Modeling Surgical Management of Uterine Atony Induced Postpartum Hemorrhage using Cadaver Dissection

Abstract

IntroductionThere is a well‐documented disconnect that medical students experience when applying preclinical anatomical knowledge to clinical applications.1 According to the United States National Inpatient Sample, postpartum hemorrhage (PPH) carries an overall incidence of up to 3% of all U.S. deliveries; this study designates uterine atony as the most common etiology of PPH, causing at least 80% of PPH cases.2Thus, fourth year medical students preparing to enter into the specialty of obstetrics and gynecology should have in vivo exposure to the surgical management of uterine atony induced PPH prior to beginning residency. Modeling arterial ligation of the anterior division of the internal iliac artery using a cadaver model is a practical approach that most resembles an in vivo illustration of PPH surgical management while also maintaining a safe, controlled environment.ObjectiveIn efforts to provide fourth year medical students with exposure to PPH management, create a guide for ligation of the internal iliac artery’s anterior division using a cadaver model.Material and MethodsDissection was completed by two fourth year HWCOM medical students anticipating entry into the specialty of obstetrics and gynecology. After completion of anterior abdominal wall dissection and peritoneal entry, GI organ were retracted for full visualization of genitourinary structures. The following arteries were identified and skeletonized in the following fashion: common iliac artery, internal iliac artery, anterior division of the internal iliac artery, umbilical artery, obturator artery, and uterine artery. The anterior division of the internal iliac artery was identified and ligated 2 cm below the bifurcation of the common iliac artery to avoid unintentional ligation of the superior gluteal artery. A picture of the arterial ligation site was captured.Results/ImagesProper arterial ligation site of the internal iliac artery’s anterior division can be visualized in the appendix.Conclusion and Significance/ImplicationSurgical management of PPH requires both anatomical knowledge of arterial and pelvic anatomy but also spatial familiarity of structures in vivo. Performing the surgical management of PPH on a cadaver model could provide fourth year medical students an opportunity to learn the appropriate sites and steps and surgical arterial ligation in a less pressured environment before entering residency. Future implications of this study could combine virtual learning tools, such as anatomy mobile applications, to further aid in medical education’s exposure to PPH management and associated anatomy.