Vanishing gastroschisis recorded earlier intra-abdominal bowel dilation diagnosis, associated with a small wall defect and no extra-abdominal dilation.Conclusion: Intra-abdominal bowel dilation and a small abdominal wall defect diameter accurately predict CG and could be a first sign of vanishing gastroschisis when they occur early. © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of the tension-free vaginal tape (TVT) procedure on the sexual function of women who underwent this treatment for stress urinary incontinence (SUI).Method: The Lemack questionnaire was mailed to 135 women treated for SUI only, with no concomitant pelvic organ prolapse repair.Results: Of the 82 returned questionnaires (60.7%), 66 (80.5%) could be included in the analysis. Compared with preoperative responses, there were no significant postoperative changes regarding frequency of sexual intercourse, satisfaction with sexual intercourse, or personal importance of having an active sexual life. Although there was a significant postsurgical decrease in urinary coital incontinence (P=0.02) and 12 women (25.5%) reported improved satisfaction from intercourse, 11 women (23.4%) complained of a worsening.Conclusion: These results suggest that TVT for SUI does not significantly affect sexual function in women. Additional prospective studies are warranted to verify these preliminary findings and compare the impact of the TVT with that of other anti-incontinence procedures. [ABSTRACT FROM AUTHOR]

Objective To evaluate maternal outcomes following uterine balloon tamponade in the management of postpartum hemorrhage. Design Retrospective case-series. Setting Two French hospitals, a level 3 university referral center and a level 2 private hospital. Population All women who underwent balloon tamponade treatment for primary postpartum hemorrhage. Methods Uterine tamponade was used after standard treatment of postpartum hemorrhage had failed. The study population was divided into two groups, successful cases where the bleeding stopped after the balloon tamponade, and failures requiring subsequent surgery or embolization. Main outcome measures Success rates. Results Uterine tamponade was used in 49 women: 30 (61%) after vaginal delivery and 19 (39%) after cesarean section. Uterine atony was the main cause of hemorrhage (86%). The overall success rate was 65%. Of 17 failures, surgery was required in 16 cases, including hysterectomy in 11, and uterine artery embolization in one case. Demographic and obstetric characteristics did not differ significantly between the success and failure groups. No complications were directly attributed to the balloon tamponade in the postpartum period. Two women had a subsequent full-term pregnancy without recurrence of postpartum hemorrhage. Conclusions Balloon tamponade is an effective, safe and readily available method for treating primary postpartum hemorrhage and could reduce the need for invasive procedures. [ABSTRACT FROM AUTHOR]

Cesarean hysterectomy is considered the reference standard treatment for placenta accreta. In young women who want the option of future pregnancy and agree to close follow-up monitoring, conservative treatment is a valid option. Several key points of both cesarean hysterectomy and conservative treatment remain debatable, such as timing of delivery, attempted removal of the placenta, use of temporal internal iliac occlusion balloon catheters, ureteral stents, prophylactic embolization, and methotrexate. In cases of placenta percreta with bladder involvement, conservative treatment may be the optimal management. Regardless of the chosen option, the woman and her partner should be warned of the high risk of maternal complications related to an abnormally invasive placenta. [ABSTRACT FROM AUTHOR]

Objective. To estimate the long-term psychological impact of severe postpartum hemorrhage in women whose uterus was preserved. Design. Retrospective study. Setting. University-affiliated tertiary referral center. Population. All consecutive women who underwent embolization for postpartum hemorrhage between 1994 and 2007 and whose uterus was preserved were included. Methods. Data were retrieved from medical files and semi-structured telephone interviews. In semi-structured interviews, women were asked about their perceptions and memories of the experience. Main Outcome Measures. Perceptions and memories of the postpartum hemorrhage during and after delivery. Results. Follow-up was successful for 68 of the 91 (74.7%) women included. Of the 46 (67.6%) who reported negative memories of the delivery and postpartum period, the main memory for 24 was a fear of dying (35.3%). Of the 28 (41.2%) who reported continued repercussions, 16 (23.5%) thought about this delivery and its complications at least once a month, five (7.3%) reported persistent fear of dying, four (5.9%) reported sexual problems, and three (4.4%) women considered that the event was, at least in part, responsible for their subsequent divorce. Of the 15 women who had a subsequent full-term pregnancy, nine (60%) reported intense anxiety throughout the pregnancy, and one (6.7%) developed depression requiring antidepressant treatment during pregnancy. Conclusions. Severe postpartum hemorrhage may have a long-term psychological impact on women despite uterine preservation. [ABSTRACT FROM AUTHOR]

