[Hypogastric artery ligation for post-partum hemorrhage]

Abstract

Post-partum hemorrhage is the leading cause of maternal mortality in Tunisia as in many other countries. In case of failure of medical measures, bilateral ligation of hypogastric arteries (BLHA) represents an interesting alternative to the hemostatic hysterectomy to preserve patients fertility.

Objective: Report our BLHA experience in the post-partum hemorrhage management.

Patients and methods: Retrospective study conducted between January 2001 and December 2008. We collected all the patients who had undergone a BLHA in case of post-partum haemorrhage.

Results: Fifty-seven BLHA were carried out during the study period. The success rate was 82.45%. The procedure failed in 10 patients. Most cases were uterine atony and placenta accreta. We reported one complication: a case of perioperative ligation of the primitive iliac artery. Surgical management was successful. Magnetic resonance imaging performed on average two months after surgery had shown a complete repermeabilization in seven cases among eight.

Conclusion: BLHA is an interesting and effective option in the management of severe post-partum hemorrhage. Technique learning is recommended especially in case of non availability of uterine artery embolization.