• Ramesh Shrestha, Sapana Shrestha, Sarita Sitaula, and Pritha Basnet.
• Department of Obstetrics and Gynaecology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
• JNMA J Nepal Med Assoc. 2020 Oct 15; 58 (230): 826-830.

AbstractPelvic hemorrhage is a major cause of maternal morbidity and mortality in developing countries. A sound clinical judgment, adequate assessment, and preparation of the patient are the best preoperative means to avoid its occurrence. Bilateral internal iliac artery ligation is a life-saving procedure to control massive obstetric and gynecological hemorrhage when other measures fail. This procedure significantly reduces the pulse pressure and rate of blood flow abolishing the‘triphammer effect’ of arterial pulsation and subsequently resulting in sluggish blood flow allowing effective thrombosis within the small bleeding vessels. This has helped to save many lives and uteruses for more than a century. No tissue necrosis occurs due to ample collateral circulation in the pelvis from the major pelvic anastomoses. An increased understanding of retroperitoneal anatomy and regional variations of the internal iliac artery is needed to reduce the risk of intraoperative and postoperative complications. Keywords: internal iliac artery ligation;operative complications;pelvic anastomoses;pelvic hemorrhage;retroperitoneal anatomy.

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