SURGICAL CONTROL OF OBSTETRIC HEMORRHAGE - HYPOGASTRIC ARTERY LIGATION OR HYSTERECTOMY

Sixty-four patients with severe postpartum hemorrhage (PPH) required surgical intervention during the years 1983 to 1987. Bilateral hypogastric artery ligation (HAL) was the initial surgical approach in 45% ( 29 64) and hysterectomy in 55% ( 35 64). HAL successfully controlled hemorrhage in 65% ( 19 29), and failed in 35% ( 10 29) where hysterectomy was required as a life saving procedure. Failure of HAL was more evident in atonic PPH than in other situations. Complications were more following hysterectomy; six ( 6 45) patients required re-exploration for intraperitoneal hemorrhage and two ( 2 45) patients died following hysterectomy. HAL was found to be a relatively easy, safe and successful procedure to be attempted as an initial surgical approach for all severe PPH, specially where uterine conservation was desired. © 1990.