The Effectiveness of Uterine Arteries Ligation in Management of Refractory Postpartum Hemorrhage

Abstract

Background: The objectives of study were to see the effectiveness of uterine arteries ligation in
cases of massive postpartum hemorrhage (PPH) which required surgical intervention and to
determine the morbidity in these patients after uterine devascularization during their hospital stay.
Material and Methods: It was a descriptive study which was carried out in Obstetric and
Gynecology Unit of Divisional Head Quarter Hospital, Faisalabad which is a tertiary care center.
All patients booked or unbooked admitted in labour ward with PPH refractory to medical treatment
were included in this study between January 2003 to December 2005. The main outcome
measures were satisfactory homeostasis achieved in terms of control of PPH, length of operative
time, post operative morbidity, re-exploration, total units of blood transfused and total hospital
stay.
Results: There were 62 patients of PPH during study period of 2 years. Uterine artery legation
was done in 20 of these patients as 1st line surgical option; in 15 out of 20 (75%) it was done
during caesarean section whereas in 5 (25%) it was applied after vaginal delivery. In 4 patients
(20%) ovarian artery ligation was also done to control PPH & 2 patients (10%) ended up in
peripartum hysterectomy. Uterine devascularization successfully controlled PPH in 99% cases.
Failure of uterine devascularization was associated with disseminated intravascular coagulation
and placenta accrete. Post operative morbidity was less in terms of anaesthetic complications
(11%), pyrexia (33%), paralytic ilieus (16.5), wound infection (22%).
Conclusion: Postpartum hemorrhage is a life threatening condition. Uterine devascularization
has proved invaluable in the control of refractory PPH as an alternative to hysterectomy.