Hypogastric artery ligation for obstetrical hemorrhage: clinical experiencein a tertiary care center

Background/aim: Several authorities advocate the use of hypogastric artery ligation (HAL) in the treatment of cases of obstetrical hemorrhage related to uterine atony or placenta accreta. We assessed the morbidity and mortality of patients who underwent HAL as a component of emergency procedures to control life-threatening uterine bleeding in a tertiary-care university hospital. Materials and methods: In this retrospective study, the clinical data of 24 eligible patients who underwent HAL between 2010 and 2013 in a university hospital to prevent or control severe uterine bleeding were collected and analyzed with regard to intraoperative and postoperative findings. Results: In the study population, there were nine patients with uterine atony managed without hysterectomy after HAL and there were 15 patients with placenta previa complicated with placenta accreta after HAL. Of these 15 patients, seven underwent hysterectomy and eight were managed without hysterectomy. Overall, the clinical features of the patients managed with or without hysterectomy were similar for patients with uterine atony and placenta previa. Conclusion: We suggest that if HAL is performed in a surgical setting as mentioned in this study, it may be a life-saving and fertility-sparing procedure.

Hypogastric artery ligation for obstetrical hemorrhage: clinical experiencein a tertiary care center

Background/aim: Several authorities advocate the use of hypogastric artery ligation (HAL) in the treatment of cases of obstetrical hemorrhage related to uterine atony or placenta accreta. We assessed the morbidity and mortality of patients who underwent HAL as a component of emergency procedures to control life-threatening uterine bleeding in a tertiary-care university hospital. Materials and methods: In this retrospective study, the clinical data of 24 eligible patients who underwent HAL between 2010 and 2013 in a university hospital to prevent or control severe uterine bleeding were collected and analyzed with regard to intraoperative and postoperative findings. Results: In the study population, there were nine patients with uterine atony managed without hysterectomy after HAL and there were 15 patients with placenta previa complicated with placenta accreta after HAL. Of these 15 patients, seven underwent hysterectomy and eight were managed without hysterectomy. Overall, the clinical features of the patients managed with or without hysterectomy were similar for patients with uterine atony and placenta previa. Conclusion: We suggest that if HAL is performed in a surgical setting as mentioned in this study, it may be a life-saving and fertility-sparing procedure.

