Efficacy of internal iliac artery ligation on the management of postpartum hemorrhage and its impact on ovarian reserve

Abstract

Aim: Time of surgical treatment for postpartum hemorrhage, still being the most important cause of maternal mortality in the developing countries, could be lifesaving. In the present report, the results of bilateral internal iliac artery ligation in cases with postpartum hemorrhage were presented, in addition, the impact of the procedure on ovarian reserve were discussed. Design and patients: Patients who gave birth between August 2010 and August 2011 in our center, treated surgically due to a diagnosis of postpartum hemorrhage were retrospectively examined. Setting: A tertiary referral center Main outcome measures: The obstetric and demographic characteristics, applied surgical procedures, the need for intensive care unit, the amount of transfusion, length of hospital stay and associated morbidities and mortalities were evaluated. Postpartum concentrations of follicle stimulation hormone (FSH) and estradiol with ovarian volume calculated by ultrasonography to evaluate the impact of procedure on ovarian reserve were also examined anc compared normal controls. Results: The prevalence of postpartum hemorrhage requiring a surgical treatment was 12.5% during the period of study. Thirteen of those underwent the ligation of bilateral internal iliac artery. The mean age of 32 (24 44), mean gravida 3,2 (1 5), mean parity 2 (0 4), mean birth week 38 (35 41) and mean birth weight were 3373 g (2500 4200). The effectiveness of bilateral internal iliac artery ligation was 84,7%. FSH and estradiol concentrations and the mean volume of the ovaries were similar between the study (n:10) and control (n:56) groups (P= 0.650, P= 0.245 and P=0.281, respectively). Conclusion: The ligation of bilateral iliac artery, a fertility preserving method, possess high efficacy for the management of postpartum hemorrhage. The ovarian reserves of patients were not adversely affected by the surgical procedure, as well.