Bilateral hypogastric artery ligation in emergency setting for intractable postpartum hemorrhage: a secondary care center experience

Objective: To report the authors' experience in bilateral hypogastric (internal iliac) artery ligation which was performed for controlling intractable postpartum hemorrhage in a secondary care center. Materials and Methods: The patients that required bilateral hypogastric artery ligation for severe intractable postpartum hemorrhage from November 2007 to August 2009 were included in this retrospective study. Data were retrieved from patients' hospital records. Results: A total of 26 cases required hypogastric artery ligation during the study period. Causes of postpartum hemorrhage included uterine atony, placental abruption, uterine rupture, and placenta accreta. Hemorrhage was effectively controlled in 20 of 26 cases (76.9%) and hysterectomy was avoided. Iliac vein injury occurred in one patient (3.8%) as an operative complication. There was one maternal death. Conclusion: Hypogastric artery ligation is an effective therapeutic option for severe postpartum hemorrhage and should be kept in mind during obstetric emergency conditions.