Evaluation of surgical hemostasis in massive obstetric hemorrhage and its outcomes.

Оценка хирургического гемостаза при массивных акушерских кровотечениях и его исходы.
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 3, Issue 33, pp. 22-28.
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The aim: to evaluate the effectiveness of the internal iliac artery ligation to stop severe obstetric hemorrhage and opportunities organ-preserving surgery in critical situations.
Methods. In our studies, we analyzed 216 cases of ligation of internal iliac arteries (IIAL) in women with severe obstetric hemorrhage in the provision of emergency obstetric care (EmOC) during the period 2004-2013years in maternity care hospitals of the Kyrgyz Republic. According to the outcome of operations cases were divided into two groups: a) Group 1 - 111 cases, which were finished by hysterectomy followed ligation of internal iliac arteries. b) Group 2 - 105 cases where it was possible to use organ-preserving surgery.
Results. Ligation of the internal iliac arteries in women with severe obstetric hemorrhage were allow for preserve uterus:  in premature detachment of the placenta - in 69.6% (32 women); Postpartum hemorrhage (hypotonic bleeding) - 58.3% (35 women); traumatic injuries of the uterus - 55.2% of cases (16 women). As a result, hysterectomies were avoided in 48.6% of cases (105 out of 216 woman) during pregnancy and delivery.
Conclusion. Ligation of internal iliac arteries is one of the effective methods of stopping the massive obstetric hemorrhage, thus preserving the uterus.


Makenjan uulu A. Evaluation of surgical hemostasis in massive obstetric hemorrhage and its outcomes.. Journal of Clinical Medicine of Kazakhstan. 2014;3(33):22-8.


