Fertility Preserving Management of Refractory Postpartum Haemorrhage: A Case of Bilateral Internal Iliac Artery Ligation Following Uterine Atony

Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality worldwide, particularly in low-resource settings. Despite advances in obstetric care, PPH continues to pose significant challenges, especially when conservative management fails. In such cases, more aggressive surgical interventions become necessary to control hemorrhage and preserve the patient's fertility. The bilateral ligation of the anterior division of the internal iliac arteries (IIAL) is a fertility-preserving procedure. This procedure has been widely adopted in obstetric practice, particularly for managing cases of uterine atony, placenta previa, and other conditions associated with massive hemorrhage. However, despite its proven efficacy, IIAL remains underutilized due to the technical expertise required and the limited exposure among obstetricians during training. This study aims to advocate for increased training and awareness to enhance its adoption in clinical practice.