Possibilities of ligation of Internal iliac artery in massive obstetric hemorrhage

Возможности перевязки внутренних подвздошных артерий при массивных акушерских кровотечениях.
Almaz Makenjan uulu 1 *
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1 Kyrgyz state medical academy by I.K.Akhunbaev, Bishkek, Kyrgyz Republic
* Corresponding Author
J CLIN MED KAZ, Volume 4, Issue 34, pp. 40-45.
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ABSTRACT

The aim of our research to study opportunities and effectiveness of the internal iliac artery ligation in the management of severe obstetric hemorrhage in the conditions of emergency obstetric care.
Methods. We analyzed 328 cases of emergency treatment of severe obstetric hemorrhage in the various levels of health facilities of the Kyrgyz Republic from January 2004 to December 2013. The control group comprised 149 cases of obstetric hemorrhage, which was produced by a hysterectomy as the primary surgical method to stop bleeding (traditional method). The main group - comprised 179 cases of hysterectomy combined with ligation of the internal iliac arteries. According to the methods used study was
divided into 2 subgroups. Subgroup 1A 68 cases where hysterectomy as a method of haemostasis was ineffective and subsequently ligation of internal iliac arteries was used to achieve definite haemostasis. Subgroup 1B 111 cases in which initially ligation of internal iliac arteries was used to stop haemorrhage and then a hysterectomy was used for medical reasons.
Results. The use of ligation of internal iliac arteries reduce the amount of intraoperative blood loss and improves the final outcome of an emergency situation. In the main group there was no patient mortality. In the control group mortality was 34.2% of all cases. The cause of death is mainly due to uncontrolled bleeding and the development of multiple organ system failure.
Conclusion. Timely internal iliac artery ligation is an effective method to combat the massive blood loss, and reduces the amount of additional blood loss.
Keywords: hysterectomy, massive obstetric hemorrhage, bilateral ligation of the internal iliac arteries

CITATION

Makenjan uulu A. Possibilities of ligation of Internal iliac artery in massive obstetric hemorrhage. Journal of Clinical Medicine of Kazakhstan. 2014;4(34):40-5.

REFERENCES

  • The World Health Report 2005: Make Every Mother and Child Count, World Health Organization,Geneva, Switzerland: WHO Press, 2005, 62 p.
  • Baudo F., Caimi T.M., Mostarda G., et al. Critical bleeding in pregnancy: a novel therapeutic approach to bleeding, Minerva Anestesiol, 2006, No. 72 (6), pp. 389-393.
  • Berg C.J., Harper M.A., Atkinson S.M., et al. Preventability of pregnancy-related deaths. Results of a state-wide review, Obstet Gynecol, 2005, No. 106, pp. 1228-1234.
  • Papp Z., Тоth-Pal E., Papp C., et al. Hypogastric artery ligation for intractable pelvic hemorrhage, Int J Gynaecol Obstet, 2006, No. 92 (1), pp. 27-31.
  • Shah M., Wright J.D. Surgical intervention in the management of postpartum haemorrhage, Semin Perinatol, 2009, No.33, pp. 109-114.
  • Garcia Lopez A., Martinez Aguirre R.R., Hernandez Romero F., et al. Hypogastric artery ligation. Safety and efficacy of a training program, Ginecol Obstet Mex, 2001, No. 69, pp. 443–448.
  • Burchell R.C. Physiology of internal iliac artery ligation, J Obstet Gynaecol Br Common, 1968, No. 72, pp. 642-651.
  • Burchel R.C. Internal iliac artery ligation: hemodynamics, Am J Obstet Gynecol, 1964, No. 24, pp. 73-79.
  • Burchell R.C., Olson G. Internal iliac artery ligation: aortograms, Obstet Gynecol, 1966, No. 94, pp. 117-124.
  • Doumouchtsis, S.K., Papageoghiou A.T., Arulkumaran S. Systematic review of conservative management of postpartum haemorrhage: what to do when medical treatment fails, Obstet Gynecol Surv, 2007, No. 62, pp. 540–547.
  • Paraskevaid E., Noelkel A. Internal iliac artery ligation in obstetrics gynecology, Eur. J. Obstet. Report Biol, 1993, No. 52, pp. 71-75.
  • Tajes R.V. Ligation of the hypo gastric arteries and its complications inthe resection of cancer of the rectum, Am J Gasteroentrol, 1956, No. 26, pp. 612-616.
  • Breslav I.Ju. Perevjazka vnutrennih podvzdoshnyh arterij v lechenii massivnyh akusherskih krovotechenij (Perevyazka the inner iliac arteries in obstetric bleeding Treatment), Avtoref. dis. … kand. med. nauk, Moskva, 2009, 25 p.
  • Refaie W., Fawzy M., Shabana A. Prophylactic bilateral internal iliac artery ligation for management of low-lying placenta accreta: a prospective study, Tanta Med J., 2014, No. 42, pp. 146-150.