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Obstetrics & Gynecology

Answer 3
  1. Bilateral uterine artery ligation. Bilateral uterine artery ligation can be performed as a first-line surgical procedure in cases of uterine atony and hemorrhage if the patient desires to preserve her fertility.2 The sutures are placed where the uterine artery enters the uterus; this is usually at the level of the internal cervical os. Internal iliac artery ligation is more difficult to perform and therefore should not be used as a first-line option. However, in cases where uterine artery ligation is unsuccessful, this method can be attempted. The external iliac artery has nothing to do with the uterus. Aortic compression can be used if the patient is coding to help resuscitate her during surgery. Cesarean hysterectomy is a final option if other methods fail or if the patient’s life is in danger due to the acute nature of the hemorrhage.

    2. O’Leary JL, O’Leary JA. Uterine artery ligation for control of post cesarean section hemorrhage. Obstet Gynecol 1974;43:849–53.

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