DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20150712

Emergency internal iliac artery ligation: a conservative lifesaving procedure

Y. M. Kabadi, Harsha B.

Abstract


Background: Internal iliac artery ligation (IIAL) is a surgical approach which causes a drop in arterial pressure and virtual elimination of the Trip-hammer effect and also preserves fertility. The objective was to study the role of IIAL in arresting and preventing postpartum hemorrhage (PPH).

Methods: A retrospective case series involving examination of the files of all the women who had Internal iliac artery ligation between June 2013 and May 2015 in the department of Obstetrics and Gynecology, Karnataka Institute of Medical Sciences, Hubli.

Results: Out of the 15 women who underwent IIAL, 14(93.3%) had therapeutic IIAL and 1(6.67%) had prophylactic IIAL. Associated procedures like B-Lynch sutures, ovarian a. ligation and uterine a. ligation were performed before the decision for IIAL. Hysterectomy was performed in 5 cases to arrest hemorrhage (33.3%). Two woman died inspite of IIAL and subtotal hysterectomy due to uncontrolled PPH. No patient suffered pelvic organ injury or ischaemic complications.

Conclusions: Bilateral ligation of Internal Iliac artery is a safe, rapid and effective way of treating PPH. Early resort to IIAL prevents hysterectomy in women with atonic PPH.


Keywords


Internal iliac artery ligation, PPH, Hysterectomy

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References


Ferrazzani S, Guariglia L, Draisci G, Sorrentino L, De Stefano V, D'Onofrio G et al. Postpartum hemorrhage. Minerva Gynecol. 2005;57(2):111-29.

Geller SE, Adams MG, Miller S. A continuum of care model for postpartum hemorrhage. Int J Fertil Women’s Med. 2007; 52(2-3):97-105.

Leung NY, Lau AC, Chan KK, Yan WW. Clinical characteristics and outcomes of obstetric patients admitted to the Intensive Care Unit: a 10-year retrospective review. Hong Kong Med J. 2010;16(1):18- 25.

Camuzcuoglu H, Toy H, Vural M, Yildiz F, Aydin H. Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy. J Obstet Gynaecol Res. 2010;36(3):538- 43.

Atala C, Biotti M. Ligation of internal iliac artery as treatment of hemorrhage in obstetrics and gynecology. Rev Chil Obstet Ginecol. 1993;58(2):119-25.

Unal O, Kars B, Buyukbayrak EE, Karsidag AY, Turan C.The effectiveness of bilateral hypogastric artery ligation for obstetric hemorrhage in three different underlying conditions and its impact on future fertility. J Matern Fetal Neonatal Med. 2011;24(10): 1273- 6.

Chelli D, Boudaya F, Dimassi K, Gharbi B, Najjar I et al.Hypogastric artery ligation for post-partum hemorrhage. J Gynecol Obstet Biol Reprod (Paris). 2010;39(1):43- 9.

Fatu C, Francu D, Puisor M, Fatu CI. Changes in the arterial pressure after ligation of the hypogastric artery. Rev Med Chir Soc Med Nat Iasi. 1996;100(12):149-50.

Rajaram P, Raghavan SS, Bupathy A, Balasubramanian SR, Habeebullah S, Umadevi P. Internal iliac artery ligation in obstetrics and gynecology. Ten years experience. Asia Oceania J Obstet Gynaecol. 1993;19(1):71-5.

Fatu C, Francu D, Puisor M, Fatu CI. The morphophysiological consequences of experimental ligation of the hypogastric arteries. Rev Med Chir Soc Med Nat Lasi. 1996;100(3-4):177-9.

Nizard J, Barrinque L, Frydman R, Fernandez H. Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage. Hum Reprod. 2003;18(4):844- 8.

Api M, Api O, Yayla M. Fertility after B-Lynch suture and hypogastric artery ligation. Fertil Steril. 2005;84(2):509.