Objective. Evaluate the efficacy of a transobturator subvesical mesh for cystocele in concomitant stress urinary incontinence (SUI). Design. Longitudinal observational study. Setting. Tertiary referral urogynecology center. Population. One hundred and five women with at least an anterior vaginal wall prolapse and concomitant SUI who underwent surgery. Methods. After reduction of prolapse elements, the intervention consisted of a non-absorbable monoprosthesis placement with two transobturator expansions and, if necessary, associated hysterectomy or infraccocygeal sacropexy. No specific procedure was performed for SUI. Main outcome measures. All patients had a physical examination and a subjective symptoms assessment via questionnaire in the preoperative period and at one-year or more after surgery. The pelvic organ prolapse quantification system was used for anatomical results. For SUI, Ingelman-Sundberg classification and cough test were used. Loss of urine was measured by a one-hour pad test. Functional results were evaluated by visual analog scale, quality-of-life questionnaires, including the pelvic floor distress inventory and the pelvic floor impact questionnaire. Results. Median follow-up was 45 months (range: 12–72). A total of 102 women (97%) were cured of their prolapse, of whom 72 (69%) were cured of their SUI and 13 (12%) showed improvement. Pad test, visual analogic scale and quality-of-life questionnaires were all improved ( p < 0.05). Complications consisted of one rectal injury, one transitory urinary retention, and two hematomas. Of the erosions 6% was observed for monofilament polypropylene prostheses. Conclusion. Transvaginal monoprosthesis for the simultaneous correction of prolapse and SUI represents an effective treatment for bulky or recurrent prolapse as well as posthysterectomy vaginal vault prolapse. [ABSTRACT FROM AUTHOR]

Objective. To estimate the effectiveness and safety of the B-Lynch suture for severe persistent postpartum hemorrhage (PPH) following vessel ligation before considering hysterectomy and its impact on menstruation and uterine cavity. Design. Cohort study. Setting. University-affiliated tertiary referral center. Population. Fifteen consecutive women who underwent B-Lynch suture for persistent PPH despite vessel ligation. Methods. Data were retrieved from medical files and telephone interviews. Main outcome measure(s). Hysterectomy, infection, hysteroscopy, future menstruations. Results. In 13 of the 15 cases (86.7%), PPH occurred after cesarean deliveries. B-Lynch sutures controlled the hemorrhage and resulted in an avoidance of immediate hysterectomy in 12 of 15 cases (80%). The postpartum period was uneventful for 14 of 15 women (93.3%). In one case hysterectomy was required due to pyometra in an ischemic uterus. In the remaining 11 women where the uterus was preserved, ambulatory hysteroscopy was normal. No women reported any differences in menses or pain compared to that they experienced before pregnancy, or any clinical symptoms of early menopause. One woman reported a subsequent pregnancy with normal conception delay, whereas the ten remaining women had no desired pregnancy due to, in each case, the fear of PPH recurrence. Conclusions. B-Lynch technique appears to be an effective procedure with a relatively low morbidity to control persistent severe PPH following a failure of vessel ligation before considering hysterectomy. [ABSTRACT FROM AUTHOR]

Background. To compare neonatal and maternal outcomes for breech first twins according to whether vaginal or cesarean delivery was planned and to verify that in appropriate selected cases, attempted vaginal delivery is a reasonable choice. Methods. A retrospective study of all twin pregnancies with the first twin in breech position and gestational age at least 35 weeks at birth at two French university hospital centers from January 1994 through December 2000. The primary outcome was a combined indicator of neonatal mortality and severe morbidity, as defined by one or more of the following: death before discharge, admission to neonatal intensive care unit, 5-minute Apgar score <7, cord blood pH <7.10, or birth trauma. Results. Cesarean delivery was planned for 71 (36.4%) patients, and attempted vaginal delivery for 124 (63.6%), 59 (47.6%) of whom were delivered vaginally and 65 (52.4%) by cesarean during labor. Neither the combined negative outcome indicator nor neonatal mortality differed significantly for either twin or either group. There were no significant differences in maternal mortality or morbidity between the two groups. The frequency of deep vein thrombophlebitis or pulmonary embolism requiring anticoagulant therapy was significantly higher in the planned cesarean group [3/71 (4.2%) versus 0/124; p=0.047]. Conclusion. When appropriate criteria are used to decide mode of delivery, a careful intrapartum protocol is followed, and an experienced obstetrician, midwife, and anesthesiologist are in attendance, attempted vaginal delivery is a reasonable option for first twins in breech position. [ABSTRACT FROM AUTHOR]

A reply by Loïc Sentilhes et al to letter to the editor about their article "B-Lynch suture for massive persistent postpartum hemorrhage following stepwise uterine devascularization," in the 2008;87 issue is presented.

