EFFICACY OF EMERGENCY INTERNAL ILIAC ARTERY LIGATION IN CONTROLLING POST PARTUM HEMORRHAGE

Abstract

Objective: 

To evaluate the efficacy of emergency bilateral internal iliac artery ligation (BIIAL) in controlling severe postpartum hemorrhage (PPH) refractory to medical management.

Methods: 

This prospective, single-center interventional case series enrolled 150 women with severe PPH over six months. All patients underwent emergency BIIAL after the failure of standard conservative measures. The primary outcome was successful control of hemorrhage without the need for further major surgical intervention (hysterectomy or embolization) within 24 hours.

Results: 

BIIAL successfully controlled hemorrhage in 142 of 150 patients, yielding a success rate of 94.7%. In 8 cases (5.3%), the procedure failed, necessitating an emergency peripartum hysterectomy. The maternal mortality rate was 1.3%. Procedure-related complications occurred in 3.3% of cases. Subgroup analysis revealed no significant difference in success rates based on the mode of delivery (cesarean vs. vaginal) or the timing of the ligation. Multivariate analysis identified placenta accreta spectrum as a significant independent predictor of procedure failure (Adjusted Odds Ratio = 4.8; 95% CI: 1.2 - 19.5; p=0.03).

Conclusion: 

Emergency bilateral internal iliac artery ligation is a highly effective and fertility-preserving surgical intervention for controlling refractory postpartum hemorrhage, with a high success rate and an acceptable safety profile. It serves as a critical life-saving procedure, especially in settings where interventional radiology is unavailable.