Role of hypogastric artery ligation in pelvic haemorrhage - is still alive

Abstract

Objectives: Management of profuse pelvic hemorrhage remains a major challenge in obstetrics as well as gynecology. Bilateral internal iliac artery ligation( BIL) has been tried in this condition with varying success. The purpose was to review efficacy of the procedure in women with intractable pelvic hemorrhage. Material and methods:This observational analysis included all cases of internal illiac artery ligation done for pelvic hemorrhage between 2007 May to 2010 May in the department of Obstetrics and Gynecology, I.P.G.M.E&R, Kolkata. Result: We analyzed a total of 20 cases of BIL. The indications included atonic PPH (30.0%), traumatic PPH (10.0%), DUB (10.0%), post operative hemorrhage (15.0%) and prophylactic major (25.0%). Other surgical methods applied before BIL were compression sutures and stepwise devascularisation. Hemostasis was achieved successfully in 73.33% cases done for therapeutic purpose. One mortality was present in a case of advanced staged carcinoma cervix due to uremia. No complication observed related to BIL. Conclusion: Atonic PPH was better controlled by BIL. Other surgical methods were observed to have poor efficacy in combating pelvic hemorrhage. BIL was an effective way of controlling all postoperative gynecological hemorrhage cases. Though scope of BIL is reduced due to newer modalities to control hemorrhage, still it is choice of option in low resource countries.

Keywords

• Bilateral internal iliac artery ligation
• Hemorrhage
• Efficacy
• Atonic PPH