ATONIC PRIMARY POSTPARTUM HAEMORRHAGE;

THE EFFICACY OF B-LYNCH SUTURE IN MANAGEMENT DURING CESAREAN SECTION

Abstract

Background: Surgical methods of reduction of bleeding from uterus by inserting
compression sutures have been developed to reduce the need for emergency hysterectomy in
patients with atonic primary postpartum haemmorhage. Objectives: To determine the efficacy
of B-Lynch brace suture in the management of atonic primary postpartum haemmorhage during
cesarean section. Study Design: A prospective observational study. Setting: Gynaecology
Department, Khyber Teaching Hospital, Peshawar. Period: 1st January 2016 to 31st December
2016. Methodology: 14 patients who underwent B-lynch suturing for atonic PPH during
cesarean section, nonresponsive to medical line of management. Patient’s age, parity, booking
status, birth weight of newborn, blood transfusion and effectiveness of procedure was noted.
The patients were followed up for 6months for any postprocedural morbidity. Results: In all 14
patients with atonic primary postpartum haemmorhage with failed medical treatment, B-lynch
suture was applied. 10(71.42%) belonged to 21-30 years age group. 8(57%) were multiparous
and 10(71.42%) were non booked. Birth weight of 9(52.94%) cases was 2-3kg.4-5 units of blood
was transfused in 6(42.8%) cases. Most common indication for cesarean section was prolonged
labor in 4(28.57%), followed by placental abruption and multiple pregnancy in 3(21.42%)
each. Success rate of this procedure was 92.85%. It failed in one patient who ended up in
hysterectomy. Patients were followed for 6 months and no postprocedural morbidity was seen.
Conclusion: This is a beneficial procedure for surgical treatment of atonic uterus especially in
young patients where fertility issues are of concern, and has added advantage of less time of
application, less bleeding and lesser skill requirement.