Outcomes of hypogastric artery ligation and transcatheter uterine artery embolization in women with postpartum hemorrhage

Abstract

Objective: This study aimed to report our experience of emergent bilateral hypogastric (internal iliac) artery ligation (HAL) in the management of intractable postpartum hemorrhage (PPH) in a tertiary care center. Materials and methods: Patients with severe postpartum hemorrhage that could not be controlled with conservative management were retrospectively reviewed from January 2013 to December 2017. Data were retrieved from patients’ hospital records. Two cases involving both transcatheter uterine artery embolization (TAE) and HAL were excluded. A total of 40 patients were included in the analysis during this period. The inclusion criteria were gestational age ≥24 weeks and primary severe PPH (blood loss ≥1500 mL within 24 h after birth). Results: A total of 40 patients with intractable PPH were included after a thorough review of their medical records. Nine of them required HAL during the study period. Causes of PPH included uterine atony, placental abruption, vaginal/cervical laceration, uterine rupture, and placenta accreta. Hemorrhage was effectively controlled in 8 of 9 patients (88.9%) in the group undergoing bilateral HAL even though their initial conditions were poor. All patients with HAL did not have to undergo hysterectomy. No immediate complications developed. There were two maternal deaths in the group undergoing TAE. Conclusion: Bilateral HAL is an effective life-saving procedure for severe intractable PPH and should be performed as soon as possible when obstetric emergency conditions are indicated. Keywords: Postpartum hemorrhage, Hypogastric artery ligation, Transcatheter uterine artery embolization