Dr Malay Sarkar, Dr Dibyendu Roy, Dr Jaydeb Mandal


BACKGROUND: Post partum haemorrhage (PPH) is one of the major causes of maternal death in our country.
Hystrectomy operation is frequently done in the management of intractable PPH.
OBJECTIVES : Study of the role of internal iliac artery ligation in intractable PPH with preservation of Reproductive
METHODOLOGY: This observational cross sectional study was conducted in our institution for a period of three years
with total 49991 delivery patients . Total patients underwent bilateral internal iliac artery ligation (BIIAL ) were 29.
Obstetric haemorrhage after 28 weeks pregnancy and haemorrhage refractory to medical therapy were included and
obstetric haemorrhage before 28 weeks and haemorrhage due to coagulopathy were excluded.
RESULTS: Before operation all 29 BIIAL patients were haemodynamically unstable. Out of 29 patients , four of them
needed another operation, among four two needed hysterectomy, two needed bilateral ovarian artery ligation, success
rate was 86.2%, one patient died of irreversible shock and ARF. Bleeding arrested by BIIAL did not require later
laparotomy in any woman.
CONCLUSION: BIIAL is a valuable procedure for the treatment of PPH. It is essential for the preservation and
maintainance of fertility. It can be reliably used in all cases of intractable PPH. All obstetrician should familiar themselves
with this procedure and lower their threshold for its use in emergency situations.


Bilateral Internal Iliac Artery Ligation, PPH, Hysterectomy, Obstetric Haemorrhage

Full Text:



Khan KS Woidyla D, Say L, Glumezoglu A M, Vanlook PF. WHO analysis of causes of maternal death : a systemic review. Lancet 2006; 36 : 1066-74.

Wagaarachhi PT Fernando L. Fertility following ligation of internal iliac arteries for life threatening obstetric haemorrgage. Hum Rerod. 2000; 15: 1311-3.

Burchell Rc. Physiology of internal iliac artery ligation. J O bstet Gynec Brit Cwlth. 1968; 75: 642-651.

Sagarra M, Glasser S, Stone M. ligation of internal iliac vessels in the control of post partum haemorrhage. Case report Obstet Gynaecol. 1960; 15: 698-701.

Leede N, Ville Y, Musset O, Mericier F, Fryman, Fernandez. Management in intractable obstetric haemorrhage: an audit study on 61 cases. Eur J Obstt G ynaecol Reprod Bio. 2001; 942 (2): 189-96.

Joshi V, Otive S. Majumdar R, ikam y, Shrivastava M. Internal artery ligation for arresting postpartum haemorrhage. BJOG. 2007; 114: 356-361.

Iwata A Murayama Y, Itakura A. et al. Limitations of internal iliac artery ligation for the reduction of intraoperative haemorrhage during caesarean hysterectomy in cases of placenta previa acreta. J Obstet Gynaecoi Res. 2010; 36:254-259.

Chelli D, Boudaya F, Dimassi K, Gharbi B, Najjar I, Safar E. Hypogastric artery ligation for post partum haemorrhage. J Gynaecol Obstet Biol Reprod (Paris). 2010; 39(1) : 43-9.

Mukherjee P, Das C, Mukherjee G. Emergency internal iliac artery ligation for obstetrical and gynaecological haemorrhage. J Obstet Gynaecol India. 2002; 32: 147-149.

Rajaram P, Raghavan SS, Bupathy A, Balasubramanian SR, Haebeebullah S, Umadevi P. Internal iliac artery ligation in obstetrics and gynaecology. Ten years experience. Asia Oceania J Obstet Gynaecol 1993; 19(1): 71-5.

Atala C, Biotti M. ligation of interal iliac artery as treatment of haemorrhage in obstetrics and Gynaecology. Rev Chil Obstet Gynaecol 1993; 58(2) : 119-25.


  • There are currently no refbacks.