Objective: To evaluate the effectiveness and safety of B lynch suture for severe postpartum hemorrhage before considering hysterectomy.
Methodology: A retrospective observational study was conducted in Cantonment General Hospital, Rawalpindi, Pakistan from January 2012 to December 2012. It included 100 patients who had primary postpartum hemorrhage (PPH). All the patients received initial medical management with syntocinone and ergometrine followed by prostaglandins. Patients failing to respond to pharmacological agents were selected for application of B Lynch suture. B Lynch suture was applied in 16 patients. Patients’ age, parity, gestational age, cause of PPH, mode of delivery and indication of lower segment cesarean section (LSCS) were recorded. Operative details, intraoperative and postoperative complications and the need for subsequent hysterectomy were noted.
Results: B lynch suture was applied in 16 patients. Mean age of the patients was 30 years. Mean gestational age was 37.63+1.088 weeks. One patient delivered vaginally and 15 had LSCS. Nine patients had history of PPH in previous pregnancy. The indications for cesarean section were fetal distress (n=1), placenta previa (n=1), placental abruption (n=4) and previous scar (n=9). Mean estimated blood loss was 1000ml (including vaginal births). All patients received either whole blood transfusion, packed cells or fresh frozen plasma. In four patients, uterine artery was ligated after application of B Lynch suture because of continuous vaginal bleeding. One (6.3%) patient needed a hysterectomy. None of the patients needed reopen laparotomy.
Conclusion: B lynch suture technique is a valuable and safe alternative to hysterectomy for control of severe PPH.
B lynch, hysterectomy .postpartum hemorrhage, brace sutures, uterine atony .