Internal iliac artery ligation to combat post partum haemorrhage: an institutional review of case series


  • Anushree Jain Department of Obstetrics and Gynecology, People’s College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
  • Rekha Uttam Sapkal Department of Obstetrics and Gynecology, People’s College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India



Internal iliac artery ligation, Peripartum hysterectomy, Postpartum haemorrhage, Uterus preservation


Background: Internal iliac artery supplies the pelvic viscera. IIAL is a valuable surgical procedure to control intractable pelvic haemorrhage with the mainstay aim of uterus preservation. There is a reduction of 85% in pulse pressure and 48% in the blood flow in the arteries distal after internal iliac artery ligation. Thus, the expertise to perform IIAL should be present in armamentarium of every obstetrician and gynaecologist.

Methods: Retrospective review of 22 cases who have undergone IIAL or Peripartum hysterectomy for management of Post- Partum haemorrhage in the study period of January 2012 till December 2015 in the Department of Obstetrics and Gynaecology of People’s College of Medical Science and Research Centre, Bhopal.

Results: Internal iliac artery ligation was performed in 53% out of which 31.8%% was for placenta previa, 4.54% for adherent placenta, 9.1% IIAL for Atonic PPH. Whereas peripartum hysterectomy was performed in 38% cases out of which 13.6% had perforation of uterus. 9% underwent hysterectomy as well as IIAL. Blood loss more than two 2 liters within period of 60-90mins was effectively and dramatically controlled with IIAL. Thus, maternal mortality reduced while preserving fertility. Control of Pelvic hemorrhage was achieved in 100% of cases.

Conclusions: Bilateral ligation of the internal iliac arteries is a safe, rapid and very effective method of controlling bleeding from UTERUS and genital tract. It plays a major role in safe guarding the patient from undergoing life threatening consequences due to pelvic haemorrhage.


Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066-74.

Selo-Ojeme DO. Primary post-partum haemorrhage. J Obstet Gynecol. 2002;22:463-9.

Arulkumaran S, De Cruze B. Surgical management of severe postpartum haemorrhage. Curr Obstet Gynecol. 1999;8:101-5.

Siegel P, Mengert WF, Internal Iliac Artery Ligation in Obstetrics and Gynecology. JAMA. 1961;178(11):1059-62.

Burchell RC. Physiology of internal iliac artery ligation. BJOG: An International J Obstetr Gynaecol. 1968;75(6):642-51.

Joshi VM, Otiv SR, Majumder R, Nikam YA, Shrivastava M. Internal iliac artery ligation for arresting postpartum haemorrhage; BJOG. 2007;114(3):356-61.

Sıddık EM, Erdal SM, Ender SH, Serdar B, Cetin B, Sibel S, Talip G. Internal iliac artery ligation for severe postpartum hemorrhage. Ginekol Pol. 2012;83:665-8.

Refaie W, Fawzy M, Shabana A. Prophylactic bilateral internal iliac artery ligation for management of low-lying placenta accreta: a prospective study. Tanta Med J. 2014;42:146-50.






Original Research Articles