Abstract
Aim
To study the outcomes, benefits and complications of internal iliac artery ligation in both obstetric and gynecological cases.
Objective
To study the outcomes, effectiveness and complications of internal iliac artery ligation (IIAL).
Method
This is an analytical longitudinal study done among women who have undergone internal iliac artery ligation in Dr. BRAMH a tertiary referral center from July 2013 to June 2015. Follow-up was done through color Doppler analysis of pelvic arteries before discharge, after 6 weeks and after 6 months.
Result
The efficacy of IIAL was 96.87 %. The mean shock index was 0.94 ± 0.26. Sixty-four women underwent IIAL out of which placenta previa (21.8 %) was the major indication. There were four maternal deaths. There were no intraoperative or ischemic complications. The greater the time interval between onset of hemorrhage and IIAL, the graver the outcome. For all women in whom uterus could be salvaged, resumption of menstrual cycles was seen within 6 months of IIAL. There was a significant decrease in the RI and PI of uterine arteries. In the ovarian arteries, there was a significant increase in RI and no significant change in PI initially. Flow in distal part of ligated internal iliac arteries could be detected in 54 (90 %) women out of 60 after 6 months of ligation of internal iliac arteries.
Conclusion
IIAL is an effective life-saving method to control obstetric and gynecological hemorrhage, and a hysterectomy can often be avoided. Early resort to IIAL is vital for improving the patient outcome. Uterine perfusion is well maintained, while there may be a decrease in ovarian perfusion. Resumption of menstrual cycles and presence of distal flow in internal iliac artery within 6 months suggest the preservation of future fertility; in order to better understand the impact of IIAL on ovarian functions and future fertility, larger studies with longer follow-up periods need to be conducted.
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References
Mukhopadhyay P, Naskar T, Hazra S, et al. Emergency internal iliac artery ligation still a life saving procedure. J Obstet Gynecol India. 2005;55(2):144–5.
Burchell RC. Physiology of internal iliac artery ligation. J Obstet Gynae Brit Cwlth. 1968;75:642–51.
Vedantham S, Godwin SC. McLucas, et al. Uterine artery embolization: an underused method of controlling haemorrhage. Am J Obstet Gynecol. 1997;176:938–48.
Kalburgi EB, et al. Emergency bilateral internal iliac artery ligation - a hospital based cross sectional study. J Clin Diagn Res. 2012;6(7):1223–5.
Simsek Y, Yilmaz E, Celik E, et al. Efficacy of internal iliac artery ligation on the management of postpartum hemorrhage and its impact on the ovarian reserve. J Turk Soc Obstet Gynecol. 2012;9(3):153–8.
Patil Y, Kathiriya D, Kshirsagar NS, et al. Role of Internal Iliac Artery Ligation in Control of Pelvic Haemorrhage. Int J Recent Trends Sci Technol. 2014;9(3):461–4.
Naithani V, Solanki J. Bilateral internal iliac artery ligation-a boon for severe post partum hemorrhage. J Evol Med Dent Sci. 2013;2(9):4.
Domingo S, Perales-Puchalt A, Soler I, et al. Clinical outcome, fertility and uterine artery Doppler scans in women with obstetric bilateral internal iliac artery ligation or embolisation. J Obstet Gynaecol. 2013;33(7):701–4.
Cannon CM, Braxton CC, Kling-Smith M, et al. Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma. 2009;67:1426–30.
Birkhahn RH, Gaeta TJ, Van Deusen SK, et al. The ability of traditional vital signs and shock index to identify ruptured ectopic pregnancy. Am J Obstet Gynecol. 2003;189:1293–6.
Joshi V, Otiv S, Majumder R, et al. Internal iliac artery ligation for arresting postpartum haemorrhage. BJOG. 2007;114:356–61.
Perveen F, Memon GU, Rabia S. Use of bilateral internal iliac artery ligation for controlling severe obstetric haemorrhage. Pak J Med Sci. 2011;27(1):94–7.
Camuzcuoglu H, Toy H, Vural M, et al. Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy. J Obstet Gynaecol Res. 2006;36(3):538–43.
Papp Z, Tóth-Pál E, Cs P, et al. Hypogastric artery ligation for intractable pelvic hemorrhage. Int J Gynecol Obstet. 2006;92:27–31.
Abdel-Naby M, Youssry M, Ibrahim A, et al. Prophylactic internal Iliac artery ligation in cases of PPH due to Rupture Uterus (RCT). Bull Alex Fac Med. 2009;45(1):1–6.
Roy PK, Kharkwal KC, Das A, et al. Primary internal iliac artery ligation: An effective technique for surgical hemostasis in Wertheim’s hysterectomy. NJIRM. 2013;4(6):145–7.
Mandal D, Mandal S, Maity TK, et al. Role of hypogastric artery ligation in pelvic hemorrhage: is still alive. Al Ameen J Med Sci. 2013;6(1):12–6.
Gandhi R, Kadikar GK. Laceration of internal iliac vein during internal iliac artery ligation. Mayur Natl J Med Res. 2013;3(2):2014.
Evsen MS, et al. Internal Iliac Artery Ligation for Severe Postpartum Hemorrhage. Ginekol Pol. 2012;83:665–8.
Montgomery AL, Ram U, Kumar R, et al. For The Million Death Study Collaborators (2014) Maternal mortality in India: Causes and Healthcare Service Use Based on a Nationally Representative Survey. Jan 2014.
Nizard J, Barrinque L, Frydman R, et al. Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage. Hum Reprod. 2003;18(4):844–8.
Fu H-C, Huang K-H, Tseng C-W, et al. Comparison of clinical outcomes and spectral Doppler indices of uterine and ovarian stromal arteries in women undergoing myomectomy with or without hypogastric arterial ligation. Ultrasound Obstet Gynecol. 2006;28:831–6.
Yildirim Y, Gultekin E, Kocyigit A, et al. Color Doppler analysis of pelvic arteries following bilateral internal iliac artery ligation for severe postpartum hemorrhage. Int J Gynaecol Obstet. 2009;104(1):22–4.
Raba G, Baran P. Hemodynamic parameters following bilateral internal iliac arteries ligation as a treatment of intrapartum hemorrhage. Ginekol Pol. 2009;80(3):179–83.
Raba G. Unilateral recanalisation of hypogastric artery after ligation for postpartum haemorrhage treatment. Videosurgery Miniinv. 2014;9(2):289–91.
Khelifi A, Amamou K, Salem A, et al. Therapeutic ligature of hypogastric arteries: color Doppler follow-up. J Radiol. 2000;81:607–10.
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Abha Singh, Ruchi Kishore and Saveri Sarbhai Saxena declared that they have no conflict of interests.
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All procedures followed were in accordance with ethical standard of the responsible committee on human experiments (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
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Informed consent from human subjects was obtained.
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Dr. Abha Singh, Professor & HOD, M.B.B.S., M.S., F.I.C.S. (India), F.I.C.O.G. in a Department of Obstetrics and Gynecology, Pt. J.N.M. Medical College; Ruchi Kishore, Associate Professor in Department of Obstetrics and Gynecology, Pt. J.N.M. Medical College; Saveri Sarbhai Saxena, Third Year, P.G., in Department of Obstetrics and Gynecology, Pt. J.N.M. Medical College.
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Singh, A., Kishore, R. & Saxena, S.S. Ligating Internal Iliac Artery: Success beyond Hesitation. J Obstet Gynecol India 66 (Suppl 1), 235–241 (2016). https://doi.org/10.1007/s13224-016-0859-1
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DOI: https://doi.org/10.1007/s13224-016-0859-1