Acute lower limb ischemia following surgical management of postpartum hemorrhage: about a case and review of the literature

This is a 30-year-old patient, without history, primigravida, with a full-term pregnancy, who consulted in the obstetric emergency department for treatment of heavy metrorrhagia. After conditioning, the ultrasound showed a completely covering placenta, hence the indication for an emergency caesarean giving birth to an Apgar boy 5/10th then 9/10th. The patient presented with uterine atony resistant to medical treatment. Uterine padding and triple vascular ligation were performed. With the persistence of uterine atony, ligation of the hypogastric arteries was attempted with accidental lesion of the right external iliac artery requiring its ligation to ensure haemostasis. The patient was transferred to our training for additional care. On admission, the patient was intubated, hemodynamically stable with coldness of the right lower limb and absence of the right femoral pulse. CT angiography of the aorta and both lower limbs revealed partial occlusion of the right external iliac artery with downstream patency. Revascularization by bypass using the great saphenous vein of the contralateral limb was performed. The post-operative follow-up was simple. Postpartum hemorrhage is a serious complication in obstetrics. Hypogastric artery ligation is one of the means for the surgical management of postpartum hemorrhage. It is a standardized and effective technique, but complications are not uncommon.