Abstract
<title>Abstract</title> <p> Objective To investigate the long-term effects of bilateral ligation of the ascending branch of the uterine artery on maternal ovarian function and ovarian reserve after the treatment of postpartum hemorrhage during cesarean section, and to provide scientific evidence for the safe clinical application of this surgical procedure. Methods A total of 100 patients who underwent lower uterine segment cesarean section and experienced postpartum hemorrhage at XXX Hospital from September 2023 to June 2024 were enrolled in this study. According to the hemostatic method applied, the patients were divided into the study group (50 cases, treated with bilateral ligation of the ascending branch of the uterine artery) and the control group (50 cases, treated with conventional hemostatic methods such as intrauterine gauze packing or balloon tamponade). All patients were followed up for two years. Menstrual recovery (duration of lochia, time to first postpartum menstruation, menstrual volume and cycle regularity), ovarian function and reserve parameters (ovarian volume, antral follicle count [AFC], serum levels of AMH, FSH, LH, and E2), ovarian hemodynamic indices (PI, RI, PSV), and follicular development and ovulation status were observed and compared between the two groups at 4, 8, 12, and 24 months postoperatively. Results (1) <bold>Menstrual Recovery</bold> : There were no statistically significant differences between the two groups regarding the duration of lochia, time to first menstrual resumption postpartum, menstrual volume, or cycle regularity ( <italic>P</italic> > 0.05).( 2) <bold>Ovarian Function and Reserve</bold> : At each postoperative follow-up time point, no statistically significant differences were observed between the two groups in ovarian volume, antral follicle count (AFC), or serum levels of AMH, FSH, LH, and E2 ( <italic>P</italic> > 0.05).( 3) <bold>Ovarian Hemodynamics</bold> : There were no statistically significant differences in the ovarian stromal blood flow pulsatility index (PI), resistance index (RI), or peak systolic velocity (PSV) between the two groups at any postoperative time point ( <italic>P</italic> > 0.05).( 4) <bold>Ovulation</bold> : No statistically significant difference was found in the rate of normal ovulation within 24 months postoperatively between the two groups ( <italic>P</italic> > 0.05). Conclusion Bilateral ligation of the ascending branch of the uterine artery effectively controls postpartum hemorrhage during cesarean section without exerting significant adverse effects on menstrual recovery, ovarian endocrine function, ovarian reserve, or ovarian blood perfusion within the first two years postpartum. This surgical technique is simple to perform, provides reliable hemostasis, and maximizes the preservation of ovarian function. It represents a safe and effective treatment modality for refractory postpartum hemorrhage and is worthy of wider clinical application. </p>