title: A change in the management of intractable obstetrical hemorrhage over 15 years in a tertiary care center.
abstract: BACKGROUND
  Peripartum hysterectomy was the gold standard to save a woman with persistent obstetrical bleeding, but compromised the menstrual and reproductive functions. Bilateral internal iliac artery ligation (BIAL) is a potentially effective, fertility preserving means of controlling pelvic hemorrhage, but with surgical and anesthetic risks and low success. Angiographic embolization has the potential to arrest severe pelvic hemorrhage without removing the uterus and without hazarding general anesthesia in a hemodynamically unstable patient.
  
  
  OBJECTIVE
  The aim of this study is to discuss change in the management of intractable obstetrical hemorrhage from removing to conserving the uterus over 15 years.
  
  
  METHODS
  A retrospective analysis of 122 cases of intractable obstetrical hemorrhage over a period of 15 years (January 1997 to December 2011) was done. We started uterine artery embolization (UAE) in 2007 for obstetrical hemorrhage. The patients were analyzed for maternal characteristics, indications, treatment modality, maternal morbidity, and mortality.
  
  
  METHODS
  Descriptive.
  
  
  RESULTS
  We analyzed 12,055 deliveries, (6029 cesarean sections; 6026 vaginal deliveries). One hundred and twenty-two cases of intractable obstetrical hemorrhage were managed with obstetrical hysterectomies in 63, UAE in 53 cases and BIAL in six cases. During the period between 1997 and 2006 intractable obstetrical hemorrhage was managed by hysterectomy/internal iliac artery ligation. The last 5 years of the study period had 80 patients with intractable obstetrical hemorrhage, 53 patients underwent arterial embolization and 35 had a hysterectomy and two had internal artery ligation. There was no mortality and significantly less morbidity in embolization group in our study.
  
  
  CONCLUSIONS
  Embolization should be tried in patients with intractable obstetrical hemorrhage before proceeding for surgical intervention.
authors.affiliation: Department of Obstetrics and Gynaecology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Juneja
authors.affiliation: Department of Obstetrics and Gynaecology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Pooja
authors.initials: P
authors.lastname: Tandon
authors.affiliation: Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Bishav
authors.initials: B
authors.lastname: Mohan
authors.affiliation: Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kaushal
keywords: Bilateral internal iliac artery ligation; obstetrical hemorrhage; uterine artery embolization