Role of Internal Iliac Artery Ligation in the Surgical Management of Intractable Obstetric Hemorrhage in a Tertiary Hospital: A Retrospective Single-center Observational Study

Aim: To evaluate the efficacy and safety of internal iliac artery ligation (IIAL) in the management of intractable obstetric hemorrhage.Materials and methods: Twenty four out of 59 patients of intractable obstetric hemorrhage who were managed with bilateral IIAL from October 2023 to December 2024 at a tertiary care hospital were included in this retrospective cohort study.The study included bilateral IIAL as the primary surgical maneuver in 17 patients of severe postpartum hemorrhage (PPH) and as an adjunct to cesarean hysterectomy in 7 women.Results: Seventeen women underwent bilateral IIAL as the primary surgical intervention due to atonic PPH (n = 5), placenta previa (n = 5), placenta accreta syndrome (PAS) (n = 3), rupture uterus (n = 2) and abruptio placenta (n = 2).Three patients with atonic PPH also underwent simultaneous stepwise devascularization, with a B-Lynch suture used in one of them.Balloon tamponade (Bakri balloon) was used in one patient with placenta previa.One patient with PAS needed compression sutures for more effective hemostasis.However, two patients with varying degree of PAS had to undergo cesarean hysterectomy inspite of IIAL due to uncontrollable PPH.Bilateral IIAL was used as an adjunct to cesarean hysterectomy in seven women with placenta increta/percreta or nonsalvageable rupture uterus due to severe persistent hemorrhage even after cesarean hysterectomy.There was one case of maternal mortality.The greater the time interval between the onset of bleeding and IIAL, the worse was the prognosis.There were no intraoperative or postoperative complications related to the procedure.In all women where IIAL was performed as a uterine sparing surgery, the menstrual cycle resumed within 6 months of IIAL.Conclusion: Bilateral IIAL is an effective, life-saving procedure to arrest intractable obstetric hemorrhage and also persistent hemorrhage after postpartum hysterectomy.As no extensive equipment is required, a little surgical expertise to perform IIAL gives much better clinical outcome.Resorting early to IIAL is essential for a good maternal prognosis.Such patients needed fewer blood transfusions, lesser ionotropic support, and shorter hospital stay.This significantly decreased the maternal morbidity and mortality and is a boon in developing countries.