The effect of three pairs of uterine vessels ligation on uterine and ovarian blood supply in patients with pathological blood loss

Introduction. To stop obstetric bleeding, organ-preserving surgical methods are used, one of which is ligation of three-layered uterine vessels. The effectiveness of organ-preserving methods comprises up to 94 %. The function of any organ depends on proper blood supply, and therefore the state of the reproductive function in women undergone organ-preserving operations is an object for further investigation.

Aim: study of blood flow in the uterus and ovaries after ligation of three pairs of uterine vessels in women with pathological blood loss.

Materials and Methods. A prospective controlled study was conducted that included main group (41 patients after ligation of three pairs of uterine vessels due to pathological blood loss during operative delivery) and control group (25 women after cesarean section without pathological blood loss and ligation of three pairs of uterine vessels). Doppler study of uterine arteries and central ovarian blood flow was performed by assessing angle-independent parameters – pulsation index (PI), resistance index (RI). Volumetric blood flow in uterine arteries and uterine arterial perfusion index were calculated.

Results. The average age of patients in main and control group was 30.0 ± 0.84 years and 25.96 ± 0.99 years (p = 0.003), respectively. The volume of blood loss in main vs. control group was 2.7 times greater (p < 0.001). Assessing PI and RI in the uterine arteries showed highly resistant blood flow, PI and RI significantly increased by 1.6 and by 1.4 times, respectively, compared with control group (p < 0.001).Calculation of volumetric blood flow in the uterine arteries in patients from main group showed a decline by 18.2–22.6 % compared to control group. It resulted in decreased arterial perfusion index of the uterus in group of patients underwent organ-preserving operations for pathological blood loss by 30.2 %. PI and IR magnitude in intraovarian blood flow turned out to increase by 2 and 1.4 times, respectively (p < 0.05).

Conclusion. The identified highly resistant blood flow in the uterus and ovaries may further result in anovulatory cycle formation due to impaired organ hemodynamics able to lead to developing ovarian insufficiency.

1. Maternal mortality. [Materinskaya smertnost']. World Health Organization, 2025. Available at: https://www.who.int/ru/news-room/fact-sheets/detail/maternal-mortality. [Accessed: 15.05.2025].

2. Escobar M.F., Nassar A.H., Theron G. et al.; FIGO Safe Motherhood and Newborn Health Committee. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet. 2022;157 Suppl 1(Suppl 1):3–50. https://doi.org/10.1002/ijgo.14116.

3. Dildy G.A. Postpartum hemorrhage: new management options. Clin Obstet Gynecol. 2002;45(2):330–44. https://doi.org/10.1097/00003081-200206000-00005.

4. National clinical protocol of the Ministry of Health of the Republic of Uzbekistan "Prevention and tactics of management of postpartum obstetric hemorrhage". [Nacional'nyj klinicheskij protokol Ministerstva zdravoohraneniya Respubliki Uzbekistan «Profilaktika i taktika vedeniya poslerodovyh akusherskih krovotechenij»]. Tashkent, 2021. 51 p. Available at: https://akusherstvo.uz/protocols. [Accessed: 15.05.2025].

5. Confidential Maternal Mortality Case Study Report 2018–2020 improving health care and women's health to save mothers' lives. [Otchet po konfidencial'nomu issledovaniyu sluchaev materinskoj smertnosti za 2018–2020 gg. Uluchshenie medicinskoj pomoshchi i zdorov'ya zhenshchin dlya spaseniya zhizni materej]. Tashkent, 2022. 159 р. (In Russ.). Available at: https://uzbekistan.unfpa.org/ru/publications/otchyot-po-konfidencial'nomu-issledovaniyu-sluchaev-materinskoj-smertnosti-za-2018–2020-gg. [Accessed: 15.05.2025].

6. Hayman R.G., Arulkumaran S., Steer P.J. Uterine compression sutures: surgical management of postpartum hemorrhage. Obstet Gynecol. 2002;99(3):502–6. https://doi.org/10.1016/s0029-7844(01)01643-x.

7. Evseeva M.P. Ligation of the uterine vessels at three levels as a method of treatment and prevention of obstetric hemorrhage. [Perevyazka matochnyh sosudov na trekh urovnyah kak sposob lecheniya i profilaktiki akusherskih krovotechenij]. Smolenskij medicinskij al'manah. 2015;(1):23–5. (In Russ.).

8. Kaplanoglu M., Karateke A., Un B. et al. Evaluation of uterine artery recanalization and doppler parameters after bilateral uterine artery ligation in women with postpartum hemorrhage. Int J Clin Exp Med. 2015;8(5):7823–9.

9. Wang W.-Q., Chu G.-H., Hou X.-X. A comparison of Doppler measures of ovarian blood flow between women with and without ovarian dysfunction and correlations of Doppler indices with ovarian dysfunction markers: a meta-analysis. Ann Transl Med. 2023;11(2):110. https://doi.org/10.21037/atm-22-5813.

10. Ozerskaya I.A. Standartization of ultrasound examination of the pelvic organs in women. [Standartizaciya ul'trazvukovogo issledovaniya organov malogo taza u zhenshchin]. Medicinskaya vizualizaciya. 2018;(5):84–93. (In Russ.). https://doi.org/10.24835/1607-2018-5-84-93.

11. Gizzo S., Saccardi C., Patrelli T.S. et al. Fertility rate and subsequent pregnancy outcomes after conservative surgical techniques in postpartum hemorrhage: 15 years of literature. Fertil Steril. 2013;99(7):2097–107. https://doi.org/10.1016/j.fertnstert.2013.02.013.

12. Inoyatova N.M., Asatova M.M. The mechanism of development of secondary hypogonadotropic ovarian insufficiency in women with bleeding in childbirth and organ-preserving operations. [Mekhanizm razvitiya vtorichnoj gipogonadotropnoj yaichnikovoj nedostatochnosti u zhenshchin s krovotecheniyami v rodah i organosohranyayushchimi operaciyami]. Novyj den' v medicine. 2021;(3):340–4. (In Russ.).

13. Trifonova N.S. The state of the reproductive system in women after organ-saving surgery in obstetric hemorrhages. [Sostoyanie reproduktivnoj sistemy zhenshchin posle organosohranyayushchih operacij vo vremya akusherskih krovotechenij: Avtoref. dis... kand. med. nauk]. Moscow, 2008. 24 p. (In Russ.).