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I. Hypogastric artery ligation for intractable pelvic hemorrhage
Author(s) -
Papp Z.,
TóthPál E.,
Papp C.,
Sziller I.,
Gávai M.,
Silhavy M.,
Hupuczi P.
Publication year - 2006
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2005.08.022
Subject(s) - medicine , uterine artery , ligation , surgery , placenta previa , uterus , hysterectomy , uterine atony , placental abruption , internal iliac artery , pregnancy , placenta , fetus , gestation , genetics , biology
Objective To assess the outcomes of bilateral hypogastric (internal iliac) ligation performed to control intractable pelvic hemorrhage and avoid hysterectomy. Methods A review of indications and outcomes for 117 cases of bilateral hypogastric artery ligation over 15 years (1990–2004). Results Apart from a slight lesion to the hypogastric vein, no complications were observed. Hemorrhage was effectively controlled in all 37 obstetric cases. In 13 of these cases, the uterus was preserved even when there was cervical pregnancy, placenta previa, placental abruption, uterine atony, and uterine rupture, and 4 women were delivered of mature infants. Hemorrhage was effectively controlled in 41 of 80 gynecologic cases. Prophylactic reduction of pelvic blood flow was the indication for the procedure in 39 cases, 5 of whom involving Jehovah's Witnesses adverse to blood transfusion. The uterus was preserved in only a few of the 41 controlled cases, but one woman (so far) was delivered of a mature infant. Conclusion Hypogastric artery ligation was found to be indicated if (1) life‐threatening pelvic hemorrhage could not be controlled by conservative methods; (2) prophylactic reduction of pelvic blood flow was needed to prevent anticipated hemorrhage; and (3) preservation of reproductive function was desired. The procedure was found to be safe and usually effective and should be taught during obstetric and gynecologic training.