title: [Which surgical strategy to adopt for the management of postpartum haemorrhage and how to improve the effects of hypogastric arteries ligation?]
abstract: The objective were to identify the success factors of bilateral hypogastric arteries ligation and to assess its role in surgical treatment of postpartum hemorrhages. We conducted a retrospective study of all the cases of postpartum hemorrhage requiring surgical treatment between January 2008 and December 2011. The study included 88 patients (0,47% of all births). Uterine atony was the most common etiology (64,8 % of patients). Bilateral ligation of the hypogastric arteries was performed in 81.8% of patients. When surgery was the first choice treatment, its success rate was 66%. This rate was variable depending on the etiology of hemorrhage, the presence or the absence of hemostasis disorders and the time between diagnosis and surgical treatment. In case of uterine atony, the association with a second conservative technique, when the first was inadequate, helped stop the bleeding in 98% of cases. Ligation of hypogastric arteries is an effective surgical technique for the treatment of postpartum hemorrhage. Its success rate has increased thanks to early implementation and to the association with other conservative techniques.
authors.affiliation: Service C, Centre de Maternité et de Néonatologie de Tunis, Faculté de médecine de Tunis, Université Tunis El Manar, Tunisie.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Kehila
authors.affiliation: Service C, Centre de Maternité et de Néonatologie de Tunis, Faculté de médecine de Tunis, Université Tunis El Manar, Tunisie.
authors.forename: Sadok
authors.initials: S
authors.lastname: Derouich
authors.affiliation: Service A, Centre de Maternité et de Néonatologie de Tunis, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
authors.forename: Dalenda
authors.initials: D
authors.lastname: Chelli
authors.affiliation: Service C, Centre de Maternité et de Néonatologie de Tunis, Faculté de médecine de Tunis, Université Tunis El Manar, Tunisie.
authors.forename: Omar
authors.initials: O
authors.lastname: Touhami
authors.affiliation: Service de Réanimation, Centre de Maternité et de Néonatologie de Tunis, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
authors.forename: Sofiene Ben
authors.initials: SB
authors.lastname: Marzouk
authors.affiliation: Service C, Centre de Maternité et de Néonatologie de Tunis, Faculté de médecine de Tunis, Université Tunis El Manar, Tunisie.
authors.forename: Sonia Ben
authors.initials: SB
authors.lastname: Khedher
authors.affiliation: Service C, Centre de Maternité et de Néonatologie de Tunis, Faculté de médecine de Tunis, Université Tunis El Manar, Tunisie.
authors.forename: Mohamed Bedis
authors.initials: MB
authors.lastname: Chanoufi
authors.affiliation: Service A, Centre de Maternité et de Néonatologie de Tunis, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
authors.forename: Fethia
authors.initials: F
authors.lastname: Boudaya
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008026:Ligation; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014593:Uterine Inertia; D055815:Young Adult
keywords: Haemostatics brace suturing; Hemostasis hysterectomy; Ligation of hypogastric arteries; Postpartum hemorrhage; Vascular ligation