Can internal iliac artery ligation be an alternative to pelvic devascularization/hysterectomy for obstetric and pelvic haemorrhage?

Abstract

Aim: To evaluate the role of Internal Iliac Artery Ligation (IIAL) as an alternative to pelvic devascularization and hysterectomy for obstetric haemorrhage and pelvic haemorrhage following gynaecological surgery. Study design: Retrospective study performed over 25 women who underwent therapeutic IIAL/Pelvic devascularization to combat haemorrhage. Study area: Santokba Durlabhji Memorial Hospital (SDMH), Jaipur from January 2016 to July 2020. Study Sample: Women admitted to SDM Hospital, for obstetric or gynaecological intervention who underwent IIAL/Pelvic devascularization/Hysterectomy to combat haemorrhage. Method: Bilateral or unilateral IIAL/ Pelvic devascularization performed. Outcome: Need for hysterectomy following IIAL to combat haemorrahge or morbidity, mortality and complications following procedure. Results: Total of 23 patients underwent IIAL, 16 bilateral and 7 unilateral. All ligations were done through a transperitoneal approach. 2 out of 23 ligations were performed for gynaecological indication. Out of 21 patients with obstetric complications, 9 underwent IIAL due to atonic postpartum haemorrhage, 2 for complete and 1 for incomplete placenta previa, 3 for placenta previa with adherent placenta, 2 for haemorrhagic shock in previous scar, 2 for uterine rupture. Other 2 were done as there was an extension of uterine incision. There were 2 patients who underwent systemic devascularisation. Bleeding was controlled only in one case while other one required subtotal hysterectomy. Conclusions: IIAL is an effective procedure to combat both obstetric and pelvic haemorrahge in a short span of time. Further it prevents women from undergoing hysterectomy and its following complications.