Christopher B-Lynch Consultant (Obstetrics and Gynaecological Surgery),
Adeyemi Coker Registrar (Obstetrics and Gynaecology),
Adegboyega H. Lawal Registrar (Obstetrics and Gynaecology),
Jaf Abu Senior House Officer (Obstetrics and Gynaecology),
Michael J. Cowen Consultant (Anaesthesia)
Milton Keynes General Hospital NHS Trust, Oxford Regional Health Authority
The B-Lynch suturing technique (brace suture) may be particularly useful because of its simplicity of application, life saving potential, relative safety, and its capacity for preserving the uterus and thus fertility. Satisfactory haemostasis can be assessed immediately after application. If it fails, other more radical surgical methods as mentioned in this paper and in the literature can be considered. The special advantage of this innovative technique is an alternative to major surgical procedures to control pelvic arterial pulse pressure or hysterectomy. This suturing technique has been successfully applied with no problems to date and no apparent complications.
Postpartum haemorrhage is a serious obstetric problem. Life threatening postpartum haemorrhage can be a nightmare. Current clinical methods are unsuitable for the objective assessment of postpartum haemorrhage, and each patient’s ability to compensate varies considerably. There are no reliable data on the true incidence of severe life threatening postpartum haemorrhage. The morbidity and mortality rise not only with delay in diagnosis and treatment but also in accordance with any increase in caesarean section rate. Available methods to control postpartum haemorrhage depend on the cause but in general delaying diagnosis and treatment may lead to a life threatening situation. Five percent of vaginal deliveries may lead to postpartum haemorrhage with a blood loss > 1 L3. The common causes include uterine atony, lower genital tract lacerations, retained placenta and placental fragments, coagulopathy, uterine inversion and ruptured uterus 9 These causes can individually or collectively lead to life threatening situations.
Published data suggest a variety of acceptable methods of treatment such as simple bi-manual compression, ecbolics such as oxytocins, syntometrine and prostaglandins which are safe and effective but occasionally prove inadequate or unsatisfactory. Surgical methods vary depending on the site of bleeding, the severity of the condition and the cardiovascular stability of the patient. Various surgical methods to reduce pelvic pulse pressure have been described, from simple surgical ligature of the uterine artery to more complicated uterine, ovarian and internal iliac artery ligature 3 7. These procedures need skill which may not normally be possessed by the duty Registrar faced with such problems in the middle of the night. Probably some Consultants have never done such complicated procedures because of the relative rarity of this emergency obstetric problem.
We describe an innovative method which is simple and effective, tried and tested with a successful outcome for the control of life threatening postpartum haemorrhage, as an alternative to more complicated surgery including hysterectomy.
A Video demonstrating the B-Lynch Suture technique
Dr. Chez from Contemporary OB/GYN (August 1998, Vol43 No.8)
Imagine that you are in the operating room and have just completed a delivery through a low transverse uterine incision. You have manually removed the placenta, the uterus has become atonic, and there are no secundines. The uterus continues to hemorrhage despite direct manual massage, rapid infusion of oxytocin, and direct injection of prostaglandin F2a· You could attempt to suture the uterine arteries or perform a hypogastric ligation. This discussion describes an alternative technique, the B-Lynch suture. In outlining the steps involved, we assume that the surgeon is right-handed and standing on the right side of the patient. — Ronald A. Chez, MD
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