ATONIC PRIMARY POSTPARTUM HAEMORRHAGE;

Abstract

Background: Surgical methods of reduction of bleeding from uterus by insertingcompression sutures have been developed to reduce the need for emergency hysterectomy inpatients with atonic primary postpartum haemmorhage. Objectives: To determine the efficacyof B-Lynch brace suture in the management of atonic primary postpartum haemmorhage duringcesarean section. Study Design: A prospective observational study. Setting: GynaecologyDepartment, Khyber Teaching Hospital, Peshawar. Period: 1st January 2016 to 31st December2016. Methodology: 14 patients who underwent B-lynch suturing for atonic PPH duringcesarean section, nonresponsive to medical line of management. Patient’s age, parity, bookingstatus, 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 14patients with atonic primary postpartum haemmorhage with failed medical treatment, B-lynchsuture was applied. 10(71.42%) belonged to 21-30 years age group. 8(57%) were multiparousand 10(71.42%) were non booked. Birth weight of 9(52.94%) cases was 2-3kg.4-5 units of bloodwas transfused in 6(42.8%) cases. Most common indication for cesarean section was prolongedlabor 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 inhysterectomy. 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 inyoung patients where fertility issues are of concern, and has added advantage of less time ofapplication, less bleeding and lesser skill requirement.