Epidemiological Investigation Of Intractable Postpartum Hemorrhage And Its Effect On The Ovarian Reserve Function

Objective.To investigate the effect of intractable postpartum hemorrhage on ovarian reserve function,then provide evidences for the prevention and treatment for iatrogenic premature ovarian failure.Methods.At Department of Obstetrics,Beijing Hospital,since January 2016 to April 2020,49 patients of refractory postpartum hemorrhage were collected for research group,and 70 patients of vaginal delivery without pregnancy complications and postpartum hemorrhage were collected for control group.The research continued 12 months.The base information for searching and analysis includes age,postpartum breastfeeding,postpartum menstruation,pregnancy history,menstrual history,pelvic surgery history,history of radiotherapy and chemotherapy,history of infection such as mumps,history of disease of thyroid dysfunction,history of immune diseases such as systemic lupus erythematosus,etc.Measurement of height,body mass,waist circumference,hip circumference,serum follicle stimulation hormone(FSH),estradiol(E2),anti-mtillerian hormone(AMH),inhitin B(inhibin B,InHB),chromosome karyotype and ultrasound indicators such as sinus follicle number,ovarian arterial pulsation index,ovarian blood flow resistance index and the ratio level of end-diastolic blood flow velocity.Results.Multiple Logistic regression analysis showed that modes of delivery,multiple pregnancies,placental factors,volume resuscitation(transfusion time),etiological treatment(suture of laceration of tract,contraction therapy,etc.),macrosomia,and times of births were related risk factors for refractory postpartum hemorrhage(P<0.05).There was no significant difference between advanced age,pregnancy time and intractable postpartum hemorrhage(P>0.05).Compared with the control group,there were significant differences on onset time of colostrum,postpartum lactation volume in 72 hours,time of menstrual return and postpartum menstrual cycle in search group(P<0.05).The hormone level of the search group on the third postpartum day had no significant difference compared with the control group(P>0.05).The levels of INHB、AMH and FSH at 42 days,6 months and 1 year postpartum were significantly lower than those of the control group,and the levels of E2 at 42 days,postpartum were significantly higher than those in the control group(P<0.05).There was no significant difference in the levels of E2 at 6 months and 1 year and LH level at 42 days,6 months and 1 year postpartum between the refractory postpartum bleeding group and the control group(P>0.05).Compared with the control group,the RI,PI and S/D of the ovarian artery in the search group at 42 days,6 months and one year postpartum had no significant differences(P>0.05).There was no significant difference in the number of sinus follicles(AFC)between the two groups at postpartum 42 days and postpartum 6 months(P>0.05).The number of sinus follicles(AFC)in the search group at postpartum one year was significantly lower than that in the control group,with statistical significance(P<0.05).Conclusion:The pathological process of intractable postpartum hemorrhage can lead to ovarian reserve dysfunction,which can be an important iatrogenic factor of premature ovarian failure.The mode of delivery and treatment are the important iatrogenic factors for the occurrence and clinical outcome of refractory postpartum hemorrhage.The levels of INHB,AMH and FSH can reflect the ovarian reserve function,which is a relatively reliable clinical monitoring method.