A Successful Case of Postpartum Haemorrhage Managed with Internal Iliac Artery Ligation

A report describes a case of a 35-year-old primigravid who presented at 38 weeks of gestation with gestational hypertension, thrombocytopenia, and large subserosal fibroid in the lower uterine segment. Her ultrasound (USG) report showed a single live intrauterine pregnancy accompanied by a subserosal fibroid (10×9×5.4 cm) in the lower uterine segment.

The patient was prescribed labetalol 100 mg orally TID to control the hypertension. She was incidentally diagnosed with gestational thrombocytopenia (platelet counts 52000/mm3).  

The patient experienced spontaneous labor. However, intrapartum monitoring was non-reassuring, with poor beat-to-beat variability. Artificial membrane rupture showed thick meconium-stained amniotic fluid. Thus, an emergency cesarean section was planned. 

Surgery revealed a single large subserosal vascular fibroid (10×9×5) populating most of the lower uterine segment. A lower uterine segment was chosen for incision, sparing fibroid edges, and a healthy Female child was delivered. The fibroid caused an atonic lower segment of the uterus with difficulty in wound closure. Hence, a cesarean myomectomy with ligation of a large feeding artery was performed. Injection oxytocin 10 IU, injection carboprost 250 microgram, and tablet misoprostol 800 mg were administered along with an injection of tranexamic acid 1 gram repeated twice. Since the blood loss was not totally arrested, bilateral internal iliac artery ligation was performed. The patient recovered uneventfully and received a discharge on the seventh day after the index procedure with a normal involuting uterus.

 On further follow-up to six months, repeat USG showed no fibroid, and the patient remained asymptomatic.

Source: Obstetrics and Gynecology. 2023;13(3)