Vaginal ligation of descending branch of uterine artery in the management of massive secondary post-partum haemorrhage


  • Rudrika Chandra Department of Obstetrics and Gynecology, 9 Air Force Hospital Halwara, Ludhiana, Punjab, India
  • Sanjay Singh Department of Obstetrics and Gynecology, Base Hospital Delhi Cantt, New Delhi, India



Descending branch of uterine artery, Fertility preserving surgical approach, Hemorrhagic shock, Secondary post-partum haemorrhage (PPH), Vaginal ligation


A 25 year old lady presented on day 22 of an uneventful caesarean delivery, in a state of class IV haemorrhagic shock, secondary to sudden onset of vaginal bleeding without any inciting cause. Immediate resuscitation was initiated and the cause for massive secondary post-partum haemorrhage (PPH) was identified as an actively bleeding vessel at 3 ‘O’ clock position on a visibly healthy cervix with a well contracted uterus. This was the descending branch of left uterine artery, which was ligated after pulling the cervix with a sponge holder towards the introitus and application of Vicryl No 1-0 suture. The bleeding decreased significantly post vascular ligation. Further exploration of vagina and cervix did not reveal any active bleeding or laceration and no retained placental tissue was found inside uterine cavity on ultrasound examination. This is a rare case of Massive Secondary PPH in a post-caesarean patient due to spontaneous giving way of descending branch of uterine artery.


Khong TY, Khong TK. Delayed postpartum hemorrhage: a morphologic study of causes and their relation to other pregnancy disorders. Obstet Gynecol. 1993;82(1):17-22.

Thompson W, Harper M. Postpartum haemorrhage and abnormalities of the third stage of labour. In: Chamberlain G, Steer P, eds. Turnbull’s Obstetrics, 3rd Ed. Edinburgh: Churchill Livingstone. 2001:619-33.

Hoveyda F, MacKenzie IZ. Secondary postpartum haemorrhage: incidence, morbidity and current management. BJOG. 2001;108(9):927-30.

King PA, Duthie SJ, Dong ZG, Ma HK. Secondary postpartum haemorrhage. Aust N Z J Obstet Gynaecol. 1989;29(4):394-8.

Alexander J, Thomas PW, Sanghera J. Treatments for secondary postpartum haemorrhage (Review). Cochrane Database Syst Rev. 2008;(1): CD002867.

Ledee N, Ville Y, Musset D, Mercier F, Frydman R, Fernandez H. Management in intractable obstetric haemorrhage: an audit study on 61 cases. Eur J Obstet Gynecol Reprod Biol.2001;94(2):189-96.

Chordia SK. Management of a bleeding aberrant cervical artery following vacuum suction termination. Case report. Br J Obstet Gynaecol.1988;95(4):411-3.

Ross I. Ligation of uterine arteries per vagina in a case of recurrent secondary postpartum hemorrhage following cesarean. Aust NZJ Obstet Gynecol. 1963;5:251-8.

Moirangthem RS, Ngangom IS, Naorem NS, Chanam MS, Ariban LD . Bilateral vaginal ligation of descending branch of the uterine artery in the management of heavy genital tract bleeding. Case report. J Obstet Gynecol India. 2005;55(6):555-6.






Case Reports