Bilateral Ligation of the Anterior Branch of the Hypogastric Artery in Massive Obstetric Hemorrhage Secondary to Septic Abortion (Case Report)

Angel Millan Juarez; Carla America Suarez Juarez; Ana Elena Barrios Herandez; Ithamar Milagros Arroyo Martinez; Elizabeth Rendon Mondragon

doi:doi:10.11648/j.jgo.20210903.11

Bilateral Ligation of the Anterior Branch of the Hypogastric Artery in Massive Obstetric Hemorrhage Secondary to Septic Abortion (Case Report)

Angel Millan Juarez, Carla America Suarez Juarez, Ana Elena Barrios Herandez, Ithamar Milagros Arroyo Martinez, Elizabeth Rendon Mondragon

Published in Journal of Gynecology and Obstetrics (Volume 9, Issue 3)

Received: 6 April 2021 Accepted: 19 April 2021 Published: 8 May 2021

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Abstract

Hemorrhage is the main cause of Maternal Mortality (MM) (27%) followed by hypertensive disorders and sepsis (12%). Septic abortion is considered an intermediate risk factor for the development of Massive Obstetric Hemorrhage (MOH). The algorithm for the management of postpartum hemorrhage due to uterine atony that includes systematic pelvic devascularization has been described, but this management is really planned for resolution of the pregnancy after the 20th week of gestation, since an HMO due to abortion is un usual. We present the case of a 21-year-old patient who self-medicates a prostaglandin analog at 2 months of pregnancy, achieving only a threat of abortion, goes to the emergency room 3 months later with a diagnosis of septic shock, USG and MRI are performed with altered results, only of hepatomegaly, delayed abortion of 8 weeks of evolution and gestational trophoblastic disease. Emergency MVA was performed due to profuse bleeding, placement of a Bakri balloon and clamping of the uterine arteries without results, for which an emergency exploratory laparotomy (LAPE) was performed with ligation of the anterior trunk of the internal iliac artery, being a successful procedure, without the need for Obstetric Hysterectomy (HO). The patient is managed in intensive care and in the end the diagnosis of TSG is ruled out. Bilateral Hypogastric Artery Ligation (BHAL) in the case of Massive Obstetric Hemorrhage (MOH) secondary to delivery or cesarean section is commonly used, however it is not a technique to report when bleeding is secondary to abortion. In these cases, it is also a viable, successful, fertility-preserving surgical procedure, and an alternative to Obstetric Hysterectomy (OH) when other less invasive methods such as uterine artery clamping or Bakri balloon have failed.

Published in	Journal of Gynecology and Obstetrics (Volume 9, Issue 3)
DOI	10.11648/j.jgo.20210903.11
Page(s)	54-58
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Ligation, Hypogastric, Artery, Massive, Obstetric, Hemorrhage, Incomplete, Abortion, Preserve, Fertility

