A patient undergoes B-Lynch suture for atonic PPH unresponsive to uterotonics. Which uterine artery ligation technique, when combined with internal iliac artery ligation, is described as the 'stepwise devascularisation' approach credited to O'Leary?
- A Unilateral internal iliac artery ligation alone
- B Bilateral uterine artery ligation at the level of the internal os, followed by ovarian ligament ligation ✓
- C Utero-ovarian anastomosis division at the cornua
- D Bilateral hypogastric vein ligation
Correct answer: B. Bilateral uterine artery ligation at the level of the internal os, followed by ovarian ligament ligation
Explanation
O'Leary's stepwise devascularisation begins with bilateral uterine artery ligation at the level of the internal cervical os (Step 1), then ligation of the utero-ovarian anastomosis lateral to the cornua (Step 2), and finally bilateral internal iliac artery ligation if bleeding continues. This progressive approach preserves fertility while progressively reducing perfusion pressure. The procedure reduces pulse pressure rather than completely occluding flow, allowing collateral reconstitution.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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