Arterial balloon occlusion of the internal iliac arteries for treatment of life-threatening massive postpartum haemorrhage: a series of 15 consecutive cases

  • J.P.M. Penninx
    Corresponding author at: Department of Obstetrics & Gynecology, Máxima Medical Centre, PO Box 7777, De Run 4600, 5500 MB, Veldhoven, The Netherlands. Tel.: +31 408888384; fax: +31 408888387.
    Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands
    Search for articles by this author
  • H.L.M. Pasmans
    Department of Radiology, Máxima Medical Centre, Veldhoven, The Netherlands
    Search for articles by this author
  • S.G. Oei
    Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands

    Department of Electrical Engineering, University of Technology, Eindhoven, The Netherlands
    Search for articles by this author
Published:November 02, 2009DOI:



      To evaluate arterial balloon occlusion of the internal iliac arteries for treatment of life-threatening massive postpartum haemorrhage.

      Study design

      Retrospective cohort study at a tertiary referral perinatal centre in a teaching hospital in the Netherlands. All patients who delivered in our hospital between January 1998 and January 2008 were included in the study. A retrospective analysis of all cases of postpartum haemorrhage was performed. All 15 consecutive cases of massive postpartum haemorrhage were selected from an electronic database. The patients with massive postpartum haemorrhage (blood loss > 5000 ml) and the patients with postpartum haemorrhage treated with arterial balloon occlusion of internal iliac arteries were analyzed.


      In the study period 1246 (7%) of all 17,308 deliveries were complicated by postpartum haemorrhage. 15 (0.1%) patients suffered from massive postpartum haemorrhage. They were all treated with balloon occlusion of the internal iliac arteries. Hysterectomy was performed in 4 patients. All patients survived without any complications.