References

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[2]	Sebghati M, Chandraharan E. An update on the risk factors for and management of obstetric haemorrhage. Womens Health (Lond). 2017 Aug; 13 (2): 34-40. http://doi.org/10.117/1745505717716860.
[3]	Guasch E, Gilsanz F. Massive obstetric hemorrhage: Current approach to management. Med Intensiva. 2016 Jun-Jul; 40 (5): 298-310. English, Spanish. http://doi.org/10.1016/j.medin.2016.02.010.
[4]	O'Brien KL, Shainker SA, Lockhart EL. Transfusion Management of Obstetric Hemorrhage. Transfus Med Rev. 2018 Oct; 32 (4): 249-255. http://doi.org.10.1016/j.tmrv.2018.05.003.
[5]	Udoh A, Effa EE, Oduwole O, Okusanya BO, Okafo O. Antibiotics for treating septic abortion. Cochrane Database Syst Rev. 2016 Jul 1; 7 (7): CD011528. http://doi.org/10.1002/14651858.CD011528.pub2.
[6]	Fadel MG, Das S, Nesbitt A, Killicoat K, Gafson I, Lodhi W, Yoong W. Maternal outcomes following massive obstetric haemorrhage in an inner-city maternity unit. J Obstet Gynaecol. 2019 Jul; 39 (5): 601-605. http://doi.org/10.1080/01443615.2018.1534814.
[7]	Abha Sungh, Ruchi Kishore, Saveri Sarbhai Saxena. Ligating internal iliac artery: succes beyond hesitation. The Journal of Obstetrics and Gynecology of India, 2016.
[8]	Baggish M. Karram M. Atlas of Pelvic Anatomy and Gynecologic surgery, 4th edition, Elsevier; 2016.
[9]	Sherpa D, Johnson BD, Ben-Youssef L, Nagdev A. Diagnosis of Septic Abortion with Point-of-care Ultrasound. Clin Pract Cases Emerg Med. 2017 Jul 6; 1 (3): 268-269. http://doi.org/10.5811/cpcem.2017.3.33574.
[10]	Escobar MF, Echavarría MP, Zambrano MA, Ramos I, Kusanovic JP. Maternal sepsis. Am J Obstet Gynecol MFM. 2020 Aug; 2 (3): 100149. http://doi.org/10.1016/j.ajogmf.2020.100149.
[11]	İçen MS, Findik FM, Akin Evsen G, Ağaçayak E, Yaman Tunç S, Evsen MS, Gül T. Hypogastric artery ligation in postpartum haemorrhage: a ten-year experience at a tertiary care centre. J Obstet Gynaecol. 2020 Jun 4: 1-5. http://doi.org/10.1080/01443615.2020.1755623.
[12]	Wang CY, Pan HH, Chang CC, Lin CK. Outcomes of hypogastric artery ligation and transcatheter uterine artery embolization in women with postpartum hemorrhage. Taiwan J Obstet Gynecol. 2019 Jan; 58 (1): 72-76. http://doi.org/10.1016/j.tjog.2018.11.014.
[13]	Rauf M, Ebru C, Sevil E, Selim B. Conservative management of post-partum hemorrhage secondary to placenta previa-accreta with hypogastric artery ligation and endo-uterine hemostatic suture. J Obstet Gynaecol Res. 2017 Feb; 43 (2): 265-271. http://doi.org/10.1111/jog.13215.
[14]	Millán Juárez Á, et al. Ligadura de arterias hipogástricas proximales y tronco posterior bilaterales como profilaxis en histerectomía. Clin Invest Gin Obst. 2020. https://doi.org/10.1016/j.gine.2020.07.002.
[15]	Kuhn T, Martimucci K, Al-Khan A, Bilinski R, Zamudio S, Alvarez-Perez J. Prophylactic Hypogastric Artery Ligation during Placenta Percreta Surgery: A Retrospective Cohort Study. AJP Rep. 2018 Apr; 8 (2): e142-e145. http://doi.org/10.1055/s-0038-1666793.
[16]	Dinc G, Oğuz Ş. The efficacy of pelvic arterial embolisation for the treatment in massive vaginal haemorrhage in obstetric and gynaecological emergencies: a single-centre experience. J Obstet Gynaecol. 2019 Aug; 39 (6): 774-781. http://doi.org/10.1080/01443615.2019.1586858.
[17]	Toguchi M, Iraha Y, Ito J, Makino W, Azama K, Heianna J, Ganaha F, Aoki Y, Murayama S. Uterine artery embolization for postpartum and postabortion hemorrhage: a retrospective analysis of complications, subsequent fertility and pregnancy outcomes. Jpn J Radiol. 2020 Mar; 38 (3): 240-247. http://doi.org.10.1007/s11604-019-00907-2.

