A prospective study of B-Lynch suture in the management of atonic PPH at tertiary care centre

Abstract

Postpartum haemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity especially in the developing countries like India. Uterine compression sutures, originally described by B-Lynch et al can successfully control life-threatening PPH. With this background, we studied the use of modified B-Lynch sutures in our setup.It was a single centre, hospital based cross sectional study conducted in the department of obstetrics and gynaecology in a tertiary care hospital in Maharashtra. About 50 cases during the study period (Nov 2017 to June 2019) who failed the medical management of control of PPH were included in the study. Demographic details like age, gestational age, religion, socio economic status and gravid were noted in the case record form. Amount of blood loss, success rates, immediate complications and follow up fertility were assessed.Among the 50 study subjects, 24% had blood loss of <1000ml, 54% had loss between 1000 to 1500ml, 16% had loss of 1501 to 2000ml and 6% had loss more than 2000ml in the present study. About 80% of the cases were successful and 20% failed in the present study. About 6% of the cases had wound gaping, 12% each had fever and had hospital stay more than 5 days and 14% of the cases had wound infection in the present study. About 90% of the cases had return of regular menstruation in the present study.The success rate of B Lynch suture was 80% in the present study. There were few post operative immediate complications in our study. Follow up data also suggested that majority of them recovered with normal routine. In our experience, the B-Lynch technique is a safe, effective and easily implemented method of arresting bleeding in cases of major primary PPH due to uterine atony.