Introduction Material and Methods Results Conclusions Placenta accreta spectrum (PAS) can lead to major peripartum morbidity. Appropriate management approaches depend on the clinical severity, each individual's preference, and the treating team's expertise. Peripartum hysterectomy is the most frequently used treatment option. However, it can impact psychological well‐being and fertility. We investigated whether conservative treatment with focal resection or leaving the placenta in situ is associated with comparable or lower maternal morbidity than hysterectomy in centers of excellence within the International Society for placenta accreta spectrum (IS‐PAS). Furthermore, a survey was conducted to explore potential barriers to conservative management in antenatal counseling and intraoperative decision‐making.Confirmed PAS cases in the prospective IS‐PAS database from 22 registered centers between January 2020 and June 2022 were included in the analysis. A separate online survey with 21 questions was answered by the IS‐PAS center experts about indications, diagnostic criteria, patient counseling, surgical practice, changes from the preoperative treatment plan, and why conservative management may not be offered.A total of 234 cases were included in the analysis: 186 women received hysterectomy and 38 women were treated by focal resection, and 10 by leaving the placenta in situ. Blood loss was lower in the focal resection group and in the placenta in situ group compared to the hysterectomy group (p = 0.04). 46.4% of the women initially planned for focal resection, and 35.7% of those initially planned for leaving the placenta in situ were ultimately treated by hysterectomy. Our survey showed that the IS‐PAS centers preferred hysterectomy according to a woman's wishes (64%) and when they expected less blood loss and morbidity (41%). Eighteen percent of centers did not offer focal resection at all due to a lack of experience with this technique. Reasons for not offering to leave the placenta in situ were avoidance of unexpected reoperation (36%), puerperal infection (32%), or skepticism about the method (23%).Uterus‐preserving treatment strategies such as focal resection appear to be safe alternatives to peripartum hysterectomy. However, less than half of the IS‐PAS centers perform them. Acceptance of conservative treatments could be increased by standardized criteria for their implementation and by systematic training for PAS experts. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Tranexamic acid for preventing postpartum blood loss after cesarean delivery: a systematic review and meta-analysis of randomized controlled trials" by G. Simonazzi and colleagues, in a 2016 issue.

The article presents a case study on a 33-year-old woman who is seven weeks pregnant. It is noted that the patient had a full term delivery in 2004 and has complained from abdominal cramps. An ultrasound diagnosis of the bilateral tubal pregnancy is conducted on the patient revealing an empty uterus and two gestational sacs.

