[Indications for bilateral ligation of the uterine arteries and the hypogastric arteries in refractory obstetrical hemorrhages].

The author describes the various indications for obstetric hemostatic vascular ligations accepted today by specialists. In serious post-partum uterine hemorrhage due to pathology of contraction and or retraction of the uterus, hemorrhage refractory to classical conservative treatment, specialists use either bilateral ligation of the uterine arteries at the site of their ascending branches, or bilateral ligation of the anterior branch of the internal iliac artery (BLILA), sometimes thus avoiding hemostatic hysterectomy. However hemostatic vascular ligations may be attempted only rarely, in particular when hemostasis procedures follow one after the other in the absence of an immediate threat to the mother's life. Prophylactic BLILA may be performed immediately after hemostatic hysterectomy (as a complement before closing the abdominal wall). It thus guarantees hemostasis and avoids the possibility of reoperation to achieve hemostasis, which could be fatal. BLILA performed at the postoperative (posthysterectomy) stage, during hemostatic reoperation, is of a curative nature and is effective only when hemorrhage is coming from a branch of the internal iliac artery. In severe post-partum hemorrhage coming from the peri-uterine regions supplied by the internal iliac arteries, only BLILA may be useful when local surgical hemostasis is ineffective or impossible.