A Case of PPH with Caesar...

Case of emergency and Prophylactic internal iliac artery ligation in a case of postpartum haemorrhage with caesarean myomectomy A 33 year old primigravida 38 weeks of gestation referred ivo gestational thrombocytopenia with large subserosal fibroid of size 899 cm in lower segment. Patient went into spontaneous labour with artificial rupture of membrane revealed thick meconium stained amniotic fluid.Hence emmergency lower segment cesarean section decision was taken. Baby delivered uneventfully but there was atony of uterus with post partum hemorrhage. Lower segment was flabby with large subserosal fibroid hindering uterine closure.Hence cesarean myomectomy was conducted. Uterotonics was given along with bilateral uterine artery ligation was done followed by modified B Lynch suture. However blood lose was not totally arrested with these measures Hence decision of internal Iliac Artery ligation was taken which was done uneventfully. Intraoperatively 2 PCV; 8 RDP; 6 FFP was tranfused. Post operative course was uneventful and patient discharged on day 7 of post lscs. Performing cesarean myomectomy in a case of gestational thrombocytopenia with postpartum hemorrhage is an obstetric challenge. Internal iliac artery helps to achieve this challenge with preventing from obstetric hysterectomy which is a life saving measure.