title: Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effect of internal iliac artery (IIA) ligation performed for severe postpartum hemorrhage (PPH).
  
  
  METHODS
  Thirty-three women who underwent IIA ligation to control PPH in a tertiary referral center between June 2007 and May 2009 were included in this retrospective analysis. IIA ligation was performed as the primary surgical intervention or to control bleeding following hysterectomy.
  
  
  RESULTS
  The 33 women underwent IIA ligation due to uterine atony (n = 22), placenta previa accreta/increta/percreta (n = 5), uterine rupture (n = 4), and placental abruption (n = 2). Twenty-four women underwent IIA ligation as the primary surgical intervention. IIA ligation resulted in control of bleeding in 18/24 women (75%), and only 6/24 women (25%) showed unsuccessful management of bleeding with IIA ligation. In the six women for whom the bleeding was not controlled with IIA ligation, hysterectomy was urgently performed before closure of the abdomen. After obtaining adequate hemostasis with IIA ligation, no women required relaparotomy in the postoperative period. Nine women with persistent bleeding following hysterectomy were also treated with IIA ligation. In our study, there were no intraoperative or postoperative complications related to the procedure.
  
  
  CONCLUSIONS
  IIA ligation may be an effective and safe treatment option to arrest severe PPH. This procedure may also be useful to arrest persistent hemorrhage after hysterectomy. Increased understanding of the retroperitoneal anatomy is needed to reduce the risk of intraoperative and postoperative serious complications.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Harran University, Sanliurfa, Turkey. hakancamuzcuoglu@gmail.com
authors.forename: Hakan
authors.initials: H
authors.lastname: Camuzcuoglu
authors.forename: Harun
authors.initials: H
authors.lastname: Toy
authors.forename: Mehmet
authors.initials: M
authors.lastname: Vural
authors.forename: Fahrettin
authors.initials: F
authors.lastname: Yildiz
authors.forename: Halef
authors.initials: H
authors.lastname: Aydin
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007083:Iliac Artery / Q000601:surgery*; D008026:Ligation; D010923:Placenta Previa / Q000601:surgery; D006473:Postpartum Hemorrhage / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014593:Uterine Inertia / Q000601:surgery