Internal iliac artery ligation for severe postpartum hemorrhage.
OBJECTIVE
To evaluate the outcomes of bilateral internal iliac artery ligation (IIAL) in severe postpartum hemorrhage (PPH).


METHODS
Multi-center retrospective study.


METHODS
The study was performed from January 2005 to December 2010, at the Obstetrics and Gynecology Clinic, Dicle University Medical Faculty and Maternity Hospital, Diyarbakir, Turkey. Life-threatening cases of severe postpartum hemorrhage, which could not be controlled with conservative medical and surgical treatments and finally managed with IIAL, were retrospectively evaluated.


RESULTS
Totally 53 patients who underwent IIAL procedures were included in the study. All patients were hemodynamically unstable. The mean shock index and transfused units of blood were 1.17 +/- 0.46, 5.49 +/- 3.04, respectively. Uterine atony was the leading cause of severe postpartum hemorrhage and the need for IIAL. Coagulopathy developed in 26 (49.1%) patients during the postoperative follow-up period. Uterus was preserved in 17 (32.0%) cases. Three patients died of complications and/or morbidity associated with hemorrhage.


CONCLUSIONS
Serious PPH is most frequently associated with uterine atony and IIAL should be considered in cases with severe PPH unresponsive to other treatment modalities. If, in the antenatal period, patients have risk factors of postpartum hemorrhage, they must be transferred to appropriate centers to prevent a possibly fatal outcome.
Dicle University, School of Medicine, Department of Obstetrics and Gynecology, Diyarbakir, Turkey. mevs26@yahoo.com
Mehmet Siddik
MS
Evsen
Muhammet Erdal
ME
Sak
Hatice Ender
HE
Soydine
Serdar
S
Basaranoglu
Cetin
C
Bakir
Sibel
S
Sak
Talip
T
Gul
D000328:Adult; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008026:Ligation; D018743:Perinatal Care / Q000379:methods*; D006473:Postpartum Hemorrhage / Q000517:prevention & control* / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014421:Turkey; D014599:Uterus / Q000098:blood supply; D016387:Women's Health; D055815:Young Adult