Introduction: The increased rate of cesarean delivery has been related to increased incidence of the adhesive placenta in the last three decades. Improved management of adhesive placenta will increase the survival rate. Internal iliac artery or hypogastric artery (HA) ligation was one of the prophylactic techniques to prevent massive bleeding and expected to increase the survival rate. Aims: To determine whether HA or internal iliac artery ligation can improve the outcome of cesarean hysterectomy in cases with the adhesive placenta. Methods: This is a retrospective descriptive study involving 50 patients with confirmed adhesive placenta who underwent cesarean hysterectomy from March 2017 to January 2021 in Sanglah General Hospital. Data were presented in percentage and analyzed using the Chi-square test or Fisher's exact test. Results: The patients had a mean age of 32.5 years, with a median number of children being two and a median history of cesarean section of two times. None of the patients had a previous history of curettage. Based on the comparison of the results of patients who underwent iliac artery ligation, it was found that patients who were not treated had more complications of bladder rupture, repeated laparotomy, and had more internal bleeding (p-value 0.643, 0.630, and 0.645, consecutively). Conclusion: Patients who were not treated had more complications of bladder rupture, repeated laparotomy, and had more internal bleeding.