Reverse Blood Flow Cause of Fatal Bleeding in Severe Atonic Post-Partum Hemorrhage

Abstract

                 Obstetric haemorrhage, is the leading cause of maternal death and accounts for 50% of maternal death in developing countries. Two third of obstetric haemorrhage is postpartum haemorrhage (PPH). Emergency Internal iliac artery ligation (EIIAL) is the most effective treatment of atonic PPH when medical management fails. Still few patients continue to bleed and Hysterectomy is the last option to control bleeding and save the bleeding.

             In a case of atonic postpartum haemorrhage where EIIAL alone failed to control bleeding, Trendelenburg position controlled the bleeding. The life of the woman was saved and uterus was preserved. Here the only patent vascular connection with the Uterus is Uterine Veins. Since the Uterus lies at a lower level than Inferior Venacava (IVC), the bleeding is from reverse blood flow from (IVC) to Uterus through Pelvic and Uterine vein.

Key words: Atonic PPH, Ovarian vessels, internal iliac artery, Trendelenburg position.