Bilateral Internal Iliac Artery Ligation and its Role in Reducing Maternal Mortality

Abstract

Background: Post-partum hemorrhage (PPH) is a common complication, seen following 2-4% vaginal deliveries and 6% of caesarean sections. 35% of maternal mortality worldwide (1) and 38% of maternal mortality in India can be attributed to PPH. Material and Methods: Women who had B/L IIAL over a period of 1year 2021 at Dr. VVP Pravara Rural Hospital, Loni were reviewed retrospectively. Patients were identified using hospital records and operation theatre registers. Clinical history, routine blood investigations, patient demographic data including age, parity, mode of delivery and surgical outcome with complications of procedure were noted. Results: A total of 30 PPH deliveries were conducted during the year 2021. most common indication for B/L IIAL was PPH, seen in 26 out of 30 cases (86.6%) followed by 3 cases of placenta accreta spectrum (1%) and 1 (0.3%) with gynecological complication. Of the 30 cases requiring B/L internal iliac ligation, 9 (30%) were primigravida, 3 (10%) second gravida and 18 (60%) multiparas with 2 or more prior deliveries. Of the 5 cases further requiring obstetric hysterectomy, 2 were second gravidas and 2 multiparas. Conclusion: The ligation of the internal iliac artery as a procedure to stop pelvic hemorrhage is not practiced as commonly as it should be. However, it is safe and effective method to control massive pelvic hemorrhage in experienced hands.