Role of hypogastric artery ligation in obstetric and gynecological hemorrhage: narrative review

Hypogastric artery ligation (HAL) is a vital surgical intervention for controlling severe pelvic hemorrhage in obstetric and gynecological cases. This narrative review examines the efficacy, safety, and implications of HAL in managing life-threatening hemorrhages, including postpartum hemorrhage (PPH) and gynecological emergencies. HAL is particularly effective in addressing hemorrhage associated with uterine atony, placenta accreta spectrum disorders, and secondary bleeding following hysterectomy or gynecological surgeries. Success rates vary widely, ranging from 33.3% to 89.2%, depending on the indication and clinical scenario. HAL offers significant advantages in fertility preservation, especially in cases where uterine conservation is desired. The procedure has been shown to reduce arterial pulse pressure by 85% and overall blood flow by nearly 50%, enabling effective hemostasis. Despite these benefits, the success of HAL heavily depends on the surgeon's expertise and the timely identification of hemorrhage. While complications such as organ ischemia and collateral vessel injury are rare, their potential underscores the need for meticulous surgical technique and postoperative monitoring. The search strategy for this review included PubMed databases, focusing on articles published up to 2019 with keywords such as "Hypogastric Ligation," "hypogastric ligation gynecology," and "hypogastric ligation obstetric." A total of 262 studies were initially identified, with 8 meeting the inclusion criteria for detailed analysis. These studies highlight HAL's role as a fertility-sparing, cost-effective option for managing severe pelvic hemorrhage, making it an indispensable tool in obstetric and gynecological practice.