DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20172310

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

Anushree Jain, Rekha Uttam Sapkal

Abstract


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.


Keywords


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

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References


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.