Emergency bilateral internal iliac artery ligation in massive obstetric haemorrhage: 5 years experience At Tertiary Care Hospital.

Abstract

Objectives: To study the efficacy and safety of emergency bilateral internal iliac artery ligation (BIAL) in arresting massive obstetric haemorrahge. Study Design: Retrospective study. Setting: Department of Obstetrics and Gynaecology Unit-I, Allied Hospital, Faisalabad. Period: January 2014 to December 2018. Material & Methods: Fifty eight (58) patients with obstetric haemorrhage were included in this retrospective study. Bilateral internal iliac artery ligation was performed to control massive postpartum haemorrhage, post-operative internal haemorrhage. Results: The fifty eight (58) women underwent BIAl. Booked cases were onlhy (27%) and (73%) were unbooked. Out of 58 women 16(27%) women were with morbid adherent placenta, 14(24%) with uterine atony, 11(19%) uterine rupture, 9(17%) post-operative internal haemorrhage and 8(13%) coagulopathy were underwent BIAL. Out of 58 women 15(36%) ended in hysterectomy because of failure to control bleeding and uterus preserved in (64%). Overall efficacy in term of saving maternal life was 90%. One women had ureteric injury that was managed by Urologist. One another patient required re-laparotomy for persistant internal haemorrahge. Conclusion: Bilateral internal iliac artery ligation is safe and effective technique to control massive obstetric haemorrhage. Timely decision is also important to prevent hysterectomy. BIAL should include in algorithm to control intractable obstetric haemorrhage and consultant obstetricians and gynaecologist should learn that technique.