Emergency bilateral internal iliac ligation for managing postpartum hemorrhage as life saving measure in private nursing homes in semi-urban settings

Abstract

A study of 30 cases that underwent emergency bilateral internal iliac artery ligation (EBIIAL) from June 2006 to April 2013 at private nursing homes, which can be best described as secondary level healthcare units, was undertaken to assess the efficacy and the outcome of the procedure in managing labors complicated by postpartum hemorrhage (PPH). The obstetricians managing the cases preferred to preserve the uterus for menstrual and future child bearing option and deferred obstetric hysterectomy. The procedure of embolization of uterine artery is available at tertiary care setups which are about 20 to 50 km away from the place of delivery requiring transfer of the parturient increasing the burden on the family and relatives of the parturient. EBIIAL done at the place where the parturient delivers has helped in stemming the transfers and preserving the menstrual and fertility options. The early diagnosis and recognition of failure of the uterotonic agents to control PPH helps in identifying those cases that would benefit from EBIIAL. This helps in reducing the inadvertent blood loss that occurs during atonic PPH and also minimizing the requirement for blood transfusions. In our study three parturient had to be transferred following EBIIAL for management of early disseminated intravascular coagulation (DIC) and one for diagnosing of associated Berger’s disease that was suspected after noticing temperature difference in the limbs following ligation of her iliac arteries.