Surgical control of pelvic hemorrhage: bilateral hypogastric artery ligation and method of ovarian artery ligation.

Hypogastric artery ligation and internal iliac artery ligation are the same procedure. It has been several years since extensive work on this procedure has been reported in the literature. Since this has proved to be a potentially life-saving technique in serious obstetric and pelvic hemorrhage, it is somewhat surprising to find that the procedure is poorly understood. We have reviewed this procedure in depth, emphasizing important aspects and restating indications for its use. We have also included a case presentation in which we recently performed bilateral ligation of the hypogastric arteries and the ovarian arteries to control intractable hemorrhage. Although ovarian artery ligation is often mentioned as an adjunct in controlling pelvic hemorrhage, we believe the technique has never been described in the English language. We present a surgical technique for ligating the ovarian arteries, believing that teaching both bilateral hypogastric artery ligation and ovarian artery ligation should be an integral part of obstetric and gynecologic training.