      Arterial balloon occlusion of the internal iliac arteries is a safe and in most cases effective procedure for treatment of massive life-threatening postpartum haemorrhage.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • Abou Zahr C.
        • Royston E.
        Maternal mortality: a global factbook.
        World Health Organization, Geneva1991
        • Department of Health
        Why mothers die: report on confidential enquiries into maternal deaths in the United Kingdom 1994–96.
        Stationary Office, London1998
        • Sack R.A.
        Bilateral internal iliac (hypogastric) artery ligation to control obstetric and gynecologic hemorrhage. A ten year review at the community hospital level.
        Am J Obstet Gynecol. 1973; 116: 493-497
        • Condous G.S.
        • Arulkumaran S.
        • Symonds I.
        • et al.
        The ‘Tamponade Test’ in the management of massive postpartum haemorrhage.
        Obstet Gynecol. 2003; 101: 767-772
        • Evans S.
        • McShane P.
        The efficacy of internal iliac artery ligation in obstetric hemorrhage.
        Surg Gynecol Obstet. 1985; 160: 250-253
        • Chattopadhyay S.K.
        • Deb Roy B.
        • Edrees Y.B.
        Surgical control of obstetric hemorrhage: hypogastric artery ligation or hysterectomy?.
        Int J Gynecol Obstet. 1990; 32: 345-351
        • Allahbadia G.
        Hypogastric artery ligation: a new perspective.
        J Gynecol Surg. 1993; 9: 35-42
        • Clark S.L.
        • Yeh S.Y.
        • Phelan J.P.
        • et al.
        Emergency hysterectomy for obstetric hemorrhage.
        Obstet Gynecol. 1984; 64: 376-380
        • Lynch C.B.
        • Coker A.
        • Lawal A.H.
        • et al.
        The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported.
        Br J Obstet Gynaecol. 1997; 104: 372-375
        • Hayman R.G.
        • Arulkumaran S.
        • Steer P.J.
        Uterine compression sutures: surgical management of post partum haemorrhage.
        Obstet Gynecol. 2002; 99: 502-506
        • Smith K.L.
        • Baskett T.F.
        Uterine compression sutures as an alternative to hysterectomy for severe postpartum hemorrhage.
        J Obstet Gynaecol Can. 2003; 25: 197-200
        • Vedantham S.
        • Goodwin S.C.
        • McLucas B.
        • Mohr G.
        Uterine artery embolization: an underused method of controlling pelvic hemorrhage.
        Am J Obstet Gynecol. 1997; 176: 938-948
        • Pelage J.P.
        • Le Dref O.
        • Mateo J.
        • et al.
        Life-threatening primary postpartum hemorrhage: treatment with emergency arterial embolization.
        Radiology. 1998; 208: 359-362
        • Hansch E.
        • Chitkara U.
        • McAlpine J.
        • El-Sayed Y.
        • Dake M.D.
        • Razavi M.K.
        Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience.
        Am J Obstet Gynecol. 1999; 180: 1454-1460
        • Pelage J.P.
        • Le Dref O.
        • Jacob D.
        • Soyer P.
        • Herbreteau D.
        • Rymer R.
        Selective arterial embolization of the uterine arteries in the management of intractable post-partum hemorrhage.
        Acta Obstet Gynecol Scand. 1999; 78: 698-703
        • Deux J.F.
        • Bazot M.
        • Le Blanche A.F.
        • et al.
        Is the selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage?.
        AJR. 2001; 177: 145-149
        • Boulleret C.
        • Chahid T.
        • Gallot D.
        • et al.
        Hypogastric arterial selective and superselective embolization for severe postpartum hemorrhage: a retrospective review of 36 cases.
        Cardiovasc Intervent Radiol. 2004; 27: 344-348
        • Vegas G.
        • Illescas T.
        • Muñoz M.
        • Pérez-Piñar A.
        Selective pelvic arterial embolization in the management of obstetric hemorrhage.
        Eur J Obstet Gynecol Reprod Biol. 2006; 127: 68-72
        • Oei S.G.
        • Kho S.N.
        • Ten Broeke E.D.
        • Brölmann H.A.
        Arterial balloon occlusion of the hypogastric arteries: a life-saving procedure for severe obstetric hemorrhage.
        Am J Obstet Gynecol. 2001; 185: 1255-1256
        • Baskett T.F.
        A flux of the reds: evolution of active management of the third stage of labour.
        J Roy Soc Med. 2000; 93: 489-493
        • Lu M.C.
        • Fridman M.
        • Korst L.M.
        • et al.
        Variations in the incidence of postpartum hemorrhage across hospitals in California.
        Matern Child Health J. 2005; 9: 297
        • Baskett T.F.
        Uterine compression sutures for postpartum hemorrhage.
        Obstet Gynecol. 2007; 110: 68
        • Ferguson J.E.
        • Bourgeois F.J.
        • Underwood P.B.
        B-Lynch suture for postpartum hemorrhage.
        Obstet Gynecol. 2000; 95: 1020
        • Allam M.S.
        • B-Lynch C.
        The B-Lynch and other uterine compression suture techniques.
        Int J Gynecol Obstet. 2005; 89: 236
        • Ouahba J.
        • Piketty M.
        • Huel C.
        • et al.
        Uterine compression sutures for postpartum bleeding with uterine atony.
        BJOG. 2007; 114: 619-622
        • Nizard J.
        • Barrinque L.
        • Frydman R.
        • Fernandez H.
        Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage.
        Hum Reprod. 2003; 18: 844-848
        • Joshi V.
        • Otiv S.
        • Majumder R.
        • et al.
        Internal iliac artery ligation for arresting postpartum haemorrhage.
        BJOG. 2007; 114: 356-361
        • Hess J.R.
        • Lawson J.H.
        The coagulopathy of trauma versus disseminated intravascular coagulation.
        J Trauma. 2006; 60: S12
        • Sagraves S.G.
        • Toschlog E.A.
        • Rotondo M.F.
        Damage control surgery—the intensivist's role.
        J Intensive Care Med. 2006; 21: 5
        • Zelop C.M.
        • Harlow B.L.
        • Frigoletto Jr., F.D.
        • et al.
        Emergency peripartum hysterectomy.
        Am J Obstet Gynecol. 1993; 168: 1443