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Vol 83, No 9 (2012)
ARTICLES
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Internal Iliac Artery Ligation for Severe Postpartum Hemorrhage

Mehmet Siddik Evsen, Muhammet Erdal Sak, Hatice Ender Soydinc, Serdar Basaranoglu, Cetin Bakir, Sibel Sak, Talip Gul
Ginekol Pol 2012;83(9).

open access

Vol 83, No 9 (2012)
ARTICLES

Abstract

Objective: To evaluate the outcomes of bilateral internal iliac artery ligation (IIAL) in severe postpartum hemorrhage (PPH). Design: Multi-center, retrospective study. Methods: The study was performed from January 2005 to December 2010, at the Obstetrics and Gynecology Clinic, Dicle University Medical Faculty and Maternity Hospital, Diyarbakir, Turkey. Life-threatening cases of severe postpartum hemorrhage, which could not be controlled with conservative medical and surgical treatments and finally managed with IIAL, were retrospectively evaluated. Results: Totally 53 patients who underwent IIAL procedures were included in the study. All patients were hemodynamically unstable. The mean shock index and transfused units of blood were 1.17±0.46, 5.49±3.04, respectively. Uterine atony was the leading cause of severe postpartum hemorrhage and the need for IIAL. Coagulopathy developed in 26 (49.1%) patients during the postoperative follow-up period. Uterus was preserved in 17 (32.0%) cases. Three patients died of complications and/or morbidity associated with hemorrhage. Conclusion: Serious PPH is most frequently associated with uterine atony and IIAL should be considered in cases with severe PPH unresponsive to other treatment modalities. If, in the antenatal period, patients have risk factors of postpartum hemorrhage, they must be transferred to appropriate centers to prevent a possibly fatal outcome.

Abstract

Objective: To evaluate the outcomes of bilateral internal iliac artery ligation (IIAL) in severe postpartum hemorrhage (PPH). Design: Multi-center, retrospective study. Methods: The study was performed from January 2005 to December 2010, at the Obstetrics and Gynecology Clinic, Dicle University Medical Faculty and Maternity Hospital, Diyarbakir, Turkey. Life-threatening cases of severe postpartum hemorrhage, which could not be controlled with conservative medical and surgical treatments and finally managed with IIAL, were retrospectively evaluated. Results: Totally 53 patients who underwent IIAL procedures were included in the study. All patients were hemodynamically unstable. The mean shock index and transfused units of blood were 1.17±0.46, 5.49±3.04, respectively. Uterine atony was the leading cause of severe postpartum hemorrhage and the need for IIAL. Coagulopathy developed in 26 (49.1%) patients during the postoperative follow-up period. Uterus was preserved in 17 (32.0%) cases. Three patients died of complications and/or morbidity associated with hemorrhage. Conclusion: Serious PPH is most frequently associated with uterine atony and IIAL should be considered in cases with severe PPH unresponsive to other treatment modalities. If, in the antenatal period, patients have risk factors of postpartum hemorrhage, they must be transferred to appropriate centers to prevent a possibly fatal outcome.
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Keywords

postpartum hemorrhage, hysterectomy, iliac artery, Ligation

About this article
Title

Internal Iliac Artery Ligation for Severe Postpartum Hemorrhage

Journal

Ginekologia Polska

Issue

Vol 83, No 9 (2012)

Bibliographic record

Ginekol Pol 2012;83(9).

Keywords

postpartum hemorrhage
hysterectomy
iliac artery
Ligation

Authors

Mehmet Siddik Evsen
Muhammet Erdal Sak
Hatice Ender Soydinc
Serdar Basaranoglu
Cetin Bakir
Sibel Sak
Talip Gul

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