Abstract

Postpartum hemorrhage (PPH) is a common cause of maternal morbidity and mortality in developing countries. A large number of patients respond to standard medical and surgical treatment, but in some, these procedures fail to stop bleeding. As a last resort, the obstetrician has two options–hysterectomy or ligation of internal iliac arteries. Many patients want to retain uterus. Internal iliac artery ligation (IIAL) becomes the treatment of choice for them. This procedure needs to be taught to postgraduate (PG) students of Obstetrics–Gynecology. We suggest a structured teaching program so that students can learn the skills adequately. It consists of three steps: (1) IIAL on cadavers in anatomy lecture hall. (2) Exposure of internal iliac vessels during elective cesarean or abdominal hysterectomy. (3) Prophylactic IIAL in cases of placenta previa with antenatal diagnosis of placenta accreta. The inclusion of a vascular surgeon in the training faculty is of great help in learning the procedure properly, especially in preventing complications like an injury to an internal iliac vein or tackling the injuries, should these occur.

Authors and Affiliations