  • Cantwell R., Clutton-Brock T., Cooper G., et al. Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer, 2006–08. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom // BJOG. -2011. - Vol.118. - P.1–203.
  • Driessen M., Bouvier-Colle M.H., Dupont C., et al. Postpartum haemorrhage resulting from uterine atony after vaginal delivery; factors associated with severity // Obstet Gynecol. -2011. - Vol.117. - P.21-31.
  • Souza J.P., Gulmezoglu A.M., Vogel J., et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study // Lancet. -2013. -Vol.381. - P.1747-1755.
  • Khalid S., Khan D., Wojdyla L., et al. WHO analysis of causes of maternal death: a systematic review // Lancet. -2006.- Vol.367.- P. 1066-74.
  • Macphail S., Talks K. Massive post-partum haemorrhage and management of disseminated intravascular coagulation // Curr Obstet Gyn. -2004.- Vol.14(2).- P.123-31.
  • Abdel-Aleem H., Singata M., Abdel-Aleem M., et al. Uterine massage to reduce postpartum hemorrhage after vaginal delivery // Int. J. Gynaecol Obstet. -2010. - Vol. 111(1). - P.32-6.
  • Henrich W., Surbek D., Kainer F., et al. Diagnosis and treatment of peripartum bleeding // J. Perinat Med. -2008. - Vol. 36(6). - P.467-78.
  • Knight M. Appendix 2A: Summary of United Kingdom Obstetric Surveillance System (UKOSS) Report on near-miss studies. In Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the UK // BJOG. -2011. - Vol.118(1). - P.191-195.
  • Vazquez J.A., Rivera G.V., Higareda S.H. et al. Obstetric hysterectomy. Incidence, indications and complications // Gynecol. Obstet. Mex. – 2008. – Vol. 76 (3). – P. 156–160.
  • Smith J., Mousa H.A. Peripartum hysterecomy for primary postpartum haemorrhage: In Medence and material morbidity // J. Obst Gynecol. – 2007.-Vol. 27. – P. 44-47.
  • Knight M., Spark P., Kurinczuk J., Brocklehurst P. Peripartum hysterectomy in the UK: outcomes and management of assoДИated haemorrhage// Int. J. Obstet. Anaesth. – 2006. – Vol. 15. - S. 8
  • Sentilhes L., Gromez A., Trichot C., et al. Fertility after B-Lynch suture and stepwise uterine devascularization// Fertil Steril.- 2009.- Vol.91(3). –P.934. e5-9
  • Cardone A., Zarcone R., Visconti S., et al. A new uterine suture technique for postpartum hemorrhage // Minerva Ginecol.- 2007. Jun. –Vol.59(3). –P.343-6.
  • Kirby J.M., Kachura J.R., Rajan D.K., et al. Arterial embolization for primary postpartum hemorrhage // J.Vasc Interv Radiol. -2009.–Vol.(8). –P.1036-45.
  • Delotte J., Novellas S., Koh C., et al. Obstetrical prognosis and pregnancy outcome following pelvic arterial embolisation for post-partum hemorrhage // Eur J Obstet Gynecol Reprod Biol. -2009. - Vol.145.- P.129–132.
  • Irion O., Terraz S., Boulvain M., et al. Postpartum hemmorhage: prevention and treatment by arterial embolization and activated recombinant factor VII // Rev Med Suisse. - 2008. - Vol. 4(176).- P.2269-70; 2272; 2274-5.
  • Papp Z., Тоth-Pal E., Papp C., et al. Hypogastric artery ligation for intractable pelvic hemorrhage // Int J Gynaecol Obstet. -2006.- Vol.92(1). –P. 27-31.
  • Kone M., Konan Ble R., Seni K., et al. Internal iliac arteries ligation for intractable obstetrical hemorrhage in Africa//Gynecol Obstet Fertil. -2009. Jun. - Vol.7(6). -P.476-80.
  • Kelly H.A. Ligation of both internal iliac arteries for hemorrhage in hysterectomy for carcinoma uteri // Bull Johns Hopkins Hosp. -1894.-Vol.5. –P.534.
  • Quenu E., Duval P. Ligature bilaterale de l’artere hypogastrique par voie transperitoneale // Rev Chir. -1898. –Vol.18. P.979-92.
  • Reich W.J., Nechtow M.J. Ligation of the internal iliac (hypogastric) arteries: a life-saving procedure for uncontrollable gynecologic and obstetric hemorrhage // J. Internat Coll Surgeons. -1961.-Vol.36. –P.157-68.
  • Sagarra M., Glasser T., Stone M.L. Ligation of the internal iliac vessels in the control of post-partum hemorrhage. A case report // Obstet Gynecol.- 1960.-Vol.15. –P.698-701.
  • Seigel P., Mengert W.F. Internal iliac artery ligation in obstetrics and gynecology // J. Am Med Assoc.- 1961. - Vol.178. - P.1059-62.
  • Clark S.L., Phelan J.P., Yeh S.Y., et al. Hypograstric artery ligation for obstetric hemorrhage // Obstet Gynecol. -1986. –Vol.66. - P.35-36.
  • Cruikshank S.H., Stoelk E.M. Surgical control of pelvic hemorrhage: bilateral hypogastric artery ligation and method of ovarian artery ligation // South Med. J.-1985. –Vol.78. -P.539-43.
  • Evans S., McShane P. The efficacy of internal iliac artery ligation in obstetrics hemorrhage // Surg Gynecol Obstet. -1985. -Vol.160. -P.250-3.
  • Joshi V.M, Otiv S.R., Majumder R., et al. Internal iliac artery ligation for arresting postpartum haemorrhage // BJOG. -2007. -Vol.114 (3). -P.356-361.
  • Wise A., Clark V. Challenges of major obstetric hemorrhage // Best Practice & Research Clinical Obstet. and Gynaec.- 2010. - Vol.24. -P.353–365.
  • Istvan S., Petronella H., Papp Z. Hypogastric artery ligation for severe hemorrhage in obstetric patients Save // Journal of Perinatal Medicine. -2007.- Vol.35 (3). – P.187-192.
  • Бреслав И.Ю. Перевязка внутренних подвздошных артерий в лечении массивных акушерских кровотечений: Автореф. дис. … канд. мед. наук. М.; 2009. - 25 с. 
  • Курцер М.А., Панин A.B., Сущевич Л.В., и др. Перевязка внутренних подвздошных артерий как альтернатива гистерэктомии при массивных акушерских кровотечениях // Акуш. и гин. – 2005.- №4 - С. 12-15.
  • Mukherjee S., Arulkumaran S. Post-partum haemorrhage // Obstet Gynaecol Reprod Med. – 2009. – Vol. 19. – Р.121–126.
  • Orhan U., Bulent K., Esra Esim B., et al. The effectiveness of bilateral hypogastric artery ligation for obstetric hemorrhage in three different underlying conditions and its impact on future fertility //Journal of Maternal-Fetal and Neonatal Medicine. - 2011. – Vol.24 (10). - P.1273-1276.
  • Mathlouthi N., Ben Ayed B., Dhouib M., et al. Ligation of internal iliac arteries for severe hemorrhage in obstetric // La Tunisie Medicale. – 2012. - Vol. 90 (03). – Р.248 – 252.
  • Naithani V., Solanki J. Bilateral internal iliac artery ligation-a boon for severe post partum hemorrhage // Journal of Evolution of Medical and Dental Sciences. - 2013. – Vol.2 (9) - P.1022-26.
  • Ledee N., Ville Y., Musset D., et al. Management in intractable obstetric hemorrhage: an audit stiudy on 61 cases // Eur J Obstet Gynecol Reprod Biol. – 2001. – Vol.94. – P.189-96.