Objective: To describe the shock index (SI) distribution during the first 2 hours after delivery and to evaluate its performance when measured 15 and 30 minutes after delivery for predicting postpartum haemorrhage (PPH) occurrence in the general population of parturients after vaginal delivery., Design: Secondary analysis of a multicentre randomised controlled trial testing prophylactic administration of tranexamic acid versus placebo in addition to prophylactic oxytocin to prevent PPH., Setting: 15 French maternity units in 2015-2016., Sample: 3891 women with a singleton live fetus ≥35 weeks, born vaginally., Methods: For each PPH-related predicted outcome, we calculated the area under the receiver operating characteristic curve (AUROC) values of the SI at 15 and 30 minutes after delivery and its predictive performance for SI cut-off values of 0.7, 0.9 and 1.1., Main Outcome Measures: Quantitative blood loss ≥1000 ml (QBL ≥1000 ml) measured in a graduated collector bag and provider-assessed clinically significant PPH (cPPH)., Results: Prevalence of QBL ≥1000 ml and cPPH was respectively 2.7% (104/3839) and 9.1% (354/3891). The distributions of the SI at 15 and 30 minutes after delivery were similar with a median value of 0.73 and 97th percentile of 1.11 for both. The AUROC values of the 15-minute SI for discriminating QBL ≥1000 ml and cPPH were respectively 0.66 (lower limit of the 95% confidence interval [LCI] 0.60) and 0.56 (LCI 0.52); and for the 30-minute SI 0.68 (LCI 0.61) and 0.49 (LCI 0.43)., Conclusions: The shock index at 15 and 30 minutes after delivery did not satisfactorily predict either QBL ≥1000 ml or clinical PPH., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Objective: To assess the incidence and risk factors for severe postpartum haemorrhage (PPH) in women with an anterior low-lying or praevia placenta, prior caesarean and no prenatal suspicion of placenta accreta spectrum (PAS)., Design: Population-based study in 176 maternity units in France., Population: All women with anterior low-lying (0-19 mm from the cervical internal os) or praevia placenta, diagnosed prospectively before birth, prior caesarean and no prenatal suspicion of PAS., Methods: Multivariable logistic regression to identify risk factors for severe PPH in the main population and after exclusion of women with PAS diagnosed only at birth., Main Outcome Measures: Severe PPH defined by a composite criterion either estimated blood loss of ≥1500 ml, transfusion of ≥4 or more units of packed red blood cells, embolisation or surgical treatment., Results: Of the 520 114 women constituting the source population, 230 (0.44/1000 women; 95% confidence interval [CI] 0.38-0.50) met the inclusion criteria. Severe PPH rate was 24.8% (95% CI 19.2-30.4) overall, 27.5% (95% CI 21.8-33.3) in women with placenta praevia and 15.4% (95% CI 10.7-20.0) in women with low-lying placenta. PAS was diagnosed at birth in 22 women (9.9%; 95% CI 5.8-13.4), although previously unsuspected. After their exclusion, severe PPH incidence was 17.3% (95% CI 12.4-22.2). In multivariate analysis, the only factor associated with a higher severe PPH risk was placenta previa (aOR, 3.65; 95%CI, 1.20-15.8)., Conclusion: Severe PPH is frequent among women with anterior low-lying or praevia placenta and prior caesarean, even after exclusion of women with PAS. The risk of severe PPH for those with praevia is nearly twice that with low-lying placenta., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Objective: To compare the management and outcomes of women with placenta accreta spectrum (PAS) in France and the UK., Design: Two population-based cohorts., Setting: All obstetrician-led hospitals in the UK and maternity hospitals in eight French regions., Population: A cohort of 219 women with PAS in France and a cohort of 154 women with PAS in the UK., Methods: The management and outcomes of women with PAS were compared between the UK and France., Main Outcome Measures: Median blood loss, severe postpartum haemorrhage (≥3 l), postpartum infection and damage to surrounding organs., Results: The management of PAS differed between the two countries: a larger proportion of women with PAS in the UK had a caesarean hysterectomy compared with France (43% vs 26%, p < 0.001), whereas in France a larger proportion of women with PAS received a uterus-preserving approach compared with the UK (36% vs 19%, p < 0.001). The total median blood loss in the UK was 3 l (IQR 1.7-6.5 l), compared with 1 l (IQR 0.5-2.5 l) in France; more women with PAS had a severe postpartum haemorrhage (PPH) in the UK compared with women with PAS in France (58% vs 21%, p < 0.001) [Correction added on 06 May 2022, after first online publication: '24 hour' has been changed to 'total' in the preceding sentence]. There was no difference between the UK and French populations for postpartum infection or organ damage., Conclusions: The UK and France have very different approaches to managing PAS, with more women in France receiving a uterine-conserving approach and more women in the UK undergoing caesarean hysterectomy. A life-threatening haemorrhage was more common in the UK than in France, which may be the result of differential management and/or the organisation of the healthcare systems. In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France., Tweetable Abstract: In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France., (© 2022 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Objectives: To determine and compare the fertility and pregnancy outcomes following embolisation with or without uterine-sparing surgery for postpartum haemorrhage, and to attempt to identify specific risk factors associated with an increased likelihood of intrauterine synechia., Design: Retrospective study., Setting: University-affiliated tertiary referral centre., Population: All consecutive women who had an embolisation with or without uterine-sparing surgery (vessel ligation and/or uterine compression) for postpartum haemorrhage between 1994 and 2007 were included., Methods: Data were retrieved from medical files and telephone interviews., Main Outcome Measure(s): Fertility and pregnancy outcomes, synechia., Results: Data were available for 68 of the 85 women (80%) included in the study. Among the 15 women who complained of amenorrhoea or decreased flow of menstruation, synechia was found in all those who decided to undergo an ambulatory hysteroscopy (n = 8). Seventeen women had 26 pregnancies with 19 term deliveries, one ectopic pregnancy, two abortions and four miscarriages. The clinical courses of the 19 complete gestations were uneventful, but postpartum haemorrhage recurred in six women (31.6%) (caused by placenta accreta in two women). Fertility and pregnancy outcomes did not differ between women who had undergone embolisation versus both embolisation and a uterine-sparing surgical procedure. The occurrence of synechia was significantly associated with a higher rate of placenta accreta/percreta (P < 0.001) and postpartum fever above 38.5 degrees C (P = 0.04)., Conclusions: Embolisation, whether or not associated with a uterine-sparing surgical procedure, for postpartum haemorrhage does not appear to compromise a woman's subsequent fertility and obstetric outcome. Nevertheless, these women should be considered at high risk for postpartum haemorrhage during future deliveries.