Small invasive technique of Internal Iliac Artery ligation for postpartum haemorrhage
Abstract
Objectives: Internal Iliac artery ligation (IIAL) is an effective life-saving method to control obstetric hemorrhage, and a hysterectomy
can often be avoided. A standard ligation procedure requires wide tissues dissection: incision in the peritoneum
lateral to and parallel with the ureter. That can be traumatic and is difficult in practice what results in a rare use of IIAL in
surgical emergency. As an alternative a novel, small invasive technique was used, which protocol is attached to the paper
as a video presentation file.
Material and methods: Forty-five women treated by Internal Iliac Artery ligation for postpartum haemorrhage. In 27 patients
(Cohort A) standard IIAL procedure by Kelly’s method was used. In the remaining 18 patients (Cohort B) a novel, small
invasive technique was performed. Time of both surgical procedures of IIAL was measured.
Results: Time of Standard technique of IIAL vs Novel small invasive technique of IIAL: 34 (26–41) min. vs 13 (8–16) min. p < 0.001.
Conclusions: The presented novel small invasive technique of Internal Iliac artery ligation can be an easier and safe alternative
for standard ligation procedure.
Keywords: postpartum hemorrhagesurgeryinternal iliac artery
References
- Bouet PE, Madar H, Froeliger A, et al. Surgical treatment of postpartum haemorrhage: national survey of French residents of obstetrics and gynecology. BMC Pregnancy Childbirth. 2019; 19(1): 91.
- Selçuk İ, Uzuner B, Boduç E, et al. Step-by-step ligation of the internal iliac artery. J Turk Ger Gynecol Assoc. 2019; 20(2): 123–128.
- Raba G, Baran P. Hemodynamic parameters following bilateral internal iliac arteries ligation as a treatment of intrapartum hemorrhage. Ginekol Pol. 2009; 80(3): 179–183.
- Kehila M, Derouich S, Chelli D, et al. Which surgical strategy to adopt for the management of postpartum haemorrhage and how to improve the effects of hypogastric arteries ligation? Pan Afr Med J. 2016; 25: 96.
- Kaya B, Usluogullari B, Yurttutan N, et al. Does ligation of internal iliac artery for postpartum hemorrhage affect clitoral artery blood flow and postpartum sexual functions? Eur J Obstet Gynecol Reprod Biol. 2017; 219: 124–128.
- Raba G. Internal iliac artery aneurysm after ligation for obstetric hemorrhage. Int J Gynaecol Obstet. 2009; 107(3): 249–250.
- Raba G. Effect of internal iliac artery ligation on ovarian blood supply and ovarian reserve. Climacteric. 2011; 14(1): 54–57.
- Kelly HA. Ligation of both Internal Iliac Arteries for Hæmorrhage in Hysterectomy for Carcinoma Uteri. Annals of Surgery. 1894; 20: 248.
- Royal College of Obstetricians and Gynaecologists. 2017.
- Raba G, Kotarski J, Szczupak K, et al. Uterus banding with the Osada method effectively reduces intraoperative blood loss during myomectomy. Minim Invasive Ther Allied Technol. 2016; 25(1): 43–47.
- Dohbit JS, Foumane P, Nkwabong E, et al. Uterus preserving surgery versus hysterectomy in the treatment of refractory postpartum haemorrhage in two tertiary maternity units in Cameroon: a cohort analysis of perioperative outcomes. BMC Pregnancy Childbirth. 2017; 17(1): 158.
