Publication:

Emergency internal iliac artery ligation: a conservative lifesaving procedure

Background Internal iliac artery ligation (IIAL) is a surgical approach which causes a drop in arterial pressure and virtual elimination of the Trip-hammer effect and also preserves fertility. The objective was to study the role of IIAL in arresting and preventing postpartum hemorrhage (PPH).

Methods A retrospective case series involving examination of the files of all the women who had Internal iliac artery ligation between June 2013 and May 2015 in the department of Obstetrics and Gynecology, Karnataka Institute of Medical Sciences, Hubli.

Results Out of the 15 women who underwent IIAL, 14(93.3%) had therapeutic IIAL and 1(6.67%) had prophylactic IIAL. Associated procedures like B-Lynch sutures, ovarian a. ligation and uterine a. ligation were performed before the decision for IIAL. Hysterectomy was performed in 5 cases to arrest hemorrhage (33.3%). Two woman died inspite of IIAL and subtotal hysterectomy due to uncontrolled PPH. No patient suffered pelvic organ injury or ischaemic complications.

Conclusions Bilateral ligation of Internal Iliac artery is a safe, rapid and effective way of treating PPH. Early resort to IIAL prevents hysterectomy in women with atonic PPH.