Following bilateral internal iliac artery ligation for intractable postpartum hemorrhage, bleeding continues despite technically correct placement of the ligatures. Persistent uterine perfusion is best explained by collateral flow primarily arriving through which vessel?

• A Inferior epigastric artery
• B Deep circumflex iliac artery
• C Middle sacral artery
• D Ovarian artery ✓

Explanation

Internal iliac ligation lowers pulse pressure below the capillary bed, but collateral channels persist. The most important for the uterus is the ovarian artery, arising directly from the abdominal aorta and joining the uterine artery through the utero-ovarian anastomosis above the round ligament level. This collateral supply explains the limited success rate of the procedure compared with compression sutures.

Reference: Gray's Anatomy for Students, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.