Prophylactic hypogastric artery ligation in surgery for placental invasion disorders

Objective: To determine the effectiveness of prophylactic hypogastric artery ligation (HAL) on the bleeding control in surgeries of placental invasion anomalies. Study design: In this study, an evaluation was made of the effects on bleeding of prophylactic HAL applied before hysterectomy in cases of placental invasion anomalies. A total of 45 pregnant patients with placental invasion anomalies were examined retrospectively. In Group 1 (n=19) hysterectomy alone was applied in the surgical treatment and in Group 2 (n=26), prophylactic HAL was applied before hysterectomy. The results were compared with evaluation of morbidities, particularly bleeding. Results: Statistically significantly higher values were determined in Group 1 compared to Group 2 in respect of estimated blood loss (3183 vs 2204 ml, P<0.001), amount of fluid drainage (2346 vs 700 ml, P<0.001), and mean units of packed red cells and thrombocytes transfused (5.8 vs 3.3 units, P<0.001 and 3.9 vs 2.5 units, P<0.001 respectively). The hCO3 level was statistically significantly lower in Group 1 (16.3 meq/L in Group 1, 19.2 meq/L in Group 2) (P=0.003). Conclusions: Prophylactic HAL has a protective effect on bleeding in operations of placental invasion anomalies and may be used in cases in which balloon occlusion of the hypogastric artery can not be performed.