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APA Style

Angel Millan Juarez, Carla America Suarez Juarez, Ana Elena Barrios Herandez, Ithamar Milagros Arroyo Martinez, Elizabeth Rendon Mondragon. (2021). Bilateral Ligation of the Anterior Branch of the Hypogastric Artery in Massive Obstetric Hemorrhage Secondary to Septic Abortion (Case Report). Journal of Gynecology and Obstetrics, 9(3), 54-58. https://doi.org/10.11648/j.jgo.20210903.11

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ACS Style

Angel Millan Juarez; Carla America Suarez Juarez; Ana Elena Barrios Herandez; Ithamar Milagros Arroyo Martinez; Elizabeth Rendon Mondragon. Bilateral Ligation of the Anterior Branch of the Hypogastric Artery in Massive Obstetric Hemorrhage Secondary to Septic Abortion (Case Report). J. Gynecol. Obstet. 2021, 9(3), 54-58. doi: 10.11648/j.jgo.20210903.11

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AMA Style

Angel Millan Juarez, Carla America Suarez Juarez, Ana Elena Barrios Herandez, Ithamar Milagros Arroyo Martinez, Elizabeth Rendon Mondragon. Bilateral Ligation of the Anterior Branch of the Hypogastric Artery in Massive Obstetric Hemorrhage Secondary to Septic Abortion (Case Report). J Gynecol Obstet. 2021;9(3):54-58. doi: 10.11648/j.jgo.20210903.11

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@article{10.11648/j.jgo.20210903.11,
  author = {Angel Millan Juarez and Carla America Suarez Juarez and Ana Elena Barrios Herandez and Ithamar Milagros Arroyo Martinez and Elizabeth Rendon Mondragon},
  title = {Bilateral Ligation of the Anterior Branch of the Hypogastric Artery in Massive Obstetric Hemorrhage Secondary to Septic Abortion (Case Report)},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {9},
  number = {3},
  pages = {54-58},
  doi = {10.11648/j.jgo.20210903.11},
  url = {https://doi.org/10.11648/j.jgo.20210903.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20210903.11},
  abstract = {Hemorrhage is the main cause of Maternal Mortality (MM) (27%) followed by hypertensive disorders and sepsis (12%). Septic abortion is considered an intermediate risk factor for the development of Massive Obstetric Hemorrhage (MOH). The algorithm for the management of postpartum hemorrhage due to uterine atony that includes systematic pelvic devascularization has been described, but this management is really planned for resolution of the pregnancy after the 20th week of gestation, since an HMO due to abortion is un usual. We present the case of a 21-year-old patient who self-medicates a prostaglandin analog at 2 months of pregnancy, achieving only a threat of abortion, goes to the emergency room 3 months later with a diagnosis of septic shock, USG and MRI are performed with altered results, only of hepatomegaly, delayed abortion of 8 weeks of evolution and gestational trophoblastic disease. Emergency MVA was performed due to profuse bleeding, placement of a Bakri balloon and clamping of the uterine arteries without results, for which an emergency exploratory laparotomy (LAPE) was performed with ligation of the anterior trunk of the internal iliac artery, being a successful procedure, without the need for Obstetric Hysterectomy (HO). The patient is managed in intensive care and in the end the diagnosis of TSG is ruled out. Bilateral Hypogastric Artery Ligation (BHAL) in the case of Massive Obstetric Hemorrhage (MOH) secondary to delivery or cesarean section is commonly used, however it is not a technique to report when bleeding is secondary to abortion. In these cases, it is also a viable, successful, fertility-preserving surgical procedure, and an alternative to Obstetric Hysterectomy (OH) when other less invasive methods such as uterine artery clamping or Bakri balloon have failed.},
 year = {2021}
}