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  • World Health Organization. Guidelines for Management of Postpartum Haemorrhage and Retained Placenta. Geneva, Switzerland: WHO, 2009. Available at http://apps.who.int/rhl/ archives/guideline_pphmanagement_kumars_com/en/index. html [accessed 12 August 2014].
  • Belfort MA. Overview of postpartum hemorrhage. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA, USA.
  • Doumouchtsis SK, Nikolopoulos K, Talaulikar V, Krishna A, Arulkumaran S. Menstrual and fertility outcomes following the surgical management of postpartum haemorrhage: a systematic review. BJOG 2014; 121: 382–388.
  • Sziller I, Hupuczi P, Papp Z. Hypogastric artery ligation for severe hemorrhage in obstetric patients. J Perinat Med 2007; 35: 187–192.
  • Çetin O, Şen C, Çetin İD, Uludağ S, Aydoğan B, Erenel H. Acil peripartum histerektomi olgularinin değerlendirilmesi: 5 yillik deneyim. Perinatoloji Dergisi 2011; 19: 76–80 (article in Turkish).
  • Yalınkaya A, Hakverdi AU, Ölmez G, Yalınkaya O, Yayla M. Acil peripartum histerektomi. Perinatoloji Dergisi 2004; 12: 123–127 (article in Turkish).
  • Turgut A, Sak ME, Özler A, Soydinç HE, Görük NY, Karaçor T, Yalınkaya A. Acil peripartum histerektomiler: 189 olgu deneyimimiz. Perinatoloji Dergisi 2013; 21: 113–118 (article in Turkish).
  • Morel O, Malartic C, Muhlstein J, Gayat E, Judlin P, Soyer P, Barranger E. Pelvic arterial ligations for severe post-partum hemorrhage. Indications and techniques. J Visc Surg 2011; 148: 95–102.
  • Porreco RP, Stettler RW. Surgical remedies for postpartum hemorrhage. Clin Obstet Gynecol 2010; 53: 182–195.
  • Sagarra M, Glasser ST, Stone M. Ligation of the internal iliac vessels in the control of postpartum hemorrhage: report of a case. Obstet Gynecol 1960; 15: 698–701.
  • Reich WJ, Nechtow MJ. Ligation of the internal iliac (hypogastric) arteries: a life-saving procedure for uncontrollable gynecologic and obstetric hemorrhage. J Int Coll Surg 1961; 36: 157–168.
  • Nizard J, Barrinque L, Frydman R, Fernandez H. Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage. Hum Reprod 2003; 18: 844– 848.
  • Sziller I, Hupuczi P, Papp Z. Hypogastric artery ligation for severe hemorrhage in obstetric patients. J Perinat Med 2007; 35: 187–192.
  • Şimşek Y, Yılmaz E, Çelik E, Türkçüoğlu I, Karaer A, Turhan U, Çelik O. Efficacy of internal iliac artery ligation on the management of postpartum hemorrhage and its impact on ovarian reserve. J Turk Soc Obstet Gynecol 2012; 9: 153–158.
  • Unal O, Kars B, Buyukbayrak EE, Karsidag AY, Turan C. The effectiveness of bilateral hypogastric artery ligation for obstetric hemorrhage in three different underlying conditions and its impact on future fertility. J Matern Fetal Neonatal Med 2011; 24: 1273–1276.
  • Iwata A, Murayama Y, Itakura A, Baba K, Seki H, Takeda S. Limitations of internal iliac artery ligation for the reduction of intraoperative hemorrhage during cesarean hysterectomy in cases of placenta previa accreta. J Obstet Gynaecol Res 2010; 36: 254–259.
  • Clark S, Koonings P, Phelan J. Placenta previa/accreta and prior cesarean section. Obstet Gynecol 1985; 66: 89–92.
  • Gielchinsky Y, Rojansky N, Fasouliotis S, Ezra Y. Placenta accreta: summary of 10 years: a survey of 310 cases. Placenta 2002; 23: 210–214.
  • Evsen MS, Sak ME, Soydine HE, Nur CF, Mehmet O, Gul T. Retrospective analysis of placenta accreta: management strategies – evaluation of 41 cases. Ginekol Pol 2012; 83: 501– 504.
  • Miller D, Chollet J, Goodwin T. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177: 210–214.
  • American College of Obstetricians and Gynecologists. Hemorrhagic Shock. ACOG Educational Bulletin 1997; No. 235.
  • Burchell RC, Olson G. Internal iliac artery ligation: aortograms. Am J Obstet Gynecol 1966; 94: 117– 124.
  • Pardini I. Abdominal-pelvico-femoral arterial circulation after ligation of the 2 hypogastric arteries and (in a second stage) of the left external iliac artery. Riv Ital Ginecol 1980; 59: 233–241.
  • Neve TE, Escalante MG, Tordecillas WM, Alfaro AM. Ligation of the hypogastric arteries: analysis of 400 cases. Ginecol Obstet Mex 1993; 61: 242–246.
  • Oleszczuk D, Cebulak K, Skret A, Palczak R. Long term observation of patients after bilateral ligation of internal iliac arteries. Ginekol Pol 1995; 66: 533–536.
  • Papp Z, Sztanyik L, Szabo I, Inovay J. Successful pregnancy after bilateral internal iliac artery ligation monitored by color doppler imaging. Ultrasound Obstet Gynecol 1996; 7: 211– 212.
  • Wagaarachchi PT, Fernando L. Fertility following ligation of internal iliac arteries for life-threatening obstetric haemorrhage. Hum Reprod 2000; 15: 1311–1313.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
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