Efficacy of Bilateral Internal Iliac Artery Ligation in Managing Severe Postpartum Hemorrhage: A Fertility-Preserving Alternative to Emergency Hysterectomy

Abstract

Bilateral iliac artery ligation is an effective second-line procedure to control massive obstetric and gynecological hemorrhage while preserving fertility, particularly in young women of low parity. It offers a fertility-preserving alternative to emergency obstetric hysterectomy and has also proven effective in managing secondary pelvic hemorrhage in gynecological operations. This descriptive case series, conducted at the Department of Obstetrics & Gynecology, Lady Willingdon Hospital, Lahore, over six months, included 90 women presenting with severe postpartum hemorrhage (PPH). The procedure involved a meticulous surgical technique, including retroperitoneal dissection and double ligation of the internal iliac artery without division. Antibiotics were administered to prevent infection, and patients were monitored postoperatively for 72 hours. The procedure was successful in 75 patients (83.33%) for controlling severe PPH, while 15 women (16.67%) required a hysterectomy. Among these, the most common causes for hysterectomy were trauma (46.7%), uterine atony (26.7%), and retained placenta (26.7%), with no statistically significant association between the cause of PPH and the need for hysterectomy (p-value = 0.864). The study demonstrated a low frequency of hysterectomy and highlighted the high efficacy of bilateral internal iliac artery ligation as a fertility-preserving intervention for managing severe PPH.