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TY  - JOUR
T1  - Bilateral Ligation of the Anterior Branch of the Hypogastric Artery in Massive Obstetric Hemorrhage Secondary to Septic Abortion (Case Report)
AU  - Angel Millan Juarez
AU  - Carla America Suarez Juarez
AU  - Ana Elena Barrios Herandez
AU  - Ithamar Milagros Arroyo Martinez
AU  - Elizabeth Rendon Mondragon
Y1  - 2021/05/08
PY  - 2021
N1  - https://doi.org/10.11648/j.jgo.20210903.11
DO  - 10.11648/j.jgo.20210903.11
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 54
EP  - 58
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20210903.11
AB  - Hemorrhage is the main cause of Maternal Mortality (MM) (27%) followed by hypertensive disorders and sepsis (12%). Septic abortion is considered an intermediate risk factor for the development of Massive Obstetric Hemorrhage (MOH). The algorithm for the management of postpartum hemorrhage due to uterine atony that includes systematic pelvic devascularization has been described, but this management is really planned for resolution of the pregnancy after the 20th week of gestation, since an HMO due to abortion is un usual. We present the case of a 21-year-old patient who self-medicates a prostaglandin analog at 2 months of pregnancy, achieving only a threat of abortion, goes to the emergency room 3 months later with a diagnosis of septic shock, USG and MRI are performed with altered results, only of hepatomegaly, delayed abortion of 8 weeks of evolution and gestational trophoblastic disease. Emergency MVA was performed due to profuse bleeding, placement of a Bakri balloon and clamping of the uterine arteries without results, for which an emergency exploratory laparotomy (LAPE) was performed with ligation of the anterior trunk of the internal iliac artery, being a successful procedure, without the need for Obstetric Hysterectomy (HO). The patient is managed in intensive care and in the end the diagnosis of TSG is ruled out. Bilateral Hypogastric Artery Ligation (BHAL) in the case of Massive Obstetric Hemorrhage (MOH) secondary to delivery or cesarean section is commonly used, however it is not a technique to report when bleeding is secondary to abortion. In these cases, it is also a viable, successful, fertility-preserving surgical procedure, and an alternative to Obstetric Hysterectomy (OH) when other less invasive methods such as uterine artery clamping or Bakri balloon have failed.
VL  - 9
IS  - 3
ER  -

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Author Information

Angel Millan Juarez

Oncology Gynecology Unit, Military Hospital for Women's Specialties and Neonatology, Mexico City, Mexico
Carla America Suarez Juarez

Oncology Gynecology Unit, Military Hospital for Women's Specialties and Neonatology, Mexico City, Mexico
Ana Elena Barrios Herandez

Gynecology Unit, Military Hospital for Women’s Specialties and Neonatology, Mexico City, Mexico
Ithamar Milagros Arroyo Martinez

Radiology Unit, Military Hospital for Women's Specialties and Neonatology, Mexico City, Mexico
Elizabeth Rendon Mondragon

Pathology Unit, Military Hospital for Women's Specialties and Neonatology, Mexico City, Mexico

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APA Style

Angel Millan Juarez, Carla America Suarez Juarez, Ana Elena Barrios Herandez, Ithamar Milagros Arroyo Martinez, Elizabeth Rendon Mondragon. (2021). Bilateral Ligation of the Anterior Branch of the Hypogastric Artery in Massive Obstetric Hemorrhage Secondary to Septic Abortion (Case Report). Journal of Gynecology and Obstetrics, 9(3), 54-58. https://doi.org/10.11648/j.jgo.20210903.11

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ACS Style

Angel Millan Juarez; Carla America Suarez Juarez; Ana Elena Barrios Herandez; Ithamar Milagros Arroyo Martinez; Elizabeth Rendon Mondragon. Bilateral Ligation of the Anterior Branch of the Hypogastric Artery in Massive Obstetric Hemorrhage Secondary to Septic Abortion (Case Report). J. Gynecol. Obstet. 2021, 9(3), 54-58. doi: 10.11648/j.jgo.20210903.11

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AMA Style

Angel Millan Juarez, Carla America Suarez Juarez, Ana Elena Barrios Herandez, Ithamar Milagros Arroyo Martinez, Elizabeth Rendon Mondragon. Bilateral Ligation of the Anterior Branch of the Hypogastric Artery in Massive Obstetric Hemorrhage Secondary to Septic Abortion (Case Report). J Gynecol Obstet. 2021;9(3):54-58. doi: 10.11648/j.jgo.20210903.11

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@article{10.11648/j.jgo.20210903.11,
  author = {Angel Millan Juarez and Carla America Suarez Juarez and Ana Elena Barrios Herandez and Ithamar Milagros Arroyo Martinez and Elizabeth Rendon Mondragon},
  title = {Bilateral Ligation of the Anterior Branch of the Hypogastric Artery in Massive Obstetric Hemorrhage Secondary to Septic Abortion (Case Report)},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {9},
  number = {3},
  pages = {54-58},
  doi = {10.11648/j.jgo.20210903.11},
  url = {https://doi.org/10.11648/j.jgo.20210903.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20210903.11},
  abstract = {Hemorrhage is the main cause of Maternal Mortality (MM) (27%) followed by hypertensive disorders and sepsis (12%). Septic abortion is considered an intermediate risk factor for the development of Massive Obstetric Hemorrhage (MOH). The algorithm for the management of postpartum hemorrhage due to uterine atony that includes systematic pelvic devascularization has been described, but this management is really planned for resolution of the pregnancy after the 20th week of gestation, since an HMO due to abortion is un usual. We present the case of a 21-year-old patient who self-medicates a prostaglandin analog at 2 months of pregnancy, achieving only a threat of abortion, goes to the emergency room 3 months later with a diagnosis of septic shock, USG and MRI are performed with altered results, only of hepatomegaly, delayed abortion of 8 weeks of evolution and gestational trophoblastic disease. Emergency MVA was performed due to profuse bleeding, placement of a Bakri balloon and clamping of the uterine arteries without results, for which an emergency exploratory laparotomy (LAPE) was performed with ligation of the anterior trunk of the internal iliac artery, being a successful procedure, without the need for Obstetric Hysterectomy (HO). The patient is managed in intensive care and in the end the diagnosis of TSG is ruled out. Bilateral Hypogastric Artery Ligation (BHAL) in the case of Massive Obstetric Hemorrhage (MOH) secondary to delivery or cesarean section is commonly used, however it is not a technique to report when bleeding is secondary to abortion. In these cases, it is also a viable, successful, fertility-preserving surgical procedure, and an alternative to Obstetric Hysterectomy (OH) when other less invasive methods such as uterine artery clamping or Bakri balloon have failed.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Bilateral Ligation of the Anterior Branch of the Hypogastric Artery in Massive Obstetric Hemorrhage Secondary to Septic Abortion (Case Report)
AU  - Angel Millan Juarez
AU  - Carla America Suarez Juarez
AU  - Ana Elena Barrios Herandez
AU  - Ithamar Milagros Arroyo Martinez
AU  - Elizabeth Rendon Mondragon
Y1  - 2021/05/08
PY  - 2021
N1  - https://doi.org/10.11648/j.jgo.20210903.11
DO  - 10.11648/j.jgo.20210903.11
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 54
EP  - 58
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20210903.11
AB  - Hemorrhage is the main cause of Maternal Mortality (MM) (27%) followed by hypertensive disorders and sepsis (12%). Septic abortion is considered an intermediate risk factor for the development of Massive Obstetric Hemorrhage (MOH). The algorithm for the management of postpartum hemorrhage due to uterine atony that includes systematic pelvic devascularization has been described, but this management is really planned for resolution of the pregnancy after the 20th week of gestation, since an HMO due to abortion is un usual. We present the case of a 21-year-old patient who self-medicates a prostaglandin analog at 2 months of pregnancy, achieving only a threat of abortion, goes to the emergency room 3 months later with a diagnosis of septic shock, USG and MRI are performed with altered results, only of hepatomegaly, delayed abortion of 8 weeks of evolution and gestational trophoblastic disease. Emergency MVA was performed due to profuse bleeding, placement of a Bakri balloon and clamping of the uterine arteries without results, for which an emergency exploratory laparotomy (LAPE) was performed with ligation of the anterior trunk of the internal iliac artery, being a successful procedure, without the need for Obstetric Hysterectomy (HO). The patient is managed in intensive care and in the end the diagnosis of TSG is ruled out. Bilateral Hypogastric Artery Ligation (BHAL) in the case of Massive Obstetric Hemorrhage (MOH) secondary to delivery or cesarean section is commonly used, however it is not a technique to report when bleeding is secondary to abortion. In these cases, it is also a viable, successful, fertility-preserving surgical procedure, and an alternative to Obstetric Hysterectomy (OH) when other less invasive methods such as uterine artery clamping or Bakri balloon have failed.
VL  - 9
IS  - 3
ER  -

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