Stepwise uterine devascularisation and/or internal iliac artery ligation: an alternative to obstetric hysterectomy in the management of intractable postpartum haemorrhage

Background: Objectives of the study was to estimate effectiveness and safety stepwise uterine devascularisation and/or internal iliac artery ligation as alternative obstetric hysterectomy in management uncontrollable postpartum haemorrhage.Methods: We conducted a retrospective cohort at university affiliated tertiary referral hospital year 2020-2021 department obstetrics gynaecology, government medical college, Amritsar. Stepwise hypogastric were performed 35 335 patients (10.45%) who had intractable haemorrhage after caesarean deliveries not responding classic management. This technique entails ‘three’ successive procedures bilateral vascular ligations step-by-step fashion until bleeding stops. The steps follows: (1) Bilateral ligation. (2) If did stop, ovarian performed. (3) Additionally, anterior division done few cases which failed stop. After each procedure, assessment before proceeding next step.Results: Of women primarily treated with devascularisation, success rate preserve uterus 100%. None required hysterectomy. period uneventful. There no complications survival Among followed up, normal menstruation pregnancy occurred.Conclusions: is an effective safe for haemorrhage.