Surgical control of obstetric hemorrhage: hypogastric artery ligation or hysterectomy?

• Published in: International journal of gynecology and obstetrics Vol. 32; no. 4; pp. 345 - 351
• Main Authors: Chattopadhyay, S.K., Deb Roy, B., Edrees, Y.B.
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.08.1990; Elsevier Science
• Subjects: Adolescent; Adult; Arteries - surgery; Biological and medical sciences; Delivery. Postpartum. Lactation; Disorders; Female; Gynecology. Andrology. Obstetrics; Humans; Hysterectomy; Ligation; Medical sciences; Methods; Obstetric hemorrhage; Postpartum Hemorrhage - surgery; Pregnancy; Surgical approach; Obstetric hemorrhage; Surgical approach; Human; Puerperal disorders; Internal iliac artery; Ligature; Treatment; Surgery; Complication; Evolution; Female; Hysterectomy; Hemorrhage; Comparative study
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/0020-7292(90)90112-X

Sixty-four patients with severe postpartum hemorrhage (PPH) required surgical intervention during the years 1983 to 1987. Bilateral hypogastric artery ligation (HAL) was the initial surgical approach in 45% ( 29 64 ) and hysterectomy in 55% ( 35 64 ). HAL successfully controlled hemorrhage in 65% ( 19 29 ), and failed in 35% ( 10 29 ) where hysterectomy was required as a life saving procedure. Failure of HAL was more evident in atonic PPH than in other situations. Complications were more following hysterectomy; six ( 6 45 ) patients required re-exploration for intraperitoneal hemorrhage and two ( 2 45 ) patients died following hysterectomy. HAL was found to be a relatively easy, safe and successful procedure to be attempted as an initial surgical approach for all severe PPH, specially where uterine conservation was desired.