Uterine Artery Ligation in Postpartum Haemorrhage

Abstract

Background. Postpartum haemorrhage (PPH) is still the single biggest reason women die in childbirth. About a quarter of maternal deaths in the world are caused by it, and almost all of these deaths happen in poor and middle-income countries. When uterotonics, tranexamic acid and balloon tamponade fail to stop the bleeding, the surgeon has to act quickly. Uterine artery ligation (UAL), first described by O'Leary in 1966, is one of the oldest yet most useful surgical options available in such an emergency. Objective. This review looks at the role of uterine artery ligation in the modern management of PPH. The technique, indications, success rates, complications and long-term reproductive outcome are discussed, along with a comparison against internal iliac artery ligation and uterine artery embolization. Methods. A narrative review was carried out using PubMed, Google Scholar and the Cochrane Library. Articles published in English from 2000 onwards were screened. Guidelines from FIGO, WHO, RCOG and ACOG were also reviewed. Cohort studies, case series of more than ten patients, systematic reviews and meta-analyses were considered. Results. The success rate of bilateral UAL in stopping intractable PPH lies between 80 and 96 percent in most published series. Stepwise devascularization, in which ligation is extended in stages, raises this figure even further. Complications are rare. Doppler studies have shown that the ligated arteries recanalize within a few weeks and menstruation and fertility return to normal. Compared with internal iliac artery ligation, UAL is easier, faster and more effective. Conclusion. UAL deserves a clear place as the first surgical step in PPH that does not respond to medical treatment, especially in centres where interventional radiology is not available. Training young obstetricians in this simple procedure can lower the rate of peripartum hysterectomy and save lives.

Keywords. Postpartum haemorrhage; uterine artery ligation; O'Leary suture; uterine devascularization; maternal mortality.