Effect of internal iliac artery ligation on sonographic blood changes in the uterine arteries: A case-control study in women with postpartum hemorrhage in sub-Saharan Africa

Abstract

ObjectiveInternal iliac artery ligation due to severe postpartum hemorrhage has several pathophysiological consequences in terms of blood supply of the uterus. In this context, this study aimed to evaluate the sonographic changes in the uterine arteries after internal iliac artery ligation.MethodsThe population of this case-control study consisted of women unresponsive to conservative medical treatment who underwent internal iliac artery ligation for severe postpartum hemorrhage between January 2022 and December 2022. Women who underwent internal iliac artery ligation were included in the internal iliac artery ligation group, and those with similar postpartum age, parity, and body mass index were included in the control group. This retrospective case-control study included 62 patients with postpartum hemorrhage and ongoing bleeding despite all conservative medical treatments who underwent internal iliac artery ligation as well as 86 patients who were also in the postpartum period and had similar age, body mass index, and parity but did not have a history of postpartum hemorrhage at birth and did not undergo internal iliac artery ligation. The pulsatility index, resistance index, and maximal-to-minimal diastolic flow of the uterine arteries were calculated using color and pulsed Doppler imaging at the 6-month follow-up and compared between the two groups.ResultsThere were 62 and 86 women in the internal iliac artery ligation and control groups, respectively. There was no significant difference between the two groups in terms of demographic and clinical characteristics and obstetric history (p > 0.05). There was also no significant difference between the two groups in terms of the pulsatility index, resistance index, and maximal-to-minimal diastolic flow of the uterine arteries determined at the 6-month follow-up (p > 0.05).ConclusionThe study's findings demonstrated that internal iliac artery ligation has no adverse effect on the sonographic blood flow indexes of the uterine arteries in women with postpartum hemorrhage.

Keywords: Doppler ultrasound imaging; Postpartum hemorrhage; internal iliac artery; ligation; uterine artery.

Figure 1.

Doppler blood flow metrics of the uterine arteries at 6-month follow-up. The panel illustrates the median values with range (min–max) for the pulsatility index (PI), resistance index (RI), and maximal-to-minimal diastolic flow (S/D) for both the internal iliac artery ligation (IIAL) and control groups.