Internal Iliac Artery Ligation - Life Saving Procedure in massive postpartum Hamorrhage

Abstract

Objective: To study the role of bilateral internal iliac ligation in arresting postpartum
hamorrhage.
Material and Methods: The study was carried out from 1st July 2012 to 30th June 2014 in the
department of Obstetrics and Gynaecology unit II, Services Institute of Medical Sciences /
Services Hospital Lahore. Total births were 4496 in the duration of two years. Out of them 3366
were caesarean section and 1130 were spontaneous vaginal deliveries. Total massive
postpartum hemorrhage that is blood loss > 1 litre, was in 46 patients. Internal iliac ligation was
carried out in fifteen patients. In all these patients they were failed medical treatment. Even after
B-Lynch suture and abdominal hysterectomy bleeding did not stop.
Results: Total patients enrolled in the study were fifteen. Two (13%) patients were primigravidae
in which uterus was saved and bilateral internal iliac ligation was done due to uterine atony. In five
(33%) patients due to uterine rupture and in eight (53%) patients due to morbidly adeherant
placenta there was massive hamorrhage and bilateral internal iliac ligation was done. In thirteen
(86%) patients total abdominal hysterectomy was done along bilateral internal iliac ligation. In five
(33%) patients packs were inserted after ligation at bladder base in case of morbidly adherent
placenta. Packs were removed after 48 hours in second laparotomy. All the patients were saved
and discharged in satisfactory condition except one who already came with disseminated
intracoagulation disorder. Among complications in three (20%) patients there was injury to
bladder that was stitched and in seven (46%) patients there was wound infection.
Conclusion: Early resort of bilateral internal iliac ligation effectively prevents hysterectomy in
women with atonic uterus and in uterine rupture and morbidly adherent placenta it saves the life if
done on time.