title: Is there yet a role for internal iliac artery ligation in obstetric hemorrhage with the current gain in popularity of other uterus sparing techniques?
abstract: OBJECTIVE
  To evaluate the success rates and subsequent fertility outcomes of internal iliac artery ligation (IIAL) in uterine atony (primary ligated and secondary added to other uterus sparing techniques), retroperitoneal hematoma, and placenta adherent abnormalities.
  
  
  METHODS
  Fifty two women who underwent IIAL for different causes of postpartum hemorrhage were retrospectively evaluated.
  
  
  RESULTS
  Among 26 women with intractable uterine atony, 12 had primary, and 14 secondary IIAL, due to ongoing bleeding following the B-Lynch suture or the Bakri balloon tamponade. The success rates were 91% and 71.4% in the primary and secondary IIAL groups, respectively. The success rates of IIAL in 12 women with placental adhesion abnormalities and another 12 with obstetric retroperitoneal hematoma were 75% (9/12) and 83% (10/12) respectively. Nine (17%) hysterectomies were performed after failure of IIAL. Two maternal deaths occurred in our study. The rate of achieving pregnancy was not significantly different between the groups.
  
  
  CONCLUSIONS
  Hysterectomy rates might be decreased with the addition of IIAL provided that other uterus sparing techniques; B-Lynch or the Bakri balloon was to fail separately. IIAL can save lives in severe obstetric retroperitoneal hematoma. IIAL does not affect fertility even it is combined with other uterus sparing techniques like the Bakri balloon and B-Lynch suture.
authors.affiliation: a Department of Obstetrics and Gynecology , Faculty of Medicine, Near East University , Mersin , Turkey.
authors.forename: Baris
authors.initials: B
authors.lastname: Kaya
authors.affiliation: b Department of Obstetrics and Gynecology , Gaziantep Women's Health and Maternity Hospital , Gaziantep , Turkey.
authors.forename: Zeki
authors.initials: Z
authors.lastname: Damarer
authors.affiliation: c Zekai Tahir Burak Women's Health Research and Education Hospital , Ankara , Turkey.
authors.forename: Korkut
authors.initials: K
authors.lastname: Daglar
authors.affiliation: d Department of Obstetrics and Gynecology , Sakarya University , Sakarya , Turkey , and.
authors.forename: Orhan
authors.initials: O
authors.lastname: Unal
authors.affiliation: e Department of Obstetrics and Gynecology , Klinikum Oldenburg University Hospital , Oldenburg , Germany.
authors.forename: Amr
authors.initials: A
authors.lastname: Soliman
authors.affiliation: e Department of Obstetrics and Gynecology , Klinikum Oldenburg University Hospital , Oldenburg , Germany.
authors.forename: Onur
authors.initials: O
authors.lastname: Guralp
mesh_terms: D000328:Adult; D005260:Female; D006406:Hematoma / Q000601:surgery; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D007083:Iliac Artery / Q000601:surgery*; D008026:Ligation / Q000379:methods*; D059351:Organ Sparing Treatments / Q000379:methods; D006473:Postpartum Hemorrhage / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D017211:Treatment Failure; D014593:Uterine Inertia / Q000601:surgery*; D014599:Uterus / Q000293:injuries
keywords: B-Lynch suture; Bakri balloon; Internal iliac artery ligation; fertility after internal iliac artery ligation; obstetric retroperitoneal hematoma