Surgical control of obstetric hemorrhage: hypogastric artery ligation or hysterectomy?

Abstract

Sixty-four patients with severe postpartum hemorrhage (PPH) required surgical intervention during the years 1983 to 1987. Bilateral hypogastric artery ligation (HAL) was the initial surgical approach in 45% (29/64) and hysterectomy in 55% (35/64). HAL successfully controlled hemorrhage in 65% (19/29), and failed in 35% (10/29) where hysterectomy was required as a life saving procedure. Failure of HAL was more evident in atonic PPH than in other situations. Complications were more following hysterectomy; six (6/45) patients required re-exploration for intraperitoneal hemorrhage and two (2/45) patients died following hysterectomy. HAL was found to be a relatively easy, safe and successful procedure to be attempted as an initial surgical approach for all severe PPH, specially where uterine conservation was desired.

Les hémorragies graves de la délivrance : doit-on lier, hystérectomiser ou emboliser ?

“…Les particules pour l'embolisation ou les fils pour les ligatures sont résorbables. La reprise des cycles est le plus souvent normale et plusieurs cas de grossesses après embolisation ou ligatures vasculaires ont été rapportés, même après exclusion des pédicules lomboovariens [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. Il n'y a pas d'insuffisance utéroplacentaire constatée pour les grossesses ultérieures.…”

“…Son efficacité apparaît variable selon les auteurs [1, 22,23,28,[51][52][53]. Les taux de succès sont de 42 à 100 % (Tableau 2).…”

Super-selective angiographic embolisation of a branch of the anterior pudendal artery for the treatment of intractable post-operative bleeding

“…Surgical exploration, laparotomy and internal iliac artery ligation have been the traditional treatments for abdominal and pelvic haemorrhage, with success rates quoted from 40% to 100% [2][3][4][5]. However, the risks from general anaesthesia and laparotomy are significant.…”

Interest of the Pelvic Packing in Post-partum Haemorrhage Refractory to Hysterectomy

“…Ligation of the internal iliac arteries seems to bring benefit to persistent bleeding after [8] haemostasis hysterectomy but it is only effective in bleeding of arterial origin especially decaying cervicalvaginal lesions, vaginal or pelvic thrombi. Moreover, it is a hard act, requiring some learning; and it does not seem to bring any significant benefit in the diffuse bleeding of venous origin or secondary to a haemostasis disorder [9].…”