The efficacy of internal iliac artery ligation in obstetric hemorrhage

During 1966 to 1982, 18 patients with severe obstetric hemorrhage underwent hypogastric artery ligation at our institution. Eight of 14 patients or 57 per cent (excluding three pregnancies which were terminated and a planned cesarean hysterectomy) had failed hypogastric artery ligations necessitating hysterectomy. Placenta accreta accounted for six patients of whom three required a hysterectomy. Uterine laceration was the second largest cause of hemorrhage in five patients, all of whom required a hysterectomy after hypogastric artery ligation failed. Hypogastric artery ligation does have a specific role in the management of obstetric hemorrhage, but it is not without substantial risk of failure. The obstetrician should carefully weigh whether or not the patient can undergo a more conservative procedure at the expense of a delay in the definitive treatment of hemorrhage. The instances presented herein should aid the clinician in deciding what is appropriate management for acute obstetric hemorrhage.