Background

Uterine artery ligation is procedure that treats the gynecological conditions like excessive bleeding or abnormal blood flow to the uterus. It involves surgical tying or blocking of the uterine arteries which provide essential blood to the uterus. This procedure manages the conditions like uterine fibroids, and postpartum hemorrhage. By reducing blood supply to fibroids the symptoms are alleviated and fibroids may shrink. 

Indications

Ligation of the uterine artery can be a therapeutic option for women with symptomatic uterine fibroids and aiming to decrease blood supply by reducing the tumor size and alleviate symptoms like excessive menstrual bleeding and pelvic pain. 

Postpartum hemorrhage manages with uterine artery ligation as an option to control excessive bleeding and prevent life-threatening complications. 

Uterine arteriovenous malformation is a vascular abnormality involving the uterus arteries and veins that can cause significant bleeding where uterine artery ligation is a potential treatment option. 

Uterine artery ligation may be used in certain cases of gynecological cancers, such as cervical or uterine cancer to limit blood supply to the tumor or as a step in a more extensive procedure. In severe dysmenorrhea this method will reduce blood flow to the uterus and alleviate symptoms. 

Contraindications

• Allergy or hypersensitivity 
• Unstable cardiovascular status  
• Active infection  
• Coagulopathy  
• Advanced maternal age 

Outcomes

Equipment

Surgical instruments include Artery Forceps, Scalpel, Scissors, Needle Holder, Ligasure, Sutures, Drapes, Sterile Covers, Surgical Gowns and Gloves, and Anesthesia Machine.  

These instruments are used to grasp and manipulate tissues by making incisions, cut tissues, suturing, and maintain sterility.  

Surgical sutures are used for closing incisions and securing tissues.  

Sterile Drapes and Covers surround the surgical location while surgical gowns and gloves protect against contamination.  

Anesthesia Machine administers and monitors patient during the surgery. These instruments ensure a sterile environment and prevent contamination. 

Patient preparation

The patient medical history including allergies, surgeries, and medications, should be thoroughly reviewed.  

A physical examination is conducted to assess potential risks and overall health.  

Preoperative imaging studies like ultrasound or MRI can evaluate the uterus and surrounding structures.  

A pelvic examination is used to assess the uterus size, location, and health. 

The surgeon provides a detailed explanation of the procedure, risks, benefits, and alternative options to the patient by obtaining informed consent.  

Patients are advised to fast overnight to reduce anesthesia complications. Certain medications may need to be adjusted or stopped to minimize bleeding risks but this is determined in consultation. 

Patients should arrive at the hospital at surgery center with comfortable and loosely dressing by postoperative care instructions. 

Patient position: 

The patient lies on their back with their buttocks at the operating table edge and their legs flexed for easy access to the pelvic area. 

Technique

Step 1: 

Bilateral uterine artery ligation is a straightforward and effective technique for managing non-traumatic postpartum hemorrhage where conventional conservative approaches have proven ineffective in bleeding control. 

Step 2: 

The obstetrician should position themselves on the patient right side to effectively perform the left uterine artery ligation procedure. 

Uterine artery ligation 

Step 3: 

The uterus is raised with the left hand and the thumb is positioned anterior to the broad ligament while the fingers are positioned posteriorly. 

Step 4: 

A large mayoneedle made of No. 1 chromic catgut is inserted into the myometrium and positioned 2-3 centimeters medially to the uterine vessels. 

Step 5: 

The suture is secured by maneuvering it through the non-vascular region with the broad ligament alongside the uterine artery and vein. 

Step 6: 

The procedure on the right side involves repeating the same procedure, causing ischemia, pink myometrium, and rising uterine tone. The uterus may remain atonic but bleeding is controlled. 

Step 7: 

The structures remain undivided with one ligature applied on either side and is a significant portion of myometrium. 

Laboratory tests

The Complete Blood Count is a vital test for assessing a patient blood health providing information about anemia or other blood disorders.  

Coagulation Studies like prothrombin time and activated partial thromboplastin time that assess blood clotting function to prevent bleeding disorders.  

Pregnancy tests are used to rule out pregnancy before uterine artery ligation especially for non-emergency procedures.  

Renal function tests like serum creatinine and blood urea nitrogen may be used to evaluate kidney function in cases of uterine artery ligation. 

Complications

Surgical procedures pose a risk of infection particularly in the incision site or pelvic area which can occur after uterine artery ligation. 

Excessive bleeding during surgery can occur where despite controlling bleeding being the primary objective. Careful monitoring and surgical skills are crucial to prevent this complication. 

The surgery may cause unintended harm to nearby structures such as the bladder or intestines. 

Anesthesia related side effects may include allergic reactions or breathing issues. 

Thrombosis is a serious health issue where blood clots form due to surgical procedures that can spread to other parts of the body. 

Pain management comforts and helps in recovery after surgery. 

Uterine artery ligation can potentially impact fertility by affecting blood flow to the uterus which is a concern for women seeking to maintain their fertility. 

References

https://www.sciencedirect.com/science/article/abs/pii/S1553465019309276

References

https://www.sciencedirect.com/science/article/abs/pii/S1553465019309276