Effect of internal iliac artery ligation on ovarian blood supply and ovarian reserve

Abstract

Internal iliac artery ligation in the treatment of obstetric hemorrhage leads to dilation of the ovarian arteries and reversed flow in the ovarian branches of the uterine arteries. These change the blood supply to the ovaries and impair ovarian reserve.

Efficacy of internal iliac artery ligation on the management of postpartum hemorrhage and its impact on ovarian reserve

“…Retroperitoneal of the patients have been suggested (15) . Still some investigators have claimed that this procedure has no unfavorable effect on ovarian functions, and complete consensus has not been reached on this issue (16,17) .…”

Ovarian reserve after internal iliac artery ligation

“…Limited data is available on ovarian reserve after the management of post‐partum hemorrhage including IIAL and/or hysterectomy. So far, there is only one set of data consisting of six patients in whom serum AMH levels were evaluated after the ligation of internal iliac artery . In their study, serum AMH levels were significantly lower in patients who underwent IIAL than the control group (1.3 ng/mL vs 2.54 ng/mL, P = 0.02).…”

“…The collateral circulation between the uterine and ovarian arteries provides an additional source of blood supply for the ovaries. Raba reported a reversed flow pattern in the ovarian branches of uterine arteries and dilatation of the ovarian arteries after the IIAL . Further, a decrease in the pulsatility index and systolic/diastolic ratio (S/D) in ovarian arteries was observed after the IIAL…”

“…Aligning with Raba's study, we also did not find a significant difference in terms of mean FSH levels among the groups. Ovarian reserves might be altered after procedures affecting ovarian and/or uterine blood supply . The main blood supply of the ovaries is from the ovarian artery which originates from the aorta.…”

Unilateral recanalisation of hypogastric artery after ligation for postpartum haemorrhage treatment.

“…It is a fact that IIAL does not affect the activity of the pelvis minor's organs or fertility and that complications seem to occur rarely. Complications that may occur include changes in the ovarian blood flow and the loss of ovarian reserve [2, 3]. Until now, IIAL was considered as an irreversible procedure with no possibility of recanalisation.…”