Emergency Bilateral Internal Artery Ligation in Control of Post-Partum Hemorrhage

Abstract

Objective: To study the role of emergency bilateral internal iliac artery ligation in the management of post-partum hemorrhage. Study Design: It was a retrospective study. Settings:  This study was carried out in the department of obstetrics and gynae unit 2, Lahore General Hospital Lahore. Duration: From December 2014 to December 2016. Methodology: Twenty patients with massive postpartum hemorrhage were included in this study. In all cases other procedures were also performed before ligation of internal iliac arteries. Main out comes measure was the effectiveness to control hemorrhage which was assessed by the arrest of intraperitoneal or vaginal bleeding. Detailed characteristics of the patient were entered in the Performa. Results: During study period twenty patients under went internal artery ligation (IIAL). Sixteen patients (80%) were unbooked while four patients (20%) were booked. Mean age of these Patients ranged between 20-40years. 14(70%) patients having parity between 2-8 while 6(30%) patients were primipara – In 8 (40%) patients internal ilia artery ligation was carried out due to atonic postpartum hemorrhage followed by adherent placenta in 6(30%) patient, ruptured uterus in 3(15%) cases, coagulopathy in 2(10%) patients and lower genital tract injury in one (5%) patient. 4 (28%) patients needed hysterectomy following bilateral internal iliac artery ligation because of failure to control bleeding. While 6(30%) patients under went hysterectomy before bilateral internal ilia artery ligation. Over all efficacy of this procedure in terms of uterine salvage was 71.4% and in term of saving maternal life was 95%. Conclusion:  In experienced hands bilateral internal iliac artery ligation is an effective method for controlling life threatening postpartum hemorrhage thus reducing mortality and morbidity with preservation of future fertility.