Hypogastric arteries ligation for the management of postpartum hemorrhage: a simple method of reducing uterine bleeding during surgery

Abstract

This prospective descriptive study, aimed at evaluating the efficacy of hypogastric arteries ligation (HAL) for the conservative surgical management of postpartum hemorrhage (PPH), as well as the maternal outcome, was conducted between April 1st 2010 and March 31 st 2014 in the University Teaching Hospital of Yaoundé (Cameroon). Sixteen women treated initially with HAL for PPH were recruited. The main variables recorded were maternal age and parity, the cause of PPH, the success of HAL, the additional surgical approach and the maternal outcome. Data were analyzed using SPSS version 20.0. Mean maternal age was 29 years while mean parity was 2.4. PPH was mainly due to uterine atony and placental abruption. The success rate of HAL alone was 75% and 93.7% when HAL was combined with ovarian arteries ligation. No maternal death was recorded, certainly favored by the placement of a garrote at the level of the uterine lower segment to reduce uterine bleeding during surgery. HAL can be considered as one of the first surgical options that should be given to women desiring uterine preservation. In cases of failure, selective ovarian arteries ligation should be performed before resorting to hysterectomy in cases of failure of ovarian arteries ligation.

Bilateral Internal iliac artery ligation: A life saving conservative management to control postpartum haemorrhage- clinical experiences

“…In our study, out of forty-one patients, conservation of uterus was possible in thirty-six (87.8%) patients after satisfactory control of PPH. In a similar study, the rate of conservation of uterus was 75% as reported by Nkwabong et al 15 It was similar to our study result.…”

“…Nayak et al 4 reported the indications of IILA for uterine atony 46.6%, placenta praevia 13.3%, abruptio placenta 8.8%, rupture uterus 22.2%, lower genital tract injury 4.4% and broad ligament hematoma 4.4% respectively in their study subject. In another study, uterine atony was the most common indication for requiring IILA in the case series of PPH reported by Nkwabong et al 15 and Wankhede et al 17 Our study finding was similar to the study reported in the literatures.…”

“…ureteric injury or inadvertent ligation of external iliac artery. Nkwabong et al 15 reported one case of internal iliac vein injury in their case series.…”