Internal iliac arteries ligation for intractable obstetrical hemorrhage in Africa

Objectives. Assess the efficiency of internal iliac arteries ligation in intractable obstetrical hemorrhage and ascertain success or failure factors.Patients and methods. It was a retrospective study which concerned 159 patients who underwent internal iliac arteries ligation for persistent and severe obstetrical hemorrhage from March 1992 to February 2007. Arrest of hemorrhage after ligation with survival of the patient was considered as successful; was considered as failure, persistence of hemorrhage in spite of the ligation or patient death. Results. Internal iliac arteries ligation allowed hemorrhage control in 84, 3%of cases. Main etiology of hemorrhage were: uterine atony (42,8%), abruptio placentae (31,4%). Coagulation disorders and hypovolemic shock, consequences of long delay of management were identified as bad prognosis factors. Blood transfusion was also singled out as a factor likely to ameliorate prognosis, especially in hemodynamic precarious situations. Surgical complications incidence was 1, 89%, represented by two internal iliac vein lesions and one ureteral section successfully repaired. Discussion and conclusion. Internal iliac arteries ligation is a prerequisite treatment of severe postpartum hemorrhage. The outcome is better when it is performed precociously (p = 0,0000003) before the happening of disseminated intra vascular coagulation (p = 0,006), hemodynamic troubles (p = 0,0099) and acute severe anemia (p = 0,02). It is a good alternative to arterial embolization in Africa. © 2009 Elsevier